Considerations in Blood Collection

1. The “X” indicates stopper colors that may be drawn. IF MORE THAN ONE
STOPPER COLOR IS INDICATED CHECK
WITH YOUR CLINICAL FACILITY FOR PROPER TUBE.
2. More than one test can be done on a tube. For example if a CBC and Retic count
are ordered BOTH can be done on the same
tube of blood.
3. The order of the draw MUST be followed to prevent additive carry over which
will severely compromise the results of
laboratory tests sterile blood cultures, light blue, red, purple, green, gray. IF
ONLY A LIGHT BLUE NEEDS
COLLECTING AND YOU ARE USING A BUTTERFLY A DISCARD
TUBE MUST BE DRAWN SO THAT TUBE
WILL NOT BE UNDERFILLED.
4. Correct Specimen Volume:
a. All blood collection tubes need to be filled to the correct volume this will ensure
the proper amount of blood for the
amount of additive in the tube (blood to additive ratio).
b. For example, if a 5 mL draw heparin tube is only filled with 3 mL of blood, the
heparin concentration is erroneously
high and may potentially interfere with some chemistry analytes.
c. Expiration dates should also be checked on the evacuated tubes.
d. Expired tubes should not be used, as they may have a decreased vacuum, as well
as potential changes in any additives
in the tubes.
e. Light blue and black tubes MUST be completely filled. These tubes require a
specific blood to additive ratio, failure
to completely fill WILL cause the sample to be REJECTED as accurate results
CANNOT be obtained..
5. Tourniquet Application and Time
a. The tourniquet should be applied approximately three to four inches above the
venipuncture site. The tourniquet
should be on the arm no longer than one minute.
b. A good rule of thumb to determine the one-minute tourniquet time is to remove
the tourniquet when blood starts to
flow into the first tube of blood being drawn.
c. Prolonged tourniquet time can lead to an false increase in various chemistry
analytes, including serum protein,
potassium, total protein, aspartate aminotransferase (AST), total lipids, cholesterol,
iron and lactic acid due to
hemoconcentration of blood at the puncture site.
6. Maintain microtainers and vacuum tubes in an upright, vertical position. This is
done to for two purposes:
a. Promote clot formation, if required and
b. Reduce possibility of hemolysis.
7. Each lab department will establish their own guidelines for rejection of samples
for the laboratory taking into consideration
the following factors:
a. Discrepancy between specimen and lab requisition, mislabeled samples
CANNOT be accepted.
b. Failure to write date, time and/or initials of phlebotomist - NEVER LABEL
SOMEONE ELSE’S TUBES, your initials
verify that YOU collected the sample. If any lawsuit is filed based on the results
from the tubes the person whose
initials appear on the tube WILL BE THE ONE SUED.
c. Unlabeled tubes -DO NOT BEG TO COME AND LABEL TUBE, once tube
leaves bedside the legal chain of custody
has been broken and the tube MAY NOT BE LABELED OR CORRECTED.
d. Hemolyzed specimens - usually do to IMPROPER COLLECTION
TECHNIQUE, too small of a needle, drawing from
a line, pulling too hard on the plunger of the syringe - HEMOLYSIS
ADVERSELY AFFECTS LABORATORY
RESULTS AND CANNOT BE USED.
e. Wrong tube collected.
f. Outdated supplies used.
g. Contaminated specimens.
h. Quantity Not Sufficieint (QNS)-inadequate volume
i. Anticoagulated samples that are clotted- GENTLY mix as soon as the tube is
filled, transfer blood from a syringe
IMMEDIATELY, do not lay it down and do other things.
j. Improper transport
i. time-some samples must be tested or separated IMMEDIATELY after collection
ii. temperature-some samples MUST be kept cool or warm after collection
iii. light exposure-some samples MUST be protected from the light to prevent false
decrease in analyte.
k. Timed sample drawn at wrong time
8. Many tests require special handling requirements. Refer to the following chart.
Handling Tests ordered
Chilled samples
$ place in ice slurry
IMMEDIATELY upon
collection, failure to do so will
result in REJECTION of blood
sample.
$ Some tests require collection vial
to be chilled prior to collecting.
$ If not chilled the results of the
test will be invalid and patient
may not be properly treated.
$ blood gases,
$ gastrin,
$ ammonia,
$ renin
$ angiotenson
$ lactic acid,
$ catecholamine,
$ parathyroid hormone,
$ ACTH
$ glucagon.
Warmed samples- samples which require
warming that are submitted at room
temperature MUST be rejected
$ cold agglutinins and
$ cryoglobulin.
Protect from light -
$ Failure to protect from light will
result in falsely decreased
values
$ Collect in amber tube to protect
from light.
$ If amber tube unavailable place
in box, wrap on foil
$ bilirubin,
$ vitamin B12,
$ carotene,
$ folate
$ urine samples for porphyrin
determina
tion.
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
Blood Culture X
Coagulation Tests
Prothrombin Time (PT) X
Partial Thromboplastin Time (PTT) X
Thrombin Time (TT) X
Fibrinogen X
Fibrin degradation products (FDP) X
Activated clotting time (ACT) X
D-dimer X
Cryofibrinogen - Whole blood must be drawn in a prewarmed
(37C) syringe and kept at 37C. Immediately after
collection, transfer blood to pre-warmed (37C) 3.5 mL
(sodium citrate) light blue top tube. Keep at 37C until
separated from cells.
X
Factor Assays
X
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
Hematology
Complete Blood Count (CBC) X
Hemoglobin X
Hematocrit X
White blood cell (WBC) count X
Red blood cell (RBC) X
Platelet Count X
Differential X
Erythrocyte Sedimentation Rate (ESR) X
Reticulocyte (Retic) Count X X
Hemoglobin A1C X
Eosinophil count X
Sickle cell test X
Chemistry
Glucose Levels X
Blood Alcohol Levels X
Lactate X
Bicarbonate X
Comprehensive Metabolic Panel (CMP) Old name Chem 12, SMA 12, SMA 20,
SMAC Include the following tests.
Glucose level, electrolyte and fluid balance, kidney function, and liver function.
http://www.labtestsonline.org/understanding/analytes/cmp/cmp.html
$ Glucose X X
$ Calcium X X
$ Albumin X X
$ Total Protein X X
Electrolytes
* Sodium
* Potassium
* CO2 (carbon dioxide, bicarbonate)
* Chloride
XX
$ Blood Urea Nitrogen (BUN) X X
$ Creatinine X X
$ ALP (alkaline phosphatase) X X
$ ALT X X
$ AST X X
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
$ Total Bilirubin-Protect specimen from light. X X
Basic Metabolic Panel Old Name Chem 7, SMA 7 Include the following tests:
glucose level, electrolyte and fluid balance, and
kidney function.
http://www.labtestsonline.org/understanding/analytes/bmp/bmp.html
$ Glucose X X
$ Calcium X X
Electrolytes
* Sodium
* Potassium
* CO2 (carbon dioxide, bicarbonate)
* Chloride
XX
$ Blood Urea Nitrogen (BUN) X X
$ Creatinine X X
Other Chemistry Tests
Uric Acid X X
Lactate Dehydrogenase (LD or LDH) X X
Gamma-Glutamyltransferase (GGT or GGTP) X X
Amylase X X
Triglycerides X X
Cholesterol X X
Low Density Lipids (LDL) X X
High Density Lipids (HDL) X X
Iron X X
Total Iron Binding Capacity (TIBC) X X
Creatine Kinase (CK) X X
LD Isoenzyme Panel X X
Albumin X X
Digoxin-Collect 5-7 hours after administration of last dose. X
Dilantin -Collect immediately prior to next dose. X X
Vancomycin X X
Gentamycin X
Phenobarbital X X
Theophylline X
Lithium X X
Theophylline X X
Tobramycin X X X
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
Cyclosporin - Draw just prior to morning dose for trough
level or two hours post dose.
XX
Hemoglobin Electrophoresis X
Lead
ACTH - *PLACE IN ICE SLUSH* X
ADH X
Alcohol- Prepare venipuncture site with betadine or soap
and water.
XXXX
Aldosterone - Patient must be in upright position (sitting or
standing) for 30 minutes prior to blood draw.
XX
Aluminum Red
Ammonia -*PLACE IN ICE SLUSH* X X
Arsenic Lav
Lead X Lav
B Type Natriuretic Peptide (BNP) X
Carotene (FASTING) X X
Glucagon -*PLACE IN ICE SLUSH* X
Catecholamines-*PLACE IN ICE SLUSH* Because
venipuncture stress elevates catecholamine levels, for truly
basal levels, samples should be collected a minimum of 30
minutes after resting with the patient supine. Patient
preparation: 12-14 hour fast prior to collection.
X
Carcinoembryonic Antigen (CEA) X
Ceruloplasmin X
Chromium Red
Cold Agglutinin (KEEP WARM) - NO Gel X
Copper Lav
Zinc-Do not let specimen come in contact with glass, metal
or rubber.
Lav
Manganese X Lav
Platinum Red
Selenium Lav
Cortisol - Optimal blood collection times to evaluate
diurnal variation are 8:00 AM or 4:00 PM
X
Cryoglobulin - Keep Warm -The accuracy of this test is
greatly compromised if blood is at < 37 degrees during 90
minute period after collection.
X
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
Renin Activity-Cannot test patients that have received
radioisotopes within the past 48 hours. Renin levels are
affected by high sodium diet. Patient should be in upright
(sitting or standing) or supine position for 30 minutes prior
to blood draw. Patient's posture during blood draw (upright
or supine) should be noted. Stability: No more than 4 hours
on cells at ambient temperature; NEVER refrigerate.
X
Estrogen X X
Angiotensin X
Folate, Serum X
Folate, RBC X X
Follicle Stimulating Hormone (FSH) X
Progesterone X X
Testosterone
T3 Triiodothyronine X X
T4 Thyroxine X X
thyroglobulin X X
Thyroid Antibodies X
Parathyroid Hormone *PLACE IN ICE SLUSH* X
Thyroid Stimulating Hormone (TSH) X X X
Gastrin-10 hour fast and no radioactive isotopes therapy 48
hours prior to collection.
X
HBsAb (Hepatitis B Surface Antibody) X X
HBsAg (Hepatitis B Surface Antigen) X X
HCG X X
HCV Antibody (Hepatitis C Antibody) X X
Herpesvirus 6 Human IgG & IgM Abs X X X X
HIV 1 & 2 Antibody Screen X X X X X
HIV Viral Load White
Ketones X X
Lipase X X
Magnesium X X
Myoglobin, Serum X X
Osmolality X X
Phosphorus X X
Porphorins - Protect specimen from light. X X
Test Yellow Lt. Blue Red Green Lavender Gray Black Tan Royal
Blue
Porphobilinogen - Protect specimen from light. X
Serotonin-patient should avoid avocados, bananas,
eggplant, pineapple, plums, tomatoes or walnuts for a 48
hour period prior to collection.
X
Serology
C-Reactive Protein X X
Cytomegalovirus CMV X
Epstein Barr Virus (EBV) X
Lyme Antibodies, IgG, IgM X
Rheumatoid Factor X
RPR X X
Rubella X
Streptozyme X
Mono test X
Blood Bank - Tube drawn will depend on clinical site, some sites have special
armband
ABO/D Type (ABO/Rh) X Pink
Type and Screen (Indirect Coombs Test) X Pink
Crossmatch X Pink
Direct Coombs Test or Direct Antiglobulin Test (DAT) X
Elution X
Kleihauer Betke Stain X
References
1. http://uh.edu/admin/hc/Blood_Chem.html
2. http://www.webmd.com/hw/lab_tests/tu6207.asp
3. Activated Clotting Time http://enw.org/Research-ACT.htm
4. Phlebotomy Services
http://som.ucdavis.edu/departments/pathology/clinical/phlebotomy_services
ORDER OF DRAW IS
INCORRECT
5. Test Directory - Excellent reference for looking up tests by alphabetical order
http://referencelab.clevelandclinic.org/DBSearch/Search.htm
6. ARUP Guide to Clinical Laboratory Testing Excellent reference for looking up
tests by alphabetical order
http://www.aruplab.com/testing/lab_testing.jsp
7. Pre-Analytical Considerations in Blood Collection
http://www.columbia.edu/itc/hs/medical/selective/AdvClinicalPathology/2005/lect
ure/PreAnalyticalLectureColor_Fink.pdf
8. Preanalytical Variables in the Chemistry Laboratory
http://www.bd.com/vacutainer/labnotes/Volume15Number1/
9. BLOOD COLLECTION: ROUTINE VENIPUNCTURE AND SPECIMEN
HANDLING
http://medlib.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html

GENERAL BLOOD COLLECTION

TUBE REQUIREMENTS
TEST
TUBE
TEST
TUBE
TEST
TUBE
TEST
TUBE
ABO Type *** Pink Cortisol R or Y HCG screen & quant R or Y PSA Y, R (only)
Acid Phosphatase R or Y FDP or D-dimer B HIV (signed consent) R or Y PT,
APTT (PTC & PTV) B
AFP R or Y C-Reactive Protein (CRP) R or Y IgG, IgM, IgA, IgE R or Y
Progesterone R or Y
Albumin LG or Y Ca19, Ca 125 R or Y Iron Profile (Fe, TIBC, %sat) LG or Y
Rast or Allergy R or Y
Alcohol (!use non-alcohol wipe) R or G Crossmatch*** R & L Lactic Acid G
Reticulocyte Count L
Alkaline Phosphatase R, LG or Y Cytomegelovirus (CMV) R or Y Lead L
Rheumatoid Arthritis R or Y
Ammonia L (on ice) Drug Levels* - all types R or LG LDH LG or Y RPR R
Amylase LG or Y Drug Screen R Legionella Y or R Rubella Screen R or Y
ANA R Electrolytes R, LG or Y Lipase LG or Y Sed Rate (ESR)
L
Anticardiolipin Ab R or Y Epstein Barr Ab R or Y
Lipid Profile or Coro
(Chol, Trig, HDL, LDL) LG or Y Serum Electrophoresis (SPEP)
R or Y
ASO R Ferritin R, LG or Y Lithium R or Y
Serum Immunoelectrophoresis
(SIEP)
R or Y
Bilirubin (Total & Direct) R, LG or Y Fibrinogen Levels B Liver Profile LG or Y
SGOT (AST) or SGPT (ALT) LG or Y
BUN, Creatinine
R, LG or Y
Folate (Folic Acid)
Y or R
Lupus Type Anticoagulant*
LTA
3B & R or Y
(pediatric tubes
6B)
BNP
L
Calcium R, LG or Y
Comprehensive Metabolic Panel –
CMP or General Chem R, LG or Y Lyme (Progressive) R or Y TSH, T3, T4
R or Y
Carboxyhemoglobin LG/Do not spin GGT R, LG or Y Magnesium LG or Y Free
T4 R or Y
Cardiac Enzyme Profile
(CK,CKMB,Troponin) LG Glucose LG, G or Y Mononucleosis Screen R Total
Protein
LG or Y
CBC L Glycohemoglobin (HbA1C) L Osmolality R, LG or Y Testosterone R or Y
CEA R or Y Hemoglobin & Hematocrit (H&H) L Phosphorus LG or Y Troponin I
LG
Cholesterol, Triglycerides LG or Y Hemoglobin Electrophoresis L Platelet Count
L Type and Screen*** Pink
CD4/CD8****
Rm Temp/Same Day/Before 2:30
1 10ml GR and
IL
Heparin Assay (XA) Freeze/Deliver
to Lab within 1 hour
B (on ice)
OB Panel
2L,2R,2Y
Uric Acid
LG or Y
Cold Agglutinin (keep warm)
R
Hepatitis Profiles – All
R or Y
Basic Metabolic Panel - BMP or
Profile 7 (consists of: BUN, CR,
CA,Glu,Lytes and Bicarb)
LG, Y
Vitamin B-12
Y or R
CODES AND ORDER OF THE DRAW
B - Light BlueTop (Tube must be full!)
R - Red-Top Tube
Y – Yellow Top Tube (Corvac)**
LG – Light Green Top Tube
GR – Green Top Tube
L – Lavender or Pink Top Tube
G – Grey Top Tube
*Refer to lab manual for special instructions.
**Can substitute Red Top for Yellow Top.
***Date, Time, User’s Initials on tubes and #13 BB Slip
****Obtain tube from Lab