Phlebotomy: Order of Draw and Anticoagulants
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- čas přidán 25. 07. 2024
- This video describes the correct order of draw and how tube anticoagulants work. Please note that if Blood Culture bottles are collected, the aerobic must be drawn before the anaerobic bottle. Also discussed are Quality issues including EDTA contamination.
Just started my phlebotomy course and have been feeling a bit overwhelmed. I have found your channel to be extremely helpful!! Thank you. My stress level is slowly going down. :)
I am so glad!
I just started mine Monday! This is my first video, can't wait for it to start after reading this comment!!
@@SomeOne-zw6kh I start mine last week
Hi. Hello is this validated worldwide. I'm from the uk
Hi I start my phlebotomy course this Saturday, how did it go for you?? I’m getting nervous. What do you think I need to pass/complete the class?
Just took my NH exam and passed with a score of 420. Thank you for this detailed video, could not have done it without your help
I got 410 nice job 👍 I have interview tomorrow needed a refresher course 😗 wish me luck 🍀
@@mikeperez5986 you got this, buddy!
Best of luck!
I start my phlebotomy training on the 24th ! I’m nervous and excited.. tips please lol
I’m taking my NHA exam for CPT & CET Nov 10th wish me luck your video is very helpful.
@@mikeperez5986 hello can you please tell me what’s all that’s on the NHA test getting ready to take the test and I’m so scared
Excellent! The best video that I have seen that thoroughly explains the tubes in detail. Thank you!
Thank you for your support!
This is the best order of draw video I've found, thank you!
Blood cultures 0:55
Light Blue 4:08
Red 5:12
SST 6:05
Green 7:40
Lavender 8:50
Gray 14:18
What is this
@raju The order in which tubes need to be filled and the time it is in the video
I heard ppl say that red should be last due to you want it to clot
Marion Rhodoleia that’s why you want it to be one of the first ones because you don’t want a additive from any other tub to stop that process
@@GrippysocksCC would using a vacutainer change The Order of draw?
I'm an RN,I found your video very helpful. We don't always have a detailed in-service like this we're just shown the basics and away we go. Pick up what you need as you go along. So thanks for this video. See you all in the trenches....you are appreciated.
So glad to help and thank you!!!! We do love & value all of our healthcare team members ♡
This video helped me a lot on my phlebotomy skills. Thank you for making this helpful video!
This was very educational. The perfect video for me to touch up my knowledge before I take my state exam next month
I did an online phlebotomy class that was three weeks.I was going crazy not understanding this. 3 months later (today) this finally makes sense! Thank yoooou!!
I am so glad! Congratulations and welcome to the lab family!!!!!
I am u today. Hopefully i will understand better
What online class was that ??
STARTING SCHOOL IN TWO WEEKS AND THIS IS VERY INFORMAL. THANKS
Personally, your right on target...thank you very very much, concise and clear.
Glad it was helpful.
Just finished NHA exam and passed for phlebotomy. Yippie.
CONGRATULATIONS 🤗🥳🥳🥳🥳 Welcome to the family!!!
This is the best video on the order of draw! Just started my MLT program and was very nervous. I’m also taking phlebotomy now. Your videos are extremely helpful. Thank you!!
Thank you for your support! Enjoy your program, that's exciting!
Did you get your phlebotomy certificate?
STARTED MY PHLEBOTOMY COURSE 2 WEEKS AGO , THIS VIDEO HELPED ME ALOT 😉
Congratulations!!! Hope you have a great time and learn a lot!!!
This was a SUPER helpful refresher! Thank you SO MUCH!!
You're welcome! Thank you for your support!
One of the most helpful videos Thank you!!!
This video is a life saver for me who just started a phlebotomy course
Games of Yesterday n Today Let's Plays & More hi what are the rewuirements to take a phlebotomy course?
I am starting my phlebotomy class on February 15th, 2012
Perfect, the best explanation that I found. Thank you
Thank you for your support! Glad I could help!
Thank you . Very informative. Also, you have a lovely voice. You would make a great radio host.
Thank you very much!
Great and informative video! Thank you for sharing.
ann jean
Thank you for your comment!
thank you so much for putting in the detailed information 🙏🏻 it helps a lot
I would really enjoy learning the test that go with each tube
This was awesome! I’m prepping for a job interview tomorrow after completing my certification 5 months ago, so I needed a refresher on the OOD, in case I’m asked a question about it. Very helpful resource to use along with my notes. Thank you SO much for this! ☺️ *new subscriber*
Thank you so much for your support! Glad it was helpful! Good luck tomorrow!!!!
How did your interview go? Where you asked about the drawing of blood order?
Thank you for this, in the same boat myself this morning
Thank you very much for the great video it's really good and you did explain it very well!!
LOVE YOUR VIDEO! Breaks down the order of draw so flawlessly, i feel very confident for my finals comp tomorrow thank you.
WOW. THAT was a REALLY Great video!!!
Thank you for your support!
Thanks a lot for all these useful information,I appreciate that 💛☮️🌻🙃🐻
Nurse who appreciates the in-depth and thoughtful explanations
So glad to have you! Thank you for your support!
Great informative video! Thank you!!!
Thank you for your support!
You explained this si well !!!
Thx a bunch 😊
great video please keep posting
Thanks you so much lady Gill you have really taught me a lesson
Thank you for your support!
Awesome teaching thank you!!!
This is an extremely helpful video for my classes. I tell my students to pay close attention to what happens if you draw the lavender before the others. Scary.
Thank you for your support!!! I am working on a collaboration between nursing, HIM, and lab students to talk about the effects that situation has on a patient. It should make for a really great discussion AND bring about more awareness of the issue. : )
Hi all the best regards u have up
Really helpful for my upcoming Blood Science exam! Thank you so much :)
Glad I could help!
just follow your professor instruction.
I'm sooooo glad I found this video very helpful information thank you
Glad to help!
Thank you so much for this video, I just started a job at a lab and needed a good refresher! Very good info here! You’re a life saver. Is there a video about separating serum from cmp to prepare for lab pick up!?
Thank you for your support! Glad to help!
Do you mean centrifuging the specimen or aliquoting as well (separation of serum)?
@@MedicalLabLadyGill I have figured out the centrifuging. But about separating serum do you use the same pipette per person ? Also do you put multiple serum from let’s say 3 sst tubes into one transport tube or does it have to be separated into individual transport tubes?
Fig aliquoting a specimen needs to be performed with one transfer pipette per sample. Each patient tube should have its own receiving tube. The venipuncture collection tubes each have a different additive and blood from them should never be mixed.
I am still guessing about your original question. If you are in accessioning and are delivering tubes to the bench, the SST should be centrifuged and delivered to that bench. If you're in accessioning and are preparing the tubes to be sent to a reference lab your facility usually has instructions on how to do this (they might expect phlebotomy to draw an extra tube just in case their is an add-on test ordered later in house). Usually, you can send the original collection tube or put the plasma/serum in one of the tubes provided by the reference lab.
If you use a butterfly you will spend vacuun for the blue tubes and they will take less blood. In that case you must use the red tubes first to absorb the vacuum leak and then the blue to be filled with the correct amount of ml so that the anticoagulant agent dilution is correct.
Very nicely explained. Thank you.
Thank you for this video... very informative
Thank you was worried about this part as I didn’t know if the color of tube order take test in four days
Great Video
THANK YOU THANK YOU THANK YOU!! SOOOO VERY VERY HELPFUL!
You're welcome!
I recently found your channel its been very helpful especially i liked blood bank videos.
And i hope you do blood banking videos again. Thank you.
Thank you for your support! Welcome to the family! We are getting new equipment for the fall semester and I hope to be doing more videos.
That is so interesting how doctors do that that is so amazing
I just completed last week and I'm very anxious. Praying to find a job quickly so I can get more experience to build the confidence
Congratulations and all the best! Phlebotomists are in high demand and are a very important/critical part of patient care.
@Medical Lab Lady Gill thankyou. What helps with nerves?? I'm so nervous. Praying I find a job to help me build my confidence
Very important steps she miss. You have to fill the blue tube all the way up to the line. If it is the first vial because you are not drawing blood cultures, you need to use a red tube first just to fill the butterfly needle tubing up with blood then draw the blue. If you don’t the blue tube will get air in it first then there will not be the required ratio of blood to anticoagulant and you would have to redraw.
is that what they call the "full draw"? i'm having problems in looking for the meaning of full draw.
The explanation of the blue top fill is in another video.
@@andriennevalendebelen9618 yes, there is a line on the blue top tube that marks the appropriate fill so the coagulation test results are not adversely affected. Evey additive tube needs to be filled to a certain amount so the specimen to additive ratio is appropriate for testing.
No. Use a GLASS red(no additive) or another blue.
Great video ❤❤❤
That looked cool
Thanks for your video what about the yellow tube and the blue one?
I thought if you use a butterfly you should draw aerobic first because there is air in the butterfly tube , ? What do you think
Tron TwoProgram
That is true. I think I was trying to convey that you may not always be drawing both (or any blood cultures for that matter) but said it in a poor way. Thank you for pointing this out ; )
You are right and you will always draw both
@@MissSunDaiRose Not always
I was about to say that. I agree with you. The bottles she is showing need a butterfly because they do not fit a normal vacutainer holder. We used to get these in a kit from LabCorp.
You use a Discard tube 1st when using the butterfly to get the air out of the tube .
Very informative nicely done
Thank you!
Great video. Very helpful. Can you go over the tests hat would go with the different tubes? Thank you!
Great question!
Yellow is anticoagulant, infections blood cultures. Light blue coagulation, PT/INR, Red is plain so it's chemistry draws Light green is lithium heparin PST so lactate dark green sodium heparin is ammonia and then lavender or purple edta cbc diff gray potassium oxalate sodium fluoride for like blood alcohol and glucose
Oops and gold/tiger top SST for routine chemistry
Great job 👌
Our teacher AND BOOK (Phlebotomy Essentials 6th edition by McCall and Tankersley) says the OOD is blood cultures, yellow, light blue, red, gold, light green, green, lavender, then, gray. It's so difficult learning OOD when so many people do it differently. I cant find one video of the way we do it and my teacher is terrible.
Sorry for your confusion! Going just by the color can be an issue. Yes, we try to make it easy and visual by making the phlebotomy rainbow but the order is based on the additive...which is based on the kind of specimen characteristics needed for the desired test.
Your text is the same one I use for class! ; ) The best way to study is to know why the specific additive will give you the desired specimen. For example, it would not make sense to use a SST (gold serum separator tube) for a CBC because separating the cells from the liquid portion of the blood would give falsely elevated counts.
The other part that you need to understand is how contamination of the additive may affect the next tube. The biggest offender here is the EDTA contamination of the SST. The way that EDTA binds to Calcium is a very strong bond. During testing of a contaminated chemistry profile (SST tube), that EDTA will bind the calcium so that the level will be critically low. Since, Potassium EDTA is the anticoagulant of choice...the Poatassium would also be falsely elevated/critical.
Another consideration is the body's response to the wound created by the venipuncture. Clotting is going to get initiated almost immediately. That is why the Blue tops, used for coagulation testing, are drawn first if blood cultures are not needed. Factor levels ould not be accurate if the blue tops were drawn at the end.
Please check out the link in the video description if you would like more info about the correct order of draw. Also, make sure you go by what the course text says. Focus on the name of the additive, the color, the type of specimen created by the tube (whole blood, plasma, or serum), and the types of tests measured from the tube.
Here's the link education.bd.com/images/view.aspx?productId=1537
That is so true we learn it a different way blood cultures, red then blue
My teacher is horrible too, that's why I'm here on CZcams learning this stuff all by myself because the teacher hasn't done any teaching yet & I've been in this class for 5 weeks. I hope your class goes well for you.
@@amandaclover9191
This is so disheartening. When you say the teacher is not teaching can you give an example of what you feel is missing in class?
Very informative, thank you!
Nina Gomez
You're welcome!
really helpful and subscribed!!
Awesome! Thank you for your support!
Hey I am a new subscriber and I’ve been watching your videos for about a few days now and I am so happy I found you. I am not sure if you did a video on this yet, but how do I know what color to use when it comes to test tube color look up for drawing blood from a doctor order?
That is a great question! There are differences among institutions regarding their policies & instrumentation for certain tests. As a whole, BD has great resources on which tubes are used for various tests. You can find that information here www.acllaboratories.com/static/documents/KV1259_ACL_BD_Tube_Chart_11.2020.pdf
How long should it take for the blood to clot in the red tube that has the silica in it? Is it like 30 minutes? What if someones blood clotted in less than 5 is that bad?
This is so helpful, thank you
You're welcome!
incredible video thank you
Glad to help!
Good video thank you sister
This helped soooo much thank you!
So glad to help!
at 1:41 i was under the impression that the top of the BCx bottles and the venipuncture site is cleansed with ChloraPrep and not a traditional alcohol prep pad?
I often see people draw the lithium or EDTA tube (if also ordered) before the citrate tube to “get the air out” instead of using a discard. How might this affect the results? They would draw green, blue lavender or sometimes lavender, blue no other tubes were ordered.
That is interesting. I haven't seen that before. EDTA contamination is usually of concern in chemistry tubes but it could also affect the coagulation results during testing. EDTA has a stronger bond to calcium than that of the blue top's sodium citrate. EDTA could falsely elevate/lengthen the clotting time. The best practice would be to use 2 blues at the beginning with the first as a discard tube like you referenced in you comment.
Good tutorial thanks alot
I start my program in the fall. is there any tips and tricks for studying order of draw and remembering the colors?
Congratulations!!!
The main rule is to know the additives and ideally the testing performed on them. Some of the colors are arbitrary and can be confusing. For example, you can review several comments on this video from individuals telling me I filmed the wrong order of draw because yellow is first in a textbook and on the BD site. If one looks at the additive listed it is for a blood culture bottle and should not be confused with the Gold Serum Separator Tube (SST) used for the main chemistries.
A general rule of thumb is to draw Blood Culture Bottles first (if needed), Light Blue (coagulation testing because venipuncture initiates clotting right away), a STOP LIGHT Red Gold Green (used for various chemistries), Lavender and Pink (EDTA tubes for Hematology & Blood Banking), Gray (fasting glucose)
That is the quickest way I could put that all together. Hope it will be helpful! Knowing what's in the tube and why it is used for testing will help you beyond measure. Please make sure to take the time to know them inside and out. Each of your patients and coworkers will be grateful!
Now the additives and Lab Uses -
@@zuley6957 images.app.goo.gl/Ee8DWPwCixA8pN5f9 this is one hospital's chart that includes order of draw and testing performed. Also, check out the BD website. Google "BD order of draw" and you can see the proper order of draw for regular and microtainers. PLEASE make sure to memorize by additive!!!!
I’m confused when some one comes to the lab to get blood drawn how do you know what tubes too use as in what is the easiest way to know what tube to use and if your using the right one
@@rosaliedeleon629 Their doctor should order specific tests.
There's also a basic blood work set and if nothing else is ordered then you'd just do that.
Can i use just one? Which one for PRP? Do you have to use the red one with butterfly? Is it safe to draw my own blood or could i die?
Thank you for the questions!
Venipuncture can include just one or two tubes, however, it should be performed by trained personnel. If you are interested in the benefits of PRP I suggest you make an appointment with your physician. He or she can then discuss the appropriate procedure if that treatment is right for you. Please do not try performing needle sticks on yourself or anyone else without proper training.
which tube type would you use for PRP TREATMENTS?
Question: What if I drew just the red, tiger, and yellow top out of order, does it affect the results?
Also, very informative and straight forward, thank you. I'm starting my new job and I am studying over my notes from school and youtubing it up! 🙂
Pr0D16y
Thank you for the question! I am not really sure that you would run into that kind of situation because they can be used for the same types of tests (chemistry). They are all made to provide serum by forcing the blood to clot. Therefore, if the occasion did arise and these three ONLY were not in the correct order among themselves there would probably not be a problem. But again, it is highly unlikely that you would experience this issue.
How can I you pauple top
The reason you draw reds before SSTs is because some reds are glass and have no clot activator in them. If you draw that after the SST, the blood will clot faster than it's supposed to in a glass red. So drawing red before sst helps to commit the GLASS red to memory.
Why is it that some tests require Plain Red Serum and rejects SST?
this is super useful
great video, clear explanation... thanks so much
Thank you for your support!
Thanks
Let’s say you have to do a blood draw for two different tests but they’re for the same colored tube. Do you have to use two separate tubes or can you use one tube for both tests?
Megan Obrien It usually depends on the amount of blood you need for each test
Just perfect 👍
Im a medical assistant student will be in clinical in June starting to get ready for ncct certification
I thought that an Ammonia level had to be drawn into an EDTA tube then kept on ice. Is the lithium heparin the same?
Ammonia should be drawn in a Lithium heparin (green top) tube and kept on ice. The anticoagulants do not react with the blood the same way.
are the purple and pink top not centrifuged only when your doing Blood Culture test or is that always?
The purple and pink tops have the EDTA anticoagulant in them. These tubes are used for Hematology and Blood Banking. Hematology EDTA tubes do not get centrifuged because they are used to perform complete blood counts (CBC) which analyzes the cellularity of the whole blood. Blood Banking specimens get centrifuged because the liquid and cellular portions of the blood are tested separately. The plasma (liquid portion before a clot) is tested for antibodies while the cellular portion (mainly the RBCs) are tested for proteins in the cellular membrane.
!!question: we draw our HGBA1c in lavender top.Our doctors always call them fasting glucose so I always thought thats what it was.We have never used grey top na2 edta.have we been doing this wrong all along?
HgbA1c is glucose monitoring test because RBCs are only able get cellular energy through glycolysis. So there is a chain of glucose that forms on the membrane proteins and matches the amount of levels in the blood over a long period of time. Therefore, you need a whole blood specimen to analyze the RBC.
Fasting glucose measures the amount of glucose in the liquid portion of the blood at one period in time. The RBCs must be separated from the liquid portion, by centrifugation, so as to keep them from metabolizing said glucose. They are drawn in the gray top tube because the additive in the tube inhibits utilization of glucose by the RBCs.
Thank you so much
Thank you for your support!
May i use your videos for my youtube video to describe any topic in hindi language?
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isn't the red supposed to come before blue since it's no additive and u would want to prevent any additive from getting into it?
That’s what I learned!
Thanks for the educational video! I'm wondering what age did you graduate, because most Medical Doctors graduate in the United States by age 19. Good work! Let freedom ring!
Thank you for your support! Medical Doctors graduate medical school in their 20's or 30's depending on when they started (immediately after undergraduate, after a graduate degree, or after waiting in between 2 degrees). I am not sure how it is outside of the USA.
bro 19? wtf are you talking about. not everyone is doogie howser lol
What????? Who do u know that graduated at age 19?? Gtfoh
Great video. So you stated that you put blood in both culture bottles at some point. The green cap looks intact to me though
I did not put blood in both of them.
it would be so much easier if they made the order in the rainbow formation!
Hi Ma'am, I would like to ask if what is the appropriate tube for PLATELET AGGREGATION TEST?
I was confused because there are a lot of info's on the internet and I don't know if those answers are the correct ones.
Hello, the specimen could really depend on the method you're using. However, commonly the specimen is a sodium citrate or light blue top tube.
@@MedicalLabLadyGill THANK YOU so much Ma'am
You centrifuge the edta to obtain plasma like for example to run BNP in clinical chemistry lab 🔬
Nice video but tube me kitne ka reso hota h
I start on the 21st. Somewhat terrified. A little excited... but pretty nervous
Remi wtf Same here
The culture bottles DO have to be aerobic -> anaerobic IF the line you're drawing from hasn't been purged of air first.
This may be a stupid question, but, along with drawing blood, does the phlebotomist also run all the tests on the blood?
No. In a hospital setting lab the Medical Lab Techs ( MLTS) run all the tests. We are Phlebotomy Lab Techs, we draw the blood from patients, MLTs know how to draw blood too.
My order of draw card from class has yellow last?
Could you explain why you should draw light blues before Red/SSTs? Because if lavenders can falsely elevate potassium because of the K2 EDTA, wouldn't the Sodium Citrate in light blues falsely elevate sodium?
It absolutely could cause a falsely elevated sodium, however, if you look at the normal range of sodium it naturally more abundant in the blood (the most abundant extracellular cation) than potassium. Sodium's normal range is over 100 mg/dL while potassium's is in the single digits. Some carryover from a blue top may not affect the sodium level as much as an K2EDTA could affect the potassium.
Why is the grey id the last one?
Amazing video as always Lady Gill! One question; since sodium citrate (light blue) potentially removes calcium similarly to EDTA tubes does this mean that EDTA tubes can be used for coagulation tests as well? Or does this have something to do with Sodium Citrate being a specific chemical that "disables" calcium rather chelating it completely like in EDTA tubes? Have yet to watch your recently uploaded coagulation tests videos but I foresee myself doing so soon!
Jia Xing
Thank you so much for your support and GREAT question!!!
EDTA and Sodium Citrate both chelate calcium but to a different extent (as you referred to in your question.) EDTA has a stronger, irreversible, chemical bond with the calcium than the sodium citrate (which is a reversible bond.) As noted in the coagulation videos, the reagents used for the screening tests PT and PTT have calcium in them. If the correct 9:1 whole blood to sodium citrate ratio is accurate in the tube then the desired clotting can occur with the addition of those calcium containing reagents. The same would not be true if EDTA was used.
Another reason not to use EDTA for coagulation testing deals with platelet aggregation studies. If a patient's screening tests were abnormal, without the patient taking a prescription anticoagulant, then the clinician may opt for platelet aggregation studies to decide if there is a qualitative or quantitative disorder. EDTA inhibits platelet aggregation/clumping and would therefore make the test results inaccurate.
Thanks for the clear explanation! Can't imagine the horrors that would follow a severe misdiagnosis such as hemophilia or thrombocytopenia due to a simple mistake of wrong order of draw. Hoping to see more videos coming soon and keep up the good work Lady Gill! :)
Jia Xing
Glad I could help!
Jia Xing ii
Jia Xing
Thank you 😊
Hello what Color tubes Can you Not Centrifuge ??or you can Centrifuge all of them 😐
This is a really good question! All tubes are centrifuged except for the EDTA Lavender top as a general rule of thumb, HOWEVER, it really depends on the test and specimen requirements (whole blood versus plasma versus serum). For example....
EDTA tubes are used for Hematology & Blood Banking. Blood Banking centrifuges the tube to test the red blood cells for antigens in the cell membrane and the plasma for antibodies to red cell antigens. Hematology does not centrifuge the EDTA tube because the cells need to remain suspended in the liquid plasma to obtain accurate blood cell counts.
Some point of care analyzers use whole blood in a green top (Lithium Heparin tube) whereas others use the plasma from the green top (needs to be centrifuged to get the plasma) for heart and other chemistries.
Where is the dark green tube?