- Select puncture site—antecubital (AC) fossa is most common site, but any vein below AC is acceptable.
Avoid previous puncture site areas for 24–48 hr; avoid collecting specimens above an IV site or sites that are infected or edematous. Avoid collecting from the same side as mastectomy, lymphadenectomy, dialysis shunts, or grafts. - Place tourniquet 3–4 in. above intended puncture site (preferably for no longer than 1 min).
- Cleanse site with an alcohol swab from center out using a circular motion and allow to air-dry (use iodine if collecting blood alcohol level or blood culture specimens).
- Insert needle, bevel up, at 15°–30°; stabilize needle and push specimen collection tube into needle holder; remove tourniquet when all specimens are collected.
- Place gauze or cotton ball over puncture site, apply gentle pressure, remove needle, and secure dressing with tape.
- Gently invert specimen tubes 3–5 times (do not shake).
- Label specimen tubes with Pt’s name, ID number, date, time, and your initials; send specimens to lab.
Order of Lab Draw
| Color of Top | Additives | Uses |
|---|---|---|
| Yellow, yellow-black, green, or orange | SPS. | Cultures on blood or body fluid. |
| Red | No additive. | As a discard tube when drawing blood using a butterfly needle (to remove air in tubing) or when drawing from an IV. |
| Light blue | Sodium citrate. | Coagulation tests. |
| Red marble or gold | Gel separator and clot activator. | Serum testing; most chemistry tests; immunology tests. |
| Dark green | Sodium heparin. | Blood chemistry such as whole blood and plasma testing. |
| Light green | Lithium heparin and gel separator. | Metabolic, lipid, and liver panels. |
| Lavender | EDTA. | Blood counts such as CBC, Hgb, Hct, glycosylated hemoglobin (A1c). |
| Light gray | Potassium oxalate and sodium fluoride. | Glucose; glucose tolerance test, alcohol levels. |
| Pale yellow | Acid citrate dextrose. | Genetic testing; specialized testing. |
Tubes with additives must be thoroughly mixed.
Order of Draw concepts reprinted with permission from CLSI approved standard H3-A6. Procedures for the collection of diagnostic blood specimens by venipuncture, copyright 2007 (www.clsi.org).