Phlebotomist are specially trained individuals who draw blood from a live person or animal for medical purposes. Blood is collected primarily by performing venipuncture, which is the process of obtaining blood through intravenous access, typically through a vein.

The practice of phlebotomy involves finding a suitable vein on the patient for blood extraction. Once a vein is located the phlebotomist will make a puncture with the needle. The needle is connected to a bllod sample tube that is sealed with a rubber stopper. These tube may be micro-collection tubes and they may or may not include clot activators or special gels that are used for serum spearaiton or plasma separation. Sometimes they may also include additives for reactions such as sodium polyanethol solfonate, buffered sodium citrate or something similar depending upon the reason for the blood draw. The tube may also include a reactive agent or separator/coagulant which may separate the blood from any antibacterial such as alcohol that is used at the blood collection site so that the alcohol does not affect the blood in the tube.

Order Of Draw Phlebotomy

While the job of a phlebotomist may seem to be simple, the responsibilities are significant. The phlebotomist must ascertain the needs of the patient and communicate with the doctor’s in order to get the proper collection. Depending upon the reason for the blood draw the appropriate vacuum tubes for the collection must be used. The vein must also be evaluated to determine the proper gauge needle to use.

A phlebotomist works in many different settings with many different types of patients. Occasionally a patient may be in an altered state such as a coma or anethesiology or induced sleep. The phlebotomist must be able to draw the blood regardless of the stress of the situation or the stress of the patient. It is extremely important that the sample be kept free from contaminants and that the phlebotomist also protects themselves from incidental, accidental or deliberate exposure to the patient’s bodily fluids or the needles used to collect the blood.

Order Of Draw

The tubes used for the blood collection are used in a specific order of priority or “order of draw” in order to prevent the “carry over” of chemicals contained within each tube from contaminating other more critical tubes. The tubes are identified by the color of the cap of the vacuum tube. A laboratory specific methodology is used for the additives, the different tests or the different laboratories depending upon the reason for the sample.

The order of draw is a crucial step in the drawing of blood. It has been proven that the needle piercing a tube’s stopper can transfer one tubes additive to the next tube. Even minute amounts of this transfer can seriously contaminate the sample and drastically alter the test results. Following the order of draw does not completely prevent this type of carryover but it does reduce the carryover. It also provides a standard, whereby the laboratories know of the possibilities of carryover from the previous vials. Therefore, it makes the transfer of contaminants irrelevant because of the general nature of the testing on each tube. This is why the order of draw is so important because this transfer contamination needs to be avoided as much as possible.

Order Of Draw Tubes

The first tubes that should be used in the order of draw are the sterile blood culture tubes or vials. These are the vials and tubes that have the least amount of additives. After that the second tube to be used is the blue stopper, which are the sodium citrate tubes. After that the third tubes in the order would be the serum tubes. The fourth tubes are the green stopper tubes or the heparin tubes. The fifth in the order is the lavendar stopper or the EDTA tubes and the 6th is the gray stopper or the glycolytic inhibitor tubes.

If the order of draw is mixed up it could have dangerous consequences. Some of the tubes and vials contain additives that can significantly alter test results. For example, if a patient is low on potassium and the order of draw is mixed up so that the EDTA vial contaminates one of the other tubes or vials, such as the sterile blood culture draw, the tests on the patient may show that he or she has sufficient potassium because EDTA has significant amounts of potassium. This could prove to be very dangerous for the patient in different circumstances such as surgery as a patients potassium levels need to be at a certain level before they go into a surgery situation.

Phlebotomy Order Of Draw Chart

The knowledge of the order of draw is very important for a practicing phlebotomist. Although this universal order is recommened, certain facilities may change the order within their own facility if they find it necessary based on their own internal studies and variables for their own system, so a phlebotomist must follow the established protocol and rules of their own facility. However, generally the order is the same and it is the same order that a phlebotomy student will need to learn and be tested on. You can view a chart here.

The order of draw is such an important concept for practicing phlebotomists that there is an entire industry devoted to the order of draw. A practicing phlebotomist or a phlebotomy student can purchase any number of memory aids from bracelets and necklaces to watches, badges, posters and more.

Order of draw in phlebotomy is so important and crucial to your work that even though you will be memorizing it and you will know it, it is probably something that you should check over and over again as you are taking blood samples. Therefore, any type of memory aid that works for you should probably be used so that there is not any chance of mixing up the samples. The results of the medical tests and the health of your patients depends upon it. This is just part of the significant responsibilities that you will have as a practicing phlebotomy technician.