TCH Logo Tarangnan Community HospitalClinical Laboratory Document No.: WI-P-002-A-V0 CONTROLLED COPY
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Parent Document: SOP-P-002, Sections 5.2–5.4, 5.7  |  Version: V0
Applies to: Medical Technologists, Phlebotomists, and Nursing Personnel  |  Effective Date: MM-DD-YYYY  |  Supersedes: None

BD Vacutainer Order of Draw, Tube Additives & Inversion Chart

Phlebotomy Section & Clinical Wards  |  Standard Venous Blood Collection Sequence

STOP
1-MINUTE MAXIMUM TOURNIQUET LIMIT: Tourniquet application shall never exceed 60 seconds (SOP-P-002, Section 5.4.2). Prolonged venous stasis causes hemoconcentration, falsely elevating potassium, albumin, calcium, and hematocrit while altering coagulation times. If vein selection requires > 60 seconds, release tourniquet for at least 2 minutes before re-applying.
Order Stopper Color & Type Additive & Action Laboratory Section & Tests Inversions
1st
Blood Culture
SPS / Broth Bottle
 Sodium Polyanethol Sulfonate (SPS); preserves micro-organisms Microbiology / Referral:
Blood cultures, sterile body fluids		 8–10×
Gentle mix
2nd
Light Blue
Sodium Citrate 3.2%
 0.109 M / 3.2% Sodium Citrate; binds calcium (1:9 ratio) Coagulation / Hematology:
Prothrombin Time (PT), APTT		 3–4×
Strict 1:9 fill
3rd
Plain Red (no gel)
Silica clot activator

Gold SST
Clot activator + gel separator
 Silica clot activator; plain red has no gel, Gold SST has polymer barrier gel Clinical Chemistry & Serology:
FBS, BUN, Creat, Lipids, LFTs, Dengue		 5×
Clot 20–30 min
4th
Green
Lithium Heparin
 Lithium Heparin; inhibits thrombin formation STAT Chemistry:
Electrolytes, STAT troponin, enzymes		 8–10×
Gentle mix
5th
Lavender
K2EDTA Vacuum
 Dipotassium EDTA (1.5–2.2 mg/mL); chelates calcium Hematology:
CBC, 5-Part Diff, PBS Smear, Retic, Blood Typing		 8–10×
No clots allowed
6th
Gray
Fluoride / Oxalate
 Sodium Fluoride (glycolytic inhibitor) + Potassium Oxalate Confirmatory Glucose:
Fasting Blood Sugar, OGTT curves		 8–10×
Inhibits enolase

Tube Mixing & Handling Best Practice

  • Inversion Technique: Mix immediately upon filling by gentle, complete 180° wrist rotations. Never shake vigorously; shaking causes mechanical hemolysis and cellular fragmentation.
  • Syringe Transfer: Allow tube vacuum to draw blood freely through a safety transfer device. Never force the syringe plunger down (causes severe hemolysis).
  • Fill Accuracy: Light blue (citrate) requires exact 1:9 fill to mark. Underfilled tubes falsely prolong coagulation times.

Safety, Identification & Escalation Limits

  • Two-Attempt Limit: Maximum 2 venipuncture attempts per patient encounter. Stop after 2 failures; consult Chief MT (SOP-P-001 Section 5.4).
  • Immediate Bedside Labeling: Affix patient label (2 identifiers, date, time, initials) at the bedside before leaving patient. Pre-labeling is strictly prohibited.
  • Needle Disposal: Engage safety shield immediately upon withdrawal; dispose directly into puncture-resistant sharps container. Never recap.

Note: For citrate (light-blue) draws via winged/butterfly sets, draw a discard tube first.

Prepared by: Chief Medical Technologist
Signature: _______________________ Date: ________		 Reviewed by: Pathologist
Signature: _______________________ Date: ________		 Approved by: Hospital Director
Signature: _______________________ Date: ________