Why the order of draw matters
The order of draw is the order you fill the tubes, and it exists for one reason: carryover. When a drop rides the needle into the next tube, it can carry a trace of the previous tube's additive. Even a tiny amount of EDTA, citrate, or another additive can change the next result, and the lab cannot always tell the sample was contaminated.
The order is fixed by the Clinical and Laboratory Standards Institute (CLSI), and it is graded strictly on the skills check: any tube out of order can fail the run. The order below is the sequence you say out loud as you fill.
The phlebotomy skills check, step by step
Below is the whole approved list: venipuncture with the tube order, the capillary (finger) stick, and patient identification, with every step and the must-say items marked. Open a procedure to see its steps.
The order of draw is inside the venipuncture procedure, marked in strict order, because getting the sequence wrong is the single most common reason a skills run fails.
Venipuncture with an evacuated tube system28 steps - 13 must-say
Say each step of the draw as you do it, the way you would for your instructor. Steps marked "Must say" are the safety steps.
- I check the lab order form so I know which tests and tubes I need. I set my supplies within reach: tubes standing in a rack, needle and tube holder, tourniquet, 70% alcohol pads, gauze, labels, gloves, and a sharps container. I check that the needle and tubes are not expired or damaged.
- I tell the patient my name and my job.
- I ask the patient to say their full name, and I check a second identifier, like date of birth. Both must match the lab form.must say
- I ask about allergies, like latex, the cleaning solution, or tape, and if they have ever fainted during a blood draw.
- I explain the test and get the patient's OK. They can say no any time before I draw. I get them comfortable. If they have fainted before, they lie down. Their arm rests straight, slanting a little downward.
- I clean my hands with soap and water or alcohol rub, then put on well-fitting gloves.must say
- I look at the inside of the elbow for a good, straight vein. The median cubital vein in the middle is usually easiest. I stay away from the basilic vein on the inner side, because an artery and a nerve run under it, and from spots where veins split.
- I do not draw from a spot where an IV is already in place, because the IV fluid can change the results.must say
- I put the tourniquet on about 4 to 5 finger widths, or about 2 inches, above the spot I picked, then check the vein again. I check that I can still feel a pulse below the tourniquet.
- I keep the tourniquet on for less than 2 minutes.must say
- I clean the spot with a 70% alcohol pad and let it air dry all the way.must say
- I scrub for 30 seconds, from the center outward, covering at least 2 cm, and give it about 30 seconds to dry.
- After cleaning, I do not touch the spot, not even to feel the vein. If I touch it, I clean it again.must say
- I ask the patient to make a fist. I hold the arm and put my thumb below the spot to anchor the vein.
- I tell the patient they will feel a stick. I go into the vein quickly, bevel up, at an angle of 30 degrees or less.
- Once the needle is in the vein, I push the first tube into the holder. I fill the tubes in the correct order of draw.must say
- The light blue tube must be filled to its fill line (90 to 100% full).must say
- The lavender and gray tubes also need a full draw.
- I never pour blood from one tube into another to fill it. If a tube is short or wrong, I collect it again.must say
- As each tube comes off, I gently turn it upside down and back (invert it). I never shake it. I invert it the number of times the tube maker or lab says.
- I take the tourniquet off before I pull the needle out.must say
- Some guidelines say to take it off as soon as blood flows.
- I take the last tube out of the holder, put gauze over the spot, and pull the needle out gently. I press on the gauze and ask the patient to keep the arm straight, not bent, so it does not bruise.
- I turn on the needle's safety device right away and drop the needle and holder into the sharps container.must say
- I never recap a used needle with two hands.must say
- I label every tube in front of the patient.must say
- Each label has the first and last name, ID or file number, date of birth, and the date and time I drew it. I check the labels against the form.
- I check that the spot has stopped bleeding and put on a bandage. I ask how the patient feels and tell them we are done. Then I throw used supplies in the right waste, take off my gloves, and clean my hands.
Source: WisTech Open venipuncture checklist; WHO guidelines on drawing blood (2010); NHA phlebotomy (CPT) test plan, 2025; NCCT phlebotomy (NCPT) test plan, 2025; NCCT order of draw guide
Order of draw18 steps - 6 must-say
Say each step of the draw as you do it, the way you would for your instructor. Steps marked "Must say" are the safety steps.
- I follow the order of draw so the additive in one tube does not carry over on the needle into the next tube and throw off the results.
- First, I fill blood culture bottles or yellow-top SPS tubes, because they must stay sterile.must say
- I fill the aerobic bottle before the anaerobic one. For cultures, I use my facility's culture skin prep, not just the routine alcohol wipe. I read the label, because not every yellow top is a culture tube.
- When I use a butterfly (winged) set and the light blue is the first tube I fill, I first fill a small discard tube to clear the air out of the tubing, so the light blue tube gets its full amount. I do not pick a plastic red top for the discard, because its clot activator would get into the blue tube.
- Second, I fill the light blue top.must say
- Third, I fill a red, gold, or tiger top serum tube.must say
- Fourth, I fill the green or light green top.must say
- Fifth, I fill the lavender, pink, or pearl top.must say
- Last, I fill the gray top.must say
- What the first tubes hold: light blue has sodium citrate for clotting tests like PT and aPTT and must be filled to its fill line. Plastic red has clot activator, and gold and tiger tops have clot activator and gel. Green has sodium or lithium heparin, and light green also has gel.
- What the last tubes hold: lavender, pink, and pearl have EDTA. Lavender is for blood counts, and pink is often used for blood bank. Gray has sodium fluoride and potassium oxalate for glucose and lactic acid.
- I invert each tube gently the number of times the tube maker says, for example light blue 3 to 4 times, serum tubes 5 times, and green, lavender, and gray 8 to 10 times. I invert the gray right away.
- I fill the light blue before red and gold because clot activator from a serum tube can make clotting test results wrong.
- I fill serum and green tubes before lavender because EDTA can make potassium read falsely high and calcium falsely low.
- I fill gray last because its additives change how blood cells look under the microscope, and the potassium oxalate can raise potassium and lower calcium.
- I read the tube label to confirm the additive. Colors can differ by maker, and the label wins. If my lab uses a different order, I follow the lab.
- I use the same order with a syringe, a butterfly set, or a tube holder, and for glass or plastic tubes. I use a different order for finger sticks.
- If I fill tubes out of order, I tell the lab so they can decide if it needs to be drawn again.
Source: NCCT order of draw guide; WHO guidelines on drawing blood (2010); NHA phlebotomy (CPT) test plan, 2025
Capillary (finger) puncture21 steps - 7 must-say
Say each step of the draw as you do it, the way you would for your instructor. Steps marked "Must say" are the safety steps.
- I identify the patient the same way as for a vein draw: they say their full name, I check a second identifier like date of birth, and both match the lab form.must say
- I gather a new single-use lancet (a safety lancet that retracts is best), the collection tubes, alcohol pads, gauze, and a sharps container.
- I clean my hands and put on well-fitting gloves.must say
- For an adult, I use a finger. I only use the side of the heel on babies.
- I use the middle or ring finger. Not the thumb or index finger, because they can have calluses, and not the little finger, because the tissue is thin.
- I stick the side of the fingertip pad, across the fingerprint lines, not along them.
- My finger stick goes no deeper than 2.4 mm, so 2.2 mm is about the longest lancet I would use. I pick one a bit shorter than the depth I need, because pressing down pushes it a little deeper.
- I never use a surgical blade to puncture the skin.
- I clean the spot with 70% alcohol and let it air dry.must say
- I make the stick in one fast, smooth motion, so the blood flows well and I do not need a second stick.
- I never use the same lancet twice, and I never stick the same spot twice.must say
- I wipe away the first drop of blood, because it can have tissue fluid or skin debris in it.
- I do not squeeze the finger hard. Squeezing mixes in tissue fluid and can break red cells (hemolysis).
- For a finger stick, I fill the lavender EDTA tube first. Then I fill other additive tubes like green, light green, or gray, and then serum tubes like red or gold.must say
- I fill the lavender first because platelets start to clump at the stick site, and clumps or clots ruin the blood count.
- I know that when the order calls for three or more samples, drawing from a vein may give better results.
- When I am done collecting, I press firmly on the spot to stop the bleeding.
- I drop the lancet in the sharps container.must say
- I label each tube with the patient's name, ID number, and the date.must say
- I also record the test, that it was a skin puncture, and my initials.
- I throw away waste, take off my gloves, and clean my hands.
Source: WHO guidelines on drawing blood (2010); WisTech Open venipuncture checklist; NCCT order of draw guide; NHA phlebotomy (CPT) test plan, 2025
Patient identification and labeling12 steps - 4 must-say
Say each step of the draw as you do it, the way you would for your instructor. Steps marked "Must say" are the safety steps.
- I tell the patient my name, my title, and my department.
- At a bedside, I close the curtain so the draw is private. I keep the patient's information private.
- I ask the patient to tell me their full name.must say
- I use at least two identifiers, as my facility's policy says, such as full name and date of birth.must say
- I match the name, date of birth, and hospital or file number on the lab form to the patient.must say
- If I use a wristband or ankle band, it must be on the patient. I never go by a band taped to the bed or crib, or by the bed number.
- For a child, I ask the parent or guardian to tell me the child's first and last name.
- I label the tubes in front of the patient, right after the draw.must say
- I put on each label the patient's first and last name, file or ID number, date of birth, and the date and time of the draw.
- I also record what the lab needs, such as the tests, the number of tubes, vein draw or skin puncture, and my initials.
- I check the labels against the form for accuracy, and I check them again before the samples go out.
- I put the labeled tubes in a leak-proof biohazard bag with the lab form in the outside pocket, so the form stays clean.
Source: NHA phlebotomy (CPT) test plan, 2025; WHO guidelines on drawing blood (2010); WisTech Open venipuncture checklist; NCCT phlebotomy (NCPT) test plan, 2025
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Order of draw quiz: test yourself
Order of draw quiz
Question 1 of 10 · Venous order of draw
Ana needs to fill a light blue tube, a lavender tube, and a gold SST for one patient. She is using a straight needle and a tube holder. Which order is correct?
The tubes and the order, by color
Say the order the same way every time so it comes out under pressure. The colors follow the mnemonic many programs teach, but the sequence below is the CLSI order, not the mnemonic:
- Blood culture (sterile, first: no additive, and it must be drawn first so nothing contaminates the culture).
- Light blue (sodium citrate, for coagulation).
- Red or gold (serum; gold has a gel separator).
- Green (heparin, for plasma chemistry).
- Lavender or purple (EDTA, for hematology).
- Gray (oxalate/fluoride, for glucose).
Check your program and your facility, because the exact lineup can vary by tube manufacturer, but the CLSI sequence above is what the skills check scores.
Capillary order of draw (finger and heel sticks)
A finger or heel stick has its own order because the risk is the same carryover, but the first drop is different: you wipe away the first drop of blood, which carries tissue fluid that can dilute the sample.
After the first drop is wiped, the capillary order mirrors the venipuncture order, with the EDTA (lavender) tube last so the EDTA does not contaminate the others. The full capillary procedure, step by step, is in the list above.
Practice saying the order out loud
The order of draw is exactly the kind of list that falls apart when you say it under pressure, so practise it the way you will be tested: out loud, in order.
The exam prep practice tool listens while you say the procedures, marks the steps you named against this same list, and shows the tube you skipped. Two scored runs on the phlebotomy check are free.
How phlebotomy training gets paid for
Phlebotomy training is short, usually a few weeks to a semester, and many programs qualify for WIOA training grants that cover tuition and the certification exam.
The step-by-step version is in the phlebotomy training guide linked below.