Dear Trevor / Mailbase,
This advice is flawed since the red topped plastic tube, both BD and Greiner, contains clot acitvator. It is only the glass red topped which is clot activator free.
We have just changed to one blood collection system for Leeds / Bradford - a change not without its problems! However, since we are using plastic tubes and based on experience, we decided on the following order of draw:
1. Blood culture (aerobic followed by anaerobic)
2. SST (Clinical Biochemistry)
3. Citrate
3. ACD-B (Tissue Typing)
4. Red topped
5. SST (Immunology)
6. EDTA - Crossmatch
7. EDTA - Haematology, HbA1, some specialist tests
8. Lithium Heparin + Gel - Clinical Biochemistry (stat / IV heparinised patients), Renin, aldosterone
9. Sodium Heparin - Trace elements
10. Fl/Ox - Glucose, lactate, alcohol
Hope this is helpful.
Mike
Dr. Mike Bosomworth
Operations Manager for Pathology
Principal Biochemist
Tel. 0113 2064299 Fax 0113 2065971
Mobile 07789 174344
Please visit our web-site at www.leedsteachinghospitals.com
>>> Trevor Gray <[log in to unmask]> 17/02/2003 22:28:22 >>>
Dear colleagues,
We have been reviewing our instructions to phlebotomists in regard to
the order of draw for venous blood samples. Becton-Dickinson, supplier
of our tubes recommends following the NCCLS guidelines which suggest the
following order:
"The following order-of-draw, which is recommended when drawing
several specimens during a single venepuncture, is based on pragmatism.
Its purpose is to avoid possible test result error due to cross
contamination from tube additives. This procedure should be followed for
both evacuated tubes, and syringe transfer of blood to multiple tubes.
(1) Blood culture tube
(2) Plain tube, non-additive (e. g., red stopper)
(3) Coagulation tube (e.g., blue stopper, citrate)
(4) Additive tubes:
? Gel separator tube
? Heparin (e.g., green stopper)
? EDTA (e.g.., lavender stopper)
? Oxalate/fluoride (e.g.,gray stopper)"
This seems to be counter-intuitive in that the chemistry tube (gel
separator) is drawn after the sodium citrate tube. The rationale seems
to be to avoid contaminating the citrate tube with clot activator, but I
would have thought that contamination from citrate into the clotted tube
more likely.
Has anyone any experience, anecdotal or otherwise (from a statistically
respectable sample !) which proves the case one way or the other ?
Trevor
--
Trevor Gray
Dept. of Clinical Chemistry,
Northern General Hospital,
Sheffield S5 7AU
0114 271 4309
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