As a licensed phlebotomist, it is not only important to know the order of blood drawing but also the correct procedure and standard for drawing that blood. At PhlebotomyU, we value education because we want to provide hospitals, facilities, and laboratories with the best CPT-1 phlebotomy graduates. Our program not only provides teaching in the classroom but also real-time experience in the field. We offer abbreviated classes, weekday and weekend phlebotomy training from 5 to 9 weeks. At end of training, students have hours of hands on experience making it easy to go from PhlebotomyU to a full time job.
3910 Washington Parkway Idaho Falls, ID 83404 208-529-8330 Fax: 208-523-3318
2001 S. Woodruff, Suite 15B Idaho Falls, ID 83404 208-529-8330 Fax: 208-523-3318
444 Hospital Way Building 100, Suite 224 Pocatello, ID 83201 208.529.8330 ext. 346 Fax 208-497-2098
Henry's Fork Plaza859 S Yellowstone Hwy #3202 Rexburg, ID 83440 208.529.8330 ext. 670 Fax: 208-497-2098
Yes. You do. Evidence supporting the need for a specific order in which blood collection tubes should be filled was first published over 30 years ago, yet the concept remains elusive to many healthcare professionals with sample collection responsibilities. This article not only reinforces today’s recommended order of draw, but explains how additive carryover during the collection process can alter the test result the laboratory reports. It also discusses what can happen when the order of draw is disregarded. Additive carryover occurs when the needle filling a tube comes in contact with the blood/additive mixture as the tube fills, and transfers a minute amount of blood and additive into the next tube filled. This can occur with both syringe and vacuum draws. In a syringe draw, the carryover occurs with the needle of the safety transfer device. (According to OSHA, blood collected by syringe should be transferred to the tubes using a safety transfer device, not the same needle used to perform the venipuncture.) In a tube holder draw, carryover occurs from the needle within the tube holder as tubes are exchanged. For additive carryover to occur, tubes must be filled in an inverted position so that the blood/additive mixture comes in contact with the needle that pierces the stopper. When patient positioning is such that the tubes are tilted upright relative to a horizontal plane, they fill from bottom to top. When the tube position is inverted relative to horizontal, i.e., the stopper of the tube is lower than the bottom of the tube, the tube fills from top to bottom, contaminating the needle that pierces the stopper. In practice, those who draw blood samples cannot always control the orientation of the tubes as they are filled when using a tube holder. If all tubes could be orientated in such a manner that allowed them to be filled from bottom to top, an order of draw would not be necessary; the interior needle would never come in contact with the blood/additive mixture. However, since patients present a wide range of arm positions, and contamination of the needle that punctures the stopper cannot always be prevented, an order is necessary. When additives carry over into a different tube type, test results may be dramatically affected. For example:
Note: For access to any of the many articles we've written on the order of draw in our newsletter archives, simply enter "Order of Draw" in the search window at the top of this. Additional note: For an attactive PDF of this article for posting in your facility, visit our Free Stuff page. What's Your Problem?AMT has designated Phlebotomists Recognition Week (from Feb. 14-18) |