Why Is Order of Draw Important for Patient Safety and Accuracy

Order of draw is crucial for patient safety and accuracy because it helps prevent misidentification of patients and samples. This is especially important in emergency situations where patients may be unable to communicate.

A study found that when the order of draw is not followed, there is a 10% chance of sample misidentification. This can lead to incorrect medication administration, delayed treatment, or even harm to the patient.

Incorrect labeling of samples can cause delays in diagnosis and treatment. For example, if a sample is mislabeled as a blood culture, it may be sent to the wrong lab for analysis, resulting in a delay of several hours.

Following the order of draw ensures that the correct sample is collected and sent to the lab for analysis, reducing the risk of errors and improving patient outcomes.

The order of draw may seem like a minor detail, but it's actually crucial for getting accurate test results.

In fact, the sequence of tubes is designed to prevent contamination and ensure that each sample is collected in the right condition.

For example, tubes for blood cultures are used first because they need to be collected without any additives that might interfere with the test.

Here's a quick rundown of the order of draw:

This order helps prevent additives from interfering with tests that require them, like coagulation testing.

Understanding the components of the order of draw is crucial for accurate and reliable test results. The order of draw typically follows a sequence from tubes that contain no additives to those that contain anticoagulants or other additives.

Tubes for blood cultures are the first in line, used to collect samples for detecting bacterial or fungal infections. These tubes are used to collect samples for detecting bacterial or fungal infections.

Serum tubes contain a clot activator that allows the blood to clot, separating the serum from the cells. They're commonly used for tests like lipid profiles, glucose levels, and liver function tests.

Heparin tubes contain the anticoagulant heparin and are used for tests like electrolytes, arterial blood gases, and lactate. This is a common use for heparin tubes.

EDTA tubes contain the anticoagulant ethylenediaminetetraacetic acid (EDTA) and are used for tests like complete blood count (CBC) and blood typing. EDTA tubes are a crucial component of the order of draw.

Other additive tubes contain additives like sodium fluoride or potassium oxalate and are used for tests like glucose and lactate. These tubes are used for a variety of tests.

Here's a quick rundown of the components of the order of draw:

Many phlebotomists use a mnemonic device to make the memorization process a bit easier. A mnemonic device is a phrase or saying that is easy to remember and relate back to in the future. It’s a great way to remember order of draw because you can modify the sentence to be most helpful to you.

Phlebotomists can use a sentence that identifies the tubes by color to create a useful mnemonic. This helps them remember the correct order of draw.

Maintaining sterility during the order of draw is critical to preventing cross-contamination and ensuring accurate test results.

Properly sanitizing the puncture site before beginning the blood draw is the first step to maintaining sterility. This helps minimize the risk of introducing bacteria into the bloodstream.

Phlebotomists must use sterile needles, tubes, and equipment during the blood draw process, including changing needles between tubes and avoiding touching the inside of tubes or needles. Sterile gloves should be used throughout the procedure.

Cross-contamination can lead to inaccurate test results, misdiagnosis, and potential harm to the patient.

Maintaining sterility during the order of draw is critical to ensuring the accuracy and safety of blood collection.

Cross-contamination during phlebotomy can lead to inaccurate test results, misdiagnosis, and potential harm to the patient.

The first step to maintaining sterility during the order of draw is to properly sanitize the puncture site before beginning the blood draw.

This helps to minimize the risk of introducing bacteria into the bloodstream.

Phlebotomists must ensure that they use sterile needles, tubes, and other equipment during the blood draw process.

This includes changing needles between tubes, avoiding touching the inside of tubes or needles, and using sterile gloves throughout the procedure.

Residual anticoagulant from one tube can contaminate another sample, leading to inaccurate results.

This is especially concerning in critical care settings where timely and accurate lab results are essential.

By following proper sterility protocols, phlebotomists can help prevent cross-contamination and ensure accurate test results.

Maintaining sterility during the order of draw is critical to preventing cross-contamination between different blood collection tubes. This is because cross-contamination can lead to inaccurate test results and potential harm to the patient.

The order of draw is designed to prevent this type of contamination. For example, tubes are assigned a specific order to prevent the cross-contamination of chemicals into other tubes, which can cause errors in testing.

This process is called reflux, where the chemical can move from the tube and enter the needle. Once the next tube is activated, it will have the previous chemical enter the tube, causing contamination.

Phlebotomists must study the tubes at their facility to determine which products are used for which test. This ensures that the correct tubes are used in the correct order to prevent contamination.

A study of 11 healthy volunteers found that there was no measurable EDTA carried over from the middle tube into the second serum tube. This suggests that the order of draw may not matter in routine outpatient phlebotomy using a vacutainer adaptor.

However, a larger study of 57 outpatients and 58 healthy volunteers found similar results, with no difference between the mean K, Na, calcium, MG, or phosphorus in the serum collected first and the serum collected after an EDTA or Na citrate tube.

But, a study on hospital inpatients found that 25% of serum samples with high K had detectable EDTA, suggesting that carryover is fairly frequent in inpatient settings.

A multi-center study found that the percentage of serum samples with high K contaminated with EDTA varied from 1% to almost 7% across different hospitals.

To prevent cross-contamination, phlebotomists must follow the established order of draw, which is critical to ensuring patient safety and accurate test results.

Here is a summary of the standard Order of Draw:

By following this sequence, phlebotomists can help prevent cross-contamination and ensure accurate test results.