1. 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

2. 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

3. 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 #
Peoplesoft #

4. 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#
Peoplesoft # 45764
Draw 10ml tube for all tests with R beside the test.
New Product Info
BD Ref #
Peoplesoft # 45765

6. 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

7. 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

8. 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 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

9. Resources & Contacts For supply questions call:
Online MGH Laboratory Handbook
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
All other questions, please contact:
- Laura Listro at or
- George Souza at or

10. Questions
Dennis Cox© at