Venipuncture Order of the Draw

Venipuncture Order of the Draw

• The order of the draw is crucial to prevent additive carryover from one evacuated tube to another, which can affect blood test results.
• The correct order of the draw is: blood culture bottles or yellow tube stopper, light blue, serum tubes, and then other tubes.
• Blood culture bottles or yellow tube stopper contain the additive SPS and are used for bacterial studies.
• Light blue tubes contain the additive sodium citrate and are used for coagulation tests, and must be filled 100%.
• Serum tubes may contain no additive or a clot activator, and must be allowed to clot for 30 minutes before centrifugation.

Hemoconcentration and Physical Reactions

• Hemoconcentration can occur when a tourniquet is applied too long or the patient excessively pumps their fist, causing blood flow stagnation and altering test results.
• To prevent hemoconcentration, remove the tourniquet before the 1-minute time limit and ask the patient to stop pumping their fist if necessary.
• Minor physical reactions (sweating, dizziness, nausea) can occur during or after venipuncture, but are usually not serious and resolve without treatment.
• Be aware of these reactions as they may indicate a complication of the blood collection.

Collection and Processing Errors

• Collection errors can be more common than physical complications and can have serious consequences.
• Examples of collection errors include misidentification of the patient, improper site selection and preparation, using the wrong tube, incorrect order of the draw, underfilling the tubes, failure to invert the tubes, and mislabeling of specimens.

Performing Venipuncture

• The correct order for venipuncture steps includes introducing yourself to the patient, identifying the patient, having the patient sit or lie down, washing your hands and putting on gloves, assembling the needed equipment, and positioning the patient's arm.
• Use a new needle for every attempt, even on the same patient, and do not repeatedly move the needle in and out, back and forth, or side to side if blood flow stops or no blood is evacuated into the collection tubes.
• If blood flow stops or no blood is evacuated, try another tube, and if necessary, perform another puncture.

Complications and Patient Care

• Complications can occur during or after venipuncture, including syncope, nerve damage, and hemoconcentration.
• Ask patients to let you know if they are having any problems during or after the venipuncture, and be aware of signs or symptoms that indicate the patient is having difficulty tolerating the procedure.
• Know how to identify and address these complications to minimize the chance of a negative outcome for the patient.

Venipuncture Order of the Draw

• The order of the draw was developed by the Clinical and Laboratory Standards Institute (CLSI) to improve the quality of blood tests and standardize the order of blood tube collection.
• The order is important because the use of a double-sided needle results in additive carryover from one evacuated tube to another during blood collection, which can cause test results to be altered.

Blood Culture Bottles and Yellow Tube Stopper

• Blood culture bottles come in sets of aerobic and anaerobic, with the anaerobic tube collected first when using a syringe, and the aerobic tube collected first when using a butterfly needle.
• The yellow stopper tube contains the additive SPS and is used to perform bacterial studies.

Light Blue Tubes

• The light blue stopper tube contains the additive sodium citrate and is used to perform blood collections for coagulation tests.
• Light blue tubes must be filled 100%.

Serum Tubes

• Serum tubes have different stopper colors (red, gold, speckled red and gray, or red and black) and may contain no additive or a clot activator.
• Serum tubes must be allowed to clot for 30 minutes prior to centrifugation.
• Serum tubes are used to perform chemistry blood collections.

Hemoconcentration

• Hemoconcentration can cause an alteration in test results, especially for ammonia, calcium, coagulate, potassium, and protein tests.
• It can be prevented by removing the tourniquet prior to the 1-minute time limit and asking the patient to stop pumping their fist.

Physical Reactions

• Minor physical reactions (diaphoresis, dizziness, nausea) can occur during or after a venipuncture, but these are often not serious and usually go away without treatment.
• Be aware that these reactions can be an indication that the patient is experiencing a complication of the blood collection.

Collection/Processing Errors

• Collection errors can be more common than physical complications and can have serious or fatal consequences.
• Examples of collection errors include misidentification of the patient, improper site selection and preparation, using the wrong tube, incorrect order of the draw, underfilling the tubes, failure to invert the tubes, and mislabeling of specimens.

Syncope

• Ask the patient whether they have ever fainted during a venipuncture.
• If so, have them lie down, and proceed with the collection cautiously.

Venipuncture Steps

• Introduce yourself to the patient.
• Identify the patient using at least two identifiers.
• Have the patient sit or lie down.
• Wash your hands, and don gloves.
• Assemble the needed equipment.
• Position the patient's arm in a slightly bent, downward position.