Specimen Collection Update Glass to Plastic Conversion Change in “Order of Draw” Laura Listro, MM, MT(ASCP) Associate Director of Quality & Safety MGH Pathology Service George Souza Technical Director, Lab Support Services MGH Pathology Service November 2009

Quality & Safety ~ Glass vs. Plastic Advances in Exposure Prevention, Vol. 3, 5, 1998, pg 49. - Protect health care workers from injury Laboratory Automation Robotics will break glass tubes All tubes will be plastic except for Blood culture bottles Yellow ACD solution tubes

SPECIMEN COLLECTION ALERT December 1, 2009 NEW 10ml GREEN TOP PLASTIC TUBE REPLACES 10ml GLASS Green top collection tube Plastic 10mL Green top tube with the additive Sodium Heparin is replacing the glass 10ml version. This is not the commonly used 4ml Lithium heparin gel separator tube used for general chemistry testing. The 10ml green tube is used for Special testing , for example; Vitamin B1 testing Plastic Green tops must now be mixed by inversion 8-10 times Mix the anticoagulant, (Sodium Heparin) to prevent clotting Refer to the NEW Order of draw flyer (Nov. 2009) New Product Information Item BD Ref # 367874 Peoplesoft # 290201

SPECIMEN COLLECTION ALERT December 1, 2009 NEW RED TOP PLASTIC TUBE REPLACES GLASS Red top collection tube Plastic Red top tubes now have an additive - a clot activator is spray coated inside the collection tube Plastic Red tops must now be mixed by inversion 8-10 times - mix the clot activator with the blood to initiate clotting The additive affects the order blood collection tubes are drawn - the “Order of Draw” - Must now draw red top tubes after light blue sodium citrate tubes to prevent erroneous test results in the light blue tube Draw 4ml tube for all tests with r beside the test. New Product Info. BD Ref# 367812 Peoplesoft # 45764 Draw 10ml tube for all tests with R beside the test. New Product Info BD Ref # 367820 Peoplesoft # 45765

If using a paper Lab requisition – Use 4ml Red top plastic tube for all tests with a small “r” beside the test Use 10 ml Red top plastic tube for all tests with a large “R” beside the test Continue to collect Ionized Calcium first, using ABG sampling syringe Plan to change to a collection tube sometime early 2010 For Line draws – Change in practice Follow new order of draw Cannot use plastic red top as discard if you have other tubes to collect first Clear lines using a syringe, discard, then collect specimens for testing

Reminder ~ Butterfly Needles & Blue Tops- 06/2009 For proper filling of Blue top tubes when using a Butterfly (winged collection set) and to avoid specimen rejection due to quantity not sufficient… Draw a Light Blue “discard tube” first! Discard tube MUST be a Light Blue top, to avoid cross contamination of anticoagulants. It is only necessary to draw a discard tube 1st when using a Butterfly for venipuncture. The tube vacuum fills the length of the tubing to pull blood into the tube. This is why the first tube will not completely fill and is your discard tube. When tubing is filled and flowing into the first blue top; switch to the second blue top and it will fill properly. Throw away (discard) the first blue top. Send the second, properly filled tube to the lab. Refer to proper FILL LINE below, the minimum line is etched on the tube Draw Volume Guide: Completely fill the collection tube to avoid test refusal. Blood drawn must fall above Minimum Fill Indicator (frosted line on tube) and below Maximum Fill Line (as illustrated). For blood transfer from a syringe, do not fill above illustrated dashed Maximum Fill line. 1.8 mL Psoft #91657, BD Ref #363080 Completely fill the tube as shown to avoid test refusal Invert to mix additive with blood 2.7mL Psoft #91879, BD Ref #363083 Butterfly Blues 06182009

Summary Dec.1, 2009 – Conversion Date Plastic tubes will start to be on PARS supply carts. Others; place an order for plastic tubes Plastic tubes have spray coated additive including the Red tops Plastic Red tops have a clot activator, All other tubes have a clot inhibitor (anticoagulant) Invert Plastic tubes to properly mix the additive with the blood Additives affect the order of draw Nov. 2009 - Follow New Order of Draw to prevent: Cross contamination of tube additives Wrong test results Refused tests for questionable quality of the specimen or wrong tube type Refer to Butterfly Needle & Blue Top Flyer Only when using a Butterfly needle & drawing a blue top first – must include a blue top as a discard tube

Resources & Contacts For supply questions call: Online MGH Laboratory Handbook http://mghlabtest.partners.org/index.asp From Start menu > Partners applications > Clinical References > MGH Laboratory Handbook Call Lab Support Services 4-LABS (x45227) CONTACTS For supply questions call: - Lisa Martino at 617-726-1692 All other questions, please contact: - Laura Listro at 617-726-0690 or llistro@partners.org - George Souza at 617-726-2678 or gsouza@partners.org

Questions Dennis Cox© at www.acclaimimages.com