Pick the Tube
A 2-year-old presents with pallor and lethargy. The clinician suspects iron-deficiency anaemia and orders a CBC.
You have red, green, lavender and light-blue tubes on your tray.
Which tube do you reach for?
Lavender/purple EDTA tube.
What generally comes first in the standard order of draw?
Blood cultures / microbiology specimens
A laboratory receives a specimen for a ESR.
Haematology.
The requisition says:
Patient: Jayden Smith
But the identification information you're using doesn't match.
Do you draw the blood anyway?
No. Stop and resolve the identification discrepancy according to the required patient-identification procedure.
Before you begin the procedure, you need to perform one basic infection-control action.
What is it?
Hand hygiene
What is the additive in a Yellow Tube?
What test can it be used for?
Sodium polyanethol sulfonate (SPS) / Acid Citrate Dextrose (ACD)
Test: Microbiology, Blood Bank and Immunohematology
You need to collect: Serum, EDTA and Citrate
What should the correct sequence be?
Citrate → Serum → EDTA.
You see a pink tube on the phlebotomy tray.
Which department would you associate with this tube?
Blood Bank
You're handed a requisition and told to prepare for a pediatric blood draw.
Name TWO important pieces of information you should check before collecting.
patient identification, requested tests, date/time, ordering provider, specimen requirements, collection instructions.
You have:
What equipment are you missing ?
Gloves & Cotton/Gauze
A child with suspected sepsis needs blood collected for a coagulation study.
The tube you choose contains an additive that binds calcium, preventing the blood from clotting.
Which tube are you holding?
Light blue sodium citrate
You're collecting multiple specimens and accidentally collect the EDTA tube before the serum tube.
What is the potential consequence?
EDTA additive may carry over into the subsequent specimen and interfere with laboratory results.
A child has electrolytes and glucose ordered.
Clinical Chemistry
The requisition says:
Daniel Clarke
DOB: 14/03/2017
The child's wristband says:
Daniel Clark
DOB: 14/03/2017
Do you collect?
No. The discrepancy must be resolved according to patient-identification policy before collection.
What are the types of blood collection needles?
evacuated tube system & winged infusion set
A child needs a ALT, AST & ALP test.
You have a red tube and a green tube in front of you.
Which one do you choose and what additive does it contain?
Green — lithium heparin
Put these in the correct order: Citrate, EDTA, Blood culture, Chemistry, Serum, Toxicology
Blood culture → Citrate → Serum/chemistry → EDTA → Toxicology
A requisition contains:
Name the laboratory department associated with EACH test.
CBC → Haematology
Blood culture → Microbiology
Electrolytes → Clinical Chemistry
Blood group/type & screen → Blood Bank/Transfusion Medicine
Patient: Hannibal Lector
DOB: 12/08/2016
Tests: CBC, PT/INR, glucose
Priority: STAT
What tubes do you prepare?
Lavender, Light blue, Gray
You've selected your venipuncture site.
You clean the skin and immediately touch the site again while trying to locate the vein.
What should you do?
Re-clean the site and allow it to dry before puncture.
What tube contains the additive Sodium Heparin/EDTA ?
Royal Blue
What is the Order of Draw ?
Yellow → Light blue → Red/Gold→ Green → Lavender → Gray
A requisition requests:
The blood has already been collected and the specimen has been sent to the laboratory.
The doctor approaches you and says:
“Actually, can you add a ferritin to that sample?”
However, the requisition has not been updated.
What should you do?
The additional test should be formally ordered/documented and the laboratory should confirm that the existing specimen is suitable and has sufficient volume before adding it.
A child is extremely anxious and keeps pulling their arm away during collection.
Your colleague says:
“Just hold them down and get it done.”
Name THREE things the team should consider instead.
Appropriate age-specific communication/reassurance, distraction, safe positioning/assistance, minimizing distress, and following institutional paediatric procedures.