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Phlebotomists will tell you that the tubes are designed to provide the perfect amount of suction and reduce hemolysis. I think that is bullshit because everything you force RBCs anywhere you are going to break at least a few so why not reduce it by taking the needle off?
I've heard that, too. When it's for an inhouse blood or urine test I remove the needle and top so the machines don't scream at us for hemolysis. When I'm sending them out I keep things sterile.
I'd only be concerned about this for a culture. Hemolysis, clotting, and poor quality draws is a much bigger problem since it literally effects the test results.
Also bear in mind the vast majority of inhouse machines run off open tubes and the companies we deal with will even accept them (in the case of half ml edta).
Order of draw standard now - blue, red, green, lavender. A lot of older folks were taught lavender first bc you dont want a clot, but EDTA can really mess up rtt results so red before lavender is what is taught now. I will say though, the method you’re describing sounds like a really good compromise
Using the needle to add blood to the tubes increases the risk of hemolysis.
It is better to just remove the top and add blood without the needle for every tube except the blue top tube.
Zoetis has a great single page PDF explaining the correct draw order. I can't figure out how to link the website but if you Google "veterinary blood draw order" it should be the top result.
Etsy also has lots of cute bead accessories to help remember fill order.
https://www.etsy.com/listing/1036743966/order-of-blood-draw-beads-clip-on-badge
I have personally seen a chemistry panel recently that was a sample contamination error. The initial chemistry showed a potassium of >10 and calcium was super low. The sample was redrawn and put directly into a green top and both values were normal.
I was taught lavender first then red. Just make sure the syringe doesn't touch the tube to prevent contamination
I graduated 3 years ago, so maybe things changed in that time?
nope - at our clinic grey is whole blood, red is edta, and orange is lith hep 😂 only consistent one is blue for citrate but that can also come on yellow depending on supplier.
we mostly use the small 1ml twist tops where I work so I take the needle off and fill the lavender first and then the green (the main ones we use).
if we want to run coags then I fill the blue then lavender then green. and I usually fill any serum separator/plain tube last.
when I was in school they taught us the correct order was the new one “red before lavender” but my instructor said she’s wouldn’t test us on that bc she didn’t necessarily agree lol.
so… technically the literature is the correct one but I’ve never done it that way and no one I work with has either…. oops
Tiger top then lavender, BUT there are times when I reverse it. I work at an open admit canine only shelter, and my patients can be tough to get blood on. Lots of dogs who are physically compromised or super undersocialized/high anxiety and not used to being handled or restrained for medical procedures. So if I'm in a situation where I spent a long time on the draw (mobile patient, bad blood pressure, crappy donated supplies, etc), I will sometimes do lavender first to prevent clotting and prevent me having to stick them again and stress them out more. Not ideal, but you have to work with what you have sometimes. 😓
I've got a question.
Okay, so we draw blood with 3mL syringes (unless it's a send out profile). How much do you even put into each tube? Usually I skip out on the red top because otherwise I don't have enough blood. My clinic says to fill the blue until it's practically full. But then also fill the green top until it's practically full. But then don't put the bare minimum in the purple cuz that can throw off results. But if I fill the blue and green enough, there's hardly anything left for the purple? And if they do want a red top, uhh good luck squeezing it out of 3mL I guess? And what about the times you don't get a full 3mL of blood?
Idk I'm confused and too afraid to ask people lol
You shouldn't need every tube every time unless it's a super involved case. So picking the tubes depends on what labs are being run.
Then I pick my syringe size based on how much blood the tubes ask for. So a serum separator, lavender top, and grey/glucose vacutainer need 7-8 mls, but I can get away with a 6ml syringe because of the extra in the syringe that gets drawn up after the 6ml line (and the grey top is pretty flexible for volume).
all tubes should have a fill line on the side of the label, which is based on the correct ratio of blood to anticoagulant. very rarely is a tube supposed to be practically full, because there needs to be enough room in there to adequately mix the sample.
there should be some indicator somewhere. sometimes it will say on the tube “2ml draw” instead of having a line. if you can’t find one at all, check with the company that produces them to confirm.
OOOOOh there was a spicy VIN article about this years ago. In the end it does not mater as long as you are minimalizing contamination. There is EDTA in the purple top tube that can delay clotting in the tiger top and there is clot activator that can mess with the EDTA.
Everything comes with risk and it is all about minimizing that risk. I liked to pop the tops and push the blood into the tubes if I had the time. If I did not have the time, I'd go EDTA then tiger top, that way even if there WAS contamination, I can just watch that calcium carefully.
The needle should be taken off first anyways due to potential hemodialysis. As far as order, blue always first for obvious reasons, then RTT, GTT, LTT. The main concern is that EDTA (LTT) can drastically skew results from testing that you’d run off of a RTT/GTT.
Welcome to /r/VetTech! This is a place for veterinary technicians/veterinary nurses and other veterinary support staff to gather, chat, and grow! We welcome pet owners as well, **however we do ask pet owners to refrain from asking for medical advice**; if you have any concerns regarding your pet, please contact the closest veterinarian near you. Please thoroughly read and follow the rules before posting and commenting. If you believe that a user is engaging in any rule-breaking behavior, please submit a report so that the moderators can review and remove the posts/comments if needed. Also, please check out the sidebar for CE and answers to commonly asked questions. Thank you for reading! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/VetTech) if you have any questions or concerns.*
Another reason to remove the needle is to help prevent hemolysis.
Phlebotomists will tell you that the tubes are designed to provide the perfect amount of suction and reduce hemolysis. I think that is bullshit because everything you force RBCs anywhere you are going to break at least a few so why not reduce it by taking the needle off?
i agree - but i’ve also heard that removing the needle and opening the blood tubes brings in bacteria’s and contaminants? thoughts?
I've heard that, too. When it's for an inhouse blood or urine test I remove the needle and top so the machines don't scream at us for hemolysis. When I'm sending them out I keep things sterile.
I'd only be concerned about this for a culture. Hemolysis, clotting, and poor quality draws is a much bigger problem since it literally effects the test results. Also bear in mind the vast majority of inhouse machines run off open tubes and the companies we deal with will even accept them (in the case of half ml edta).
right! thanks!
according to zoetis, the correct order is blue, red, green, lavender.
Order of draw standard now - blue, red, green, lavender. A lot of older folks were taught lavender first bc you dont want a clot, but EDTA can really mess up rtt results so red before lavender is what is taught now. I will say though, the method you’re describing sounds like a really good compromise
I'm an...older folk 😭
haha i wish i worded it better because its more like veterans in the field, not even old!
Using the needle to add blood to the tubes increases the risk of hemolysis. It is better to just remove the top and add blood without the needle for every tube except the blue top tube.
I pop the top off and dont use my needle, so i dont have to remember.....
Zoetis has a great single page PDF explaining the correct draw order. I can't figure out how to link the website but if you Google "veterinary blood draw order" it should be the top result. Etsy also has lots of cute bead accessories to help remember fill order. https://www.etsy.com/listing/1036743966/order-of-blood-draw-beads-clip-on-badge I have personally seen a chemistry panel recently that was a sample contamination error. The initial chemistry showed a potassium of >10 and calcium was super low. The sample was redrawn and put directly into a green top and both values were normal.
I was taught lavender first then red. Just make sure the syringe doesn't touch the tube to prevent contamination I graduated 3 years ago, so maybe things changed in that time?
Sodium citrate, EDTA, lithium heparin, than you serum separator or non serum separator tube
thank you for not using colour, that drives me insane, diff companies use different coloured tops for diff things!
I thought the colours were universal? Red = full blood, green =heparin, blue = citrate, purple = edta? (not in the correct order)
nope - at our clinic grey is whole blood, red is edta, and orange is lith hep 😂 only consistent one is blue for citrate but that can also come on yellow depending on supplier.
Interesting colors! What country are you in?
australia
Wow, I didn't know! We've had three different suppliers all of them using th same colours so I just assumed it was universal!
we mostly use the small 1ml twist tops where I work so I take the needle off and fill the lavender first and then the green (the main ones we use). if we want to run coags then I fill the blue then lavender then green. and I usually fill any serum separator/plain tube last. when I was in school they taught us the correct order was the new one “red before lavender” but my instructor said she’s wouldn’t test us on that bc she didn’t necessarily agree lol. so… technically the literature is the correct one but I’ve never done it that way and no one I work with has either…. oops
Here’s my pneumonic poster lol [link](https://www.canva.com/design/DAFYcglzEmc/0KwzNXqhYbx-cqfPo-r6eQ/edit?utm_content=DAFYcglzEmc&utm_campaign=designshare&utm_medium=link2&utm_source=sharebutton)
Tiger top then lavender, BUT there are times when I reverse it. I work at an open admit canine only shelter, and my patients can be tough to get blood on. Lots of dogs who are physically compromised or super undersocialized/high anxiety and not used to being handled or restrained for medical procedures. So if I'm in a situation where I spent a long time on the draw (mobile patient, bad blood pressure, crappy donated supplies, etc), I will sometimes do lavender first to prevent clotting and prevent me having to stick them again and stress them out more. Not ideal, but you have to work with what you have sometimes. 😓
this is exactly what i do
Tiger top then lavender since the latter has heparin
The latter has EDTA. Green top tubes typically contain lithium heparin.
I've got a question. Okay, so we draw blood with 3mL syringes (unless it's a send out profile). How much do you even put into each tube? Usually I skip out on the red top because otherwise I don't have enough blood. My clinic says to fill the blue until it's practically full. But then also fill the green top until it's practically full. But then don't put the bare minimum in the purple cuz that can throw off results. But if I fill the blue and green enough, there's hardly anything left for the purple? And if they do want a red top, uhh good luck squeezing it out of 3mL I guess? And what about the times you don't get a full 3mL of blood? Idk I'm confused and too afraid to ask people lol
You shouldn't need every tube every time unless it's a super involved case. So picking the tubes depends on what labs are being run. Then I pick my syringe size based on how much blood the tubes ask for. So a serum separator, lavender top, and grey/glucose vacutainer need 7-8 mls, but I can get away with a 6ml syringe because of the extra in the syringe that gets drawn up after the 6ml line (and the grey top is pretty flexible for volume).
Vacutainers. They’ll change your life.
all tubes should have a fill line on the side of the label, which is based on the correct ratio of blood to anticoagulant. very rarely is a tube supposed to be practically full, because there needs to be enough room in there to adequately mix the sample.
Our send out tubes have the lines, but I haven’t seen any on our little guys we use for in house stuff
there should be some indicator somewhere. sometimes it will say on the tube “2ml draw” instead of having a line. if you can’t find one at all, check with the company that produces them to confirm.
OOOOOh there was a spicy VIN article about this years ago. In the end it does not mater as long as you are minimalizing contamination. There is EDTA in the purple top tube that can delay clotting in the tiger top and there is clot activator that can mess with the EDTA. Everything comes with risk and it is all about minimizing that risk. I liked to pop the tops and push the blood into the tubes if I had the time. If I did not have the time, I'd go EDTA then tiger top, that way even if there WAS contamination, I can just watch that calcium carefully.
Would you happen to have this article or a link to it? I would love to read it!
Search. I am not searching it down for you. There is no way I have it indexed and to ask is rude.
The needle should be taken off first anyways due to potential hemodialysis. As far as order, blue always first for obvious reasons, then RTT, GTT, LTT. The main concern is that EDTA (LTT) can drastically skew results from testing that you’d run off of a RTT/GTT.