Order of Draw of Blood Collection Tube

Vacuum blood collection tubes are widely used in hospital and clinic, but not everyone knows the correct sequence blood collection tubes order of draw. The order of blood collection, depends on blood collection tube colors and tests, Below let we show the blood collection tube color guide for you.

Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The recommended order of draw for plastic vacutainer blood collection tubes are:

First – blood culture bottle or tube (yellow or yellow-black top)

Second – coagulation tube (Blue top).

Third – non-additive tube (red top)

Last draw – additive tubes in this order:

SST (red-gray or gold top). Contains a gel separator and clot activator.

Sodium heparin (Green top)

PSGT (light green top). Contains lithium heparin anticoagulant and a gel separator.

EDTA (lavender top)
Glucose , Oxalate/fluoride (Grey top) or other additives
NOTE: Tubes with additives must be thoroughly mixed. Clotting or erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.
You may ask why we need follow this sequences. Please at the same time see blood collection tubes and tests chart.

1. Blood cultures should always be drawn first to reduce the potential hazard bacterial, fungal, quantitative, CMV and/or other specimen contamination. Blood culture vials and tubes:

Blue, Purple culture vials contain enriched Soybean-Casin broth with CO2 and are used for bacterial and fungal blood cultures.

Yellow stopper tubes contain nutrient solution and Black stopper Isolator tubes contain a blood lysis solution.

2. Light Blue tubes must be drawn prior to collection of serum tubes to prevent contamination with clot activator and interference with the coagulation cascade.

Light Blue stopper tubes contain sodium citrate most often used for coagulation studies.

1ml of blood into a light blue 3.2% citrate discard tube must be collected prior to drawing light blue top tube(s) for the following special coagulation studies: Platelet Function Screen and Whole Blood Platelet Aggregation of Platelet Mapping. A discard tube is not required for any other Special Coagulation testing.

3.Serum tubes are coated on the inside walls with clot activator because the surface of a plastic tube does not promote coagulation.

a. Red stopper tubes are used mainly for serology and chemistry tests. They may also be used for testing in Blood Bank.

b. SANLI SST (serum separator tubes) have a red stopper with a yellow ring on top and are used for a wide variety of testing. These tubes contain a gel which separates the cells from the serum when the tube is centrifuged.

Tubes with additives:

Green stopper tubes contain lithium heparin and are used for most tests that require plasma. Green stopper tubes are also used for NH3 which requires immediate transport.

Green stopper tubes containing sodium heparin are used for special testing such as Cytogenetics.

Lavender stopper tubes contain EDTA and used for hematology studies.

Above order of blood collection draw also can apply to capillary blood collection tubes.Capillary tubes for blood collection we normally have non-additive, EDTA, serum separator, Heparin and Glucose.

Finally, blood collection tube guide can summarized as 3 points:

A. Sterility should be consider first, blood culture and blood collection should be the first.

B. Additives can not pollute non-additives, so red (no additives tubes) without need in front of other tubes that containing additives.

C. Additives should also be distinguished also. Additives have a great influence on other tests. The order of additives is that they can’t affect the latter experiments. Coagulation function testing requires higher requirements, so blue tubes rank first.