Group 1 Date Submitted: March 10,
2025
Ayyang, Keith G.
Buyagao, Carol O.
Dacnas, Kryzia Mae B.
Daluping, Rachelle
Donggalob, Rhizza L.
Pawangan, Aizy U.
Saggot, Nicole Kate D.
ACTIVITY 5
Venipuncture through Evacuated Tube System
1. In multiple draws, why should:
a. SPS tubes be filled first?
In multiple blood draws, it's essential to follow a specific order to prevent cross-
contamination between tubes, which could lead to erroneous results. Sodium polyanethol
sulfonate (SPS) tubes, commonly used for blood cultures, should be filled first. This
practice minimizes the risk of contaminating these sterile samples with additives from
other tubes, ensuring the accuracy of microbiological testing
b. Citrate tubes be filled first before serum tubes?
In phlebotomy, the order of draw is a standardized sequence for filling blood collection
tubes during multiple draws. This sequence minimizes cross-contamination between
additives in different tubes, ensuring accurate laboratory results. According to the Clinical
and Laboratory Standards Institute (CLSI) guidelines, sodium citrate tubes (commonly
light-blue top) should be filled before serum tubes. This practice prevents contamination of
the citrate tubes with clot activators from serum tubes, which could interfere with
coagulation testing.
c. Serum tubes be filled first before EDTA tubes?
Additive contamination, when it occurs, does not only result in erroneous blood values
but also in a waste of healthcare resources and, particularly, if not swiftly recognized, may
negatively affect patient care [9,10]. In general, the carryover of additives could virtually
increase or decrease some laboratory values. The contamination with EDTA can lead to
spurious electrolyte results such as hyperkalemia, hypocalcemia, hypomagnesemia,
hypozincemia, hypophosphatemia, and longer coagulation times. It can also modify other
laboratory parameters like unsaturated iron binding capacity, bicarbonate, aspartate
transaminase, alanine transaminase, lactate dehydrogenase, creatine kinase, alkaline
phosphatase, and α-amylase [11].
. Reference:"
Blood Collection Process: Venipuncture » Pathology Laboratories » College of Medicine »
University of Florida"
[Link]
venipuncture/#:~:text=This%20is%20to%20prevent%20cross,could%20lead%20to
%20erroneous%20results.
Clinical and Laboratory Standards Institute. (n.d.). Order of blood draw tubes and
additives.
Retrieved from [Link]
Karon, B. (2019, February 12). Phlebotomy top gun: Order of draw—Do we still care?
Mayo Clinic Laboratories Insights.
Retrieved from [Link]
of-draw-do-we-still-care/
Researcher: Ayyang, Keith G., Daluping, Rachelle, Pawangan, Aizy U., Dacnas, Kryzia B.
2. What is the effect of overfilled and undefilled evacuated tubes?
Overfilled and underfilled evacuated tubes can lead to erroneous laboratory test
results due to incorrect blood-to-additive ratios. According to The Ohio State University
Wexner Medical Center (2022): Underfilled tubes can cause dilution of the blood sample,
leading to falsely reduced results. Overfilled tubes may result in clotting due to
insufficient anticoagulant. Blood culture bottles must be filled to the correct volume (8-
10 mL for adults, 1 mL for infants) to ensure accurate microbial growth assessment.
Light blue sodium citrate tubes (used for coagulation tests) must be filled precisely to the
line to maintain the crucial 9:1 blood-to-anticoagulant ratio; deviations can cause
inaccurate results. A discard tube should be drawn before collecting a sodium citrate
tube to remove tissue thromboplastin (a clotting factor) and ensure proper filling,
especially when using a butterfly needle. Failure to follow these guidelines can
compromise the accuracy and reliability of laboratory test results (The Ohio State
University Wexner Medical Center, 2022).
Reference:
The Ohio State University Wexner Medical Center. (2022). Specimen collection tip
sheet.
[Link]
professionals/clinical-labs/forms-policies-procedures/general-polices-procedures-tip-
sheets/[Link]
Researcher: Buyagao, Carol O.
3. Why do evacuated tubes need to be inverted after collecting blood?
To achieve the proper mix of additive and blood, each tube must be gently inverted
as it is removed from the holder. Insufficient or delayed mixing of serum tubes may
result in delayed clotting. Inadequate mixing of anticoagulant tubes may result in
platelet clumping, clotting or incorrect test results.
References:
Tech Services. (n.d.). Tube chart.
[Link]
[Link]
Researcher: Donggalob, Rhizza L.
