Phlebotomy Order of Draw Explained: Why Sequence Matters

The order of draw in phlebotomy is a crucial aspect of healthcare diagnostics. Health professionals must acknowledge and correctly implement the sequence in which blood collection tubes are filled to prevent cross-contamination between samples and ensure accurate test results for patient care.

Understanding the importance of this sequence and mastering correct techniques in collecting fluids from tubes can contribute to the improvement of overall diagnostic procedures and enhance patients’ well-being.

Key Takeaways:

  • Adhering to the phlebotomy order of draw is essential for accurate test results and reducing cross-contamination risks.
  • Proper blood collection techniques, including patient identification/communication and equipment selection/preparation, are key for successful procedures.
  • Techniques such as heel sticks, and distraction methods with parental involvement can reduce pain & anxiety during pediatric or infant phlebotomy.
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The Importance of Phlebotomy Order of Draw

It is essential to observe the specified order of draw when dealing with glass and plastic blood collection tubes to avoid cross-contamination, which could have an impact on test outcomes.

Cross-contamination in phlebotomy happens when there is backflow or transfer of contents from one tube to another, especially if they touch for an extended period. For example, material from a clot activator tube may transfer into a different container. Adhering to the recommended drawing sequence is crucial to ensure result accuracy, preventing inappropriate additives from moving between different containers.

Professionals working with plastic tubes often use holding devices, a valuable tool that helps maintain correct arrangements. This ensures accuracy by preventing misarrangement or spillage incidents, which could otherwise compromise the integrity of testing samples, rendering diagnostic information unreliable.

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Cross-contamination risks

When phlebotomy is not done correctly, cross-contamination can occur resulting in inaccurate test results that may lead to a misdiagnosis. Sources of contamination include poor skin preparation or disinfection, damaged containers, and syringe needles/tips.

When using heparin tubes, the presence of different additives poses a particular risk. To mitigate this risk, especially in coagulation tests, it’s crucial to follow proper protocols. This involves using a blue stopper clot activator tube, commonly known as a “blue stopper coag tube.”

Adhering to these protocols helps ensure the accuracy of blood samples, preventing false positives or negatives that could arise from cross-contamination during the collection process. This dedication to proper procedures guarantees reliable and accurate test results.

Impact on patient care

The importance of sticking to the established phlebotomy order for drawing blood samples cannot be overemphasized. It is crucial for ensuring precise test results which in turn can help improve patient care and better treatment decisions.

If lab results are not accurate, it could have disastrous consequences such as delayed diagnosis, erroneous treatments being prescribed, or reduced chances of successful recovery – all resulting in additional costs incurred by healthcare professionals and patients.

In addition to the risk of cross-contamination, improperly drawn specimens can have serious consequences for clinical decision-making. Incorrectly collected samples may result in inaccurate test results, potentially leading to inappropriate medical interventions. This poses a significant risk to the health of the individuals involved, emphasizing the importance of meticulous attention to proper phlebotomy procedures and specimen handling.

To reduce any potential risks associated with inaccurate laboratory outcomes and their subsequent impacts on patient care, it is imperative for healthcare professionals, including doctors and nurses, to prioritize strict adherence to instructions for correct specimen collection techniques. Paying meticulous attention to these procedures plays a crucial role in reducing future complications and ensuring improved levels of continuity and safety in the treatment of delicate cases. This commitment to accurate specimen collection contributes to higher success rates in curative measures, surpassing common procedures used in healthcare today.

Blood Collection Tubes and Additives

Blood collection tubes, including glass ones, come in various sizes and are used to hold a predetermined amount of blood for testing. They contain special additives such as clot activators, anticoagulants, or gel separators which guarantee precise test results during the phlebotomy process.

The use of coagulation (2.1), EDTA (2.2), and serum (2.3) tubes is common in gathering samples from patients for various tests, each serving a specific purpose. These tubes play a crucial role in collecting reliable samples for testing purposes.

Coagulation tubes

Coagulation tubes are used in a variety of coagulation tests, and they have additives that help keep the blood from clotting. The substances added to these tubes include activators to stimulate clot formation as well as anticoagulants like sodium citrate which prevent clots from forming.

The role of the contents inside this type of tube is twofold: an acceleration or initiation for proper clot formation via activating factors while at the same time inhibiting any premature protein activities responsible for causing coagulopathy/co-clotting.

Specialized test samples, like those for coagulation, require specific containers, such as the specialized ‘coagulation’ laboratory collection devices. These containers facilitate easier access for clinicians when testing blood parameters related to conditions involving excessive bleeding disorders or thrombosis events.

EDTA tubes

EDTA tubes are used to collect blood samples for hematological testing. These tubes serve as anticoagulants, preserving both cell components and morphology by binding calcium ions, which ultimately interrupts the formation of clots. It is recommended to refrigerate these tubes for up to 12 hours after drawing the sample before processing within 48 hours. Freezing prior to processing is not recommended.

Serum tubes

Serum tubes, which contain a clot activator to separate serum from cells, are commonly used in various tests such as serum determinations, electrophoresis, and immunology. A gel separator is the type of anticoagulant typically used for this purpose. When collecting blood samples with these special tubes that have been allowed to form clots, it is crucial not to confuse them with tubes designed for plasma collection. Plasma collection tubes typically feature a mottled red/gray-gold or cherry top without any coagulating agent present.

Recommended Phlebotomy Order of Draw

In order to avoid contamination between different types of blood samples, it is important to adhere to a recommended phlebotomy order of draw. This will ensure that the results from tests are accurate and any chemical interactions caused by additives in one tube don’t affect the other tubes.

The standard protocol includes drawing blood culture tubes (3.1) first before moving on to coagulation vials (3.2). Non-additive and additive containers come last at number 3 point 3 on this list. (3.4).

Blood culture tubes

To ensure accurate results and prevent cross-contamination from non-sterile stoppers of other tubes, blood culture tubes are drawn first in a specific sequence known as the “order of draw.” These tubes, containing sodium citrate as an anticoagulant, play a crucial role in obtaining reliable results. Additionally, a blood culture bottle may be utilized to further enhance accuracy. Collecting this sample before any lab work is essential as it minimizes the risk of contamination while capturing vital information about the patient’s condition through respective cultures.

Coagulation tubes

Coagulation tubes are drawn second in the order of draw to guard against any disruption from other substances contained inside. These light blue-topped samples contain clot activators or anticoagulants that help with coagulation tests. At times a specific testing situation prevents usage of this type of tube and it is left unused. Collecting these tubes serves as an important part of the completion of vital blood work studies.

Non-additive and additive tubes

To prevent cross-contamination, it is essential to follow the protocols for blood collection. Non-additive tubes that lack any extra components and additive tubes that have clotting accelerators or inhibitors should be drawn in a specific order. Keeping these guidelines for sample handling will ensure accurate results as well as thwart potential contamination issues.

Proper Blood Collection Techniques

Blood collection techniques are of utmost importance in guaranteeing reliable test outcomes and a satisfying experience for patients. These involve making sure to verify the patient’s identity, selecting and readying necessary equipment appropriately, and implementing safety precautions regarding infection control during blood collection activities.

Patient identification and communication

For precise blood collection and test outcomes, proper patient identification and communication are essential. In the realm of phlebotomy, protocols for identifying patients include using two separate identifiers such as full name or hospital number combined with their date of birth.

Effective communication skills, including active listening and articulate speech, are pivotal when interacting with patients during specimen collection. These aptitudes ensure successful engagement and facilitate the accurate exchange of information throughout the process.

Equipment selection and preparation

Phlebotomy requires the use of specific tools when selecting and preparing equipment for blood collection. These tools are non-sterile gloves, alcohol wipes, tourniquets for vein identification, specially designed needles for venipuncture, tubes to collect samples, labels for accurate specimen identification, and gauze or bandages for post-procedure application.

Selecting components for phlebotomy involves careful consideration, such as prioritizing protection through the use of gloves, ensuring skin purification with iodine or rubbing alcohol, and facilitating vein identification with an appropriate strap. Following these steps, it’s essential to use test containers and apply labels before addressing any resulting wound care needs through dressings or bandaging.

Infection control and safety measures

Ensuring the safety and infection control measures during blood collection is paramount for both the patient and the phlebotomist. Adhering to standard precautions and transmission-based protocols, maintaining proper hygiene practices, advocating for employee immunization, and conducting regular staff exams are recommended to minimize associated risks. Correct use of gloves, coupled with consistent handwashing at each step of the process, are critical elements that contribute to successful outcomes when handling this delicate matter.

Troubleshooting Phlebotomy Issues

To successfully and safely complete a phlebotomy procedure, the practitioner needs to be well-versed in techniques for avoiding hematomas (5.1) as well as strategies to tackle tricky veins (5.2). This section focuses on these key topics of concern when executing such an undertaking. By understanding possible issues that may arise during the process while possessing sound technique, it is more likely results can be achieved with fewer complications or obstacles along the way.

Hematoma prevention

When drawing blood with a needle, it is important to practice proper venipuncture techniques to decrease the chance of hematoma formation. This can be achieved by inserting the needle correctly, avoiding excessive probing, and applying pressure after removal. Factors contributing largely towards this issue are difficulties encountered during penetration along with leakage of blood outwards from its original location. Subsequently, using pressure at the puncture site following extraction helps reduce bleeding while supporting clotting processes there.

Handling difficult veins

When dealing with hard-to-access veins during blood draws, it is important to remain patient and have the right technique. Reasons for these difficulties include small/invisible vessels, collapsing or rolling of veins due to dehydration or lack of venous patency, inadequate securing when taking a sample from an arm as well as failing to recognize how far up that vein goes in relation to the elbow.

Phlebotomists employ diverse methods, including palpation combined with tourniquets, utilizing gravity when applicable, and deploying specialized tools such as lights/vein finders and ultrasound technology. These approaches collectively assist in identifying challenging veins required for the collection of needed samples.

Pediatric and Infant Blood Collection

Blood collection can be challenging when done on pediatric and infant patients due to their more delicate veins. This section will look at heel sticks as an option for newborns (6.1) while also exploring ways of reducing the pain and stress associated with blood sampling in children (6.2).

Heel sticks for newborns

The preferred method for drawing blood from newborns is heel pricking. To perform this procedure correctly, the baby’s leg should be held below the heart, and the fingertips are placed under the calf muscle and posterior ankle, while the thumb grasps the foot. For healthy infants, a 1mm depth by 2.5 mm length lancet is suitable, while smaller lancets can be used for premature or low birth weight babies. The process involves firmly gripping the infant’s heels, puncturing them with the appropriate size lancet, and collecting samples either into a collection device or onto filter paper for testing purposes.

Reducing pain and anxiety

To minimize fear and discomfort during pediatric phlebotomy, involving parents and incorporating distraction techniques is crucial. Music or stories can effectively divert the child’s attention during the procedure. A parent’s soothing talk or touch support offers comfort, and the use of flashcards, toys, or squeezing rubber balls serves as effective methods to divert their focus from the procedure, contributing to a more positive experience.

By incorporating these methods and involving parents to help calm children before needle procedures, medical personnel can enhance success in providing care through blood extraction services, such as phlebotomy. This approach ensures the extraction of necessary information without compromising patients’ mental health further.


By following the correct order of draw, using blood collection tubes and additives correctly, and adhering to appropriate techniques for pediatric or infant patients, healthcare professionals can ensure the accuracy of test results by reducing cross-contamination while still providing quality patient care. Committing to proper phlebotomy processes, including utilizing the right type of collection tubes as well as practicing good technique when collecting samples from a variety of patients can lead to better outcomes.

Further Reading

Frequently Asked Questions

Why does it matter what order you draw blood?

Drawing blood in the correct order is crucial to ensure the accuracy of test results and prevent the mixing of different components within collection tubes. The standardized universal approach to phlebotomy, regardless of the sampling method, plays a key role in this process. Properly drawing blood, coupled with using the right collection tubes, helps prevent cross-contamination, safeguarding the integrity of assessment outcomes.

What happens if the proper order of draw is not followed?

Not following the correct sequence when taking samples can lead to K EDTA being unintentionally added, routinely, or irregularly. This could have an impact on test results being accurately determined. To avoid this, the appropriate order of draw must be strictly adhered to during sample collection.

How do you remember the order of a phlebotomy draw?

Remembering the order of a phlebotomy draw can be easily done with the saying “Your brother Robert gives lovely gifts” which stands for Yellow, Light Blue, Red, Light Green, Dark Green, Lavender, and Gray.

Following this order ensures that any complications from testing are avoided.

What are the 7 basic steps to a blood draw?

To draw blood, first assemble equipment, then identify and prepare the patient. Select a site, perform hand hygiene and put on gloves, disinfect the entry site, take blood, and fill laboratory sample tubes in the correct order. Finally, remove the needle and apply labels to the tubes.

What are the common additives in blood collection tubes?

Common additives in blood collection tubes include clot activators, anticoagulants, and gel separators to ensure accurate results.