PHLEB CHP 7 - Tubes, Order of Draw, and Blood Tests

Before beginning the procedure…

technician must verify additive listed on tube and check expiration date.

Additives that prevent coagulation:

• EDTA

• heparin

• sodium citrate

binds to calcium

Tubes without additives…

allow blood to clot and must be centrifuge to separate blood components. Serum must be aliquoted to be placed into transfer tube for testing.

After collecting blood from a patient…

immediately label tube with: name, DOB, date/time of draw, and technician’s initials.

Plasma

Liquid portion that has an anti-coagulant.

Serum

Liquid portion that has clotted and has no more clotting factors.

Standard Order of Draw:

1. Blood Culture Bottles/Yellow-Top Tube

2. Light Blue-Top Tube with discard tube

3. Red-Top Tube

4. Gold-Top (SST) Tube

5. Light Green-Top Tube

6. Dark Green-Top Tube

7. Lavender-Top Tube

8. Pink-Top Tube

9. Grey-Top Tube

10. Royal Blue Red/Lavender-Top Tube

Blood Culture Bottle Types

1. Aerobic (with oxygen)

2. Anaerobic (without oxygen)

Blood Cultures (BCx or BC)

Additive: Nutrient Broth

Laboratory Dept: Microbiology

Common Tests: Culture and Sensitivity (C&S)

Inversion: 3-4 times

Light Blue-Top Tube

Additive: Sodium Citrate

Specimen Type: Plasma

Laboratory Dept: Coagulation

Common Tests: PT/INR, PTT, aPTT, D-Dimer

Inversion: 3-4 times

Need discard tube.

Label and send.

Red-Top Tube

Additive: None in glass discard tube. Clot activator in plastic tube.

Specimen Type: Serum

Laboratory Dept: Chemistry

Common Tests: Therapeutic Drug Monitoring

Inversions: 5 times

Could be SST (non STAT situations)

Blood clotting upright for 30-60 mins. Centrifuge, then aliquot serum to another tube, then send.

Serum Separator Tube (SST)

Contains clot activator and a gel separator, to separate serum.

Plasma Separator Tube (PST)

Contains gel. When centrifuged, gel moves to the center to form a barrier between plasma and blood cells.

STAT testing

Includes hCG, electrolytes, ionized calcium, and drug monitoring.

No gel tubes.

Gold-Top (SST) Tube

Additive: Silica (clot activator) and thixotropic gel

Specimen Type: Serum

Laboratory Dept: Chemistry

Common tests: Metabolic panels, lipid panels, CRP, hCG, electrolytes, hepatitis panel, hepatic function panel, renal function panel

Inversion: 5-10 times

Allow blood to clot upright 30-45 mins, then centrifuge 15-30 mins, then send.

Light Green-Top Tube

Additive: Lithium heparin, with or without thixotropic gel

Specimen Type: Plasma

Laboratory Dept: Chemistry

Common Tests: STAT chemistry tests, hCG, electrolytes

Inversion: 8 times

If tube contains gel, centrifuge it.

Label, and send.

Dark Green-Top Tube

Additive: Sodium heparin

Specimen Type: Plasma

Laboratory Dept: Chemistry

Common Tests: Ammonia

Inversion: 8 times

For ammonia testing, immediately place specimen in specimen bag, then in an ice slurry, to preserve accuracy.

Sample must be separated from cells within 15 minutes of collection.

Lavender-Top Tube

Additive: K2 EDTA (anticoagulant)

Specimen Type: Whole blood, or plasma

Laboratory Dept: Hematology

Common Tests: CBC, ESR, H&H, hemoglobin A1c (HbA1c), ammonia

Inversion: 8 times

At least 2/3 full. Send.

Pink-Top Tube

Additive: K2 EDTA (anticoagulant)

Specimen Type: Whole blood

Laboratory Dept: Blood Bank/Immunohematology

Common Tests: Blood typing, crossmatching

Inversion: 8 times

Drawn in the same order as lavender-top tubes.

Send.

Grey-Top Tube

Additive: Sodium fluoride and Potassium oxalate

Specimen Type: Plasma

Laboratory Dept: Chemistry

Common Test: Glucose, lactic acid, blood alcohol (ETOH)

Inversion: 8 times

Must be filled completely.

When doing ETOH test, use chlorohexidine as cleanser instead of alcohol.

In a lactic acid test, it must be done without a tourniquet, then immediately placed on ice.

Label and send.