For the collection of aerobic and anaerobic blood culture, straight needle vacuum blood collection is usually used, and the aerobic bottle should be the first bottle; If the butterfly wing needle is used for collection, the aerobic bottle should also be the first bottle. At this time, the air in the butterfly wing needle connecting pipe is introduced into the aerobic bottle; However, if the syringe is used for collection, the anaerobic bottle should be the first bottle, because when the blood in the syringe is injected into the blood culture bottle, the air bubbles will rise due to light air. At this time, there is a high possibility of gas in the blood at the upper part of the syringe, and the introduction of oxygen into the anaerobic bottle should be avoided. Recently, in the official account of the nurse network, the article cited 7 reasons and Countermeasures for venous blood collection and unqualified blood samples. When referring to the blood collection sequence, some netizens asked questions. The author sorted out relevant materials for your reference. If there are differences, you are welcome to leave a message at the end of the article for discussion.

Vacuum blood collection sequence, which comes first and which comes later?

The author consulted the human health edition nursing textbook basic nursing, the human health edition basic clinical examination, the recommended collection sequence of venous blood formulated by Beijing Union Medical College Hospital with reference to CLSI (h3-a6), and the American CLSI (American Committee for clinical and laboratory standardization) h3-a6.

Blood collection sequence of basic nursing in nursing textbook of human health Edition

First draw blood for culture → anticoagulant tube → dry test tube.

The human health edition of basic clinical examination is divided into glass blood collection vessels and plastic blood collection vessels

The sequence of collecting blood samples with glass collecting vessels and multiple tubes: blood culture tube → anticoagulant free serum tube → sodium citrate anticoagulant tube → other anticoagulant tubes

Plastic blood collection tube: blood culture (yellow) → sodium citrate anticoagulant tube (blue) → serum tube with or without coagulant or gel separation → heparin tube with or without gel separation (green) → EDTA anticoagulant tube (purple) → glucose decomposition inhibitor tube (gray).

Beijing Union Medical College Hospital formulates the recommended collection sequence of venous blood with reference to CLSI (h3-a6)

Blood culture tube → non additive tube (white cap) appropriate trace elements or special items → coagulation item tube (blue cap) → blood sedimentation tube (black tube) → serum tube (red cap or yellow cap) → heparin plasma tube (green cap) → EDTA tube (purple cap) → anti blood glucose fermentation tube (gray cap) → anaerobic bottle is preferred when collecting blood culture with syringe.

Note: the blood collection needle is divided into straight needle and needle with butterfly wing. When the butterfly wing method is used for blood collection under special circumstances, and there are no special items such as blood culture and trace elements, the first tube is a white hat tube as a discarded tube. (however, it is difficult to discard a tube of blood in clinic)

CLSI h3-a6 acquisition sequence

Blood culture tube → coagulation vessel (blue cap) → serum tube, with or without coagulant, with or without separation gel (red cap) → heparin tube, with or without plasma separation gel (green cap) → EDTA tube, with or without separation gel (purple cap) → glycolysis inhibitor tube (gray cap).

Differences between venous blood collection in Beijing Union Medical College Hospital and CLSI h3-a6 collection in the United States

1. ESR sequence is not recommended in the original guidelines

2. Both the anticoagulant of blood sinking tube and the anticoagulant of blood coagulation vessel are sodium citrate, but the concentration and amount are different.

3. The blood sinking tube is similar to the coagulating vessel, and the sampling amount is strictly required. If the sampling amount may be insufficient, it should be given priority.

4. The white cap tube is not recommended in the h3-a6 guide, that is, the sampling sequence without additives. It is mainly used for blood sample collection of trace elements or test items easily disturbed by various anticoagulants or coagulants in clinical experiments. However, due to the narrow application range of white hat tube, coagulation vessel is more commonly used as the first tube in clinic.

Is the blue anticoagulant tube first or the biochemical drying tube first?

Can the blue hat tube be used as the first tube to draw blood?

In h3-a6 version, it is clearly pointed out that when the coagulation vessel is collected as the first tube, it has no effect on the results of prothrombin time and international standard ratio in patients with normal coagulation function or patients treated with warfarin anticoagulation, and has no effect on the activated part of thromboplastin time in patients with normal coagulation function (in case of straight needle puncture, if butterfly wing needle is used, the "dead cavity" shall be considered) Effect on the first tube of blood). Therefore, it is recommended that the coagulation vessel be collected as the first tube. For special coagulation items, it can be collected in the second tube after the conventional coagulation items.

In clinical practice, special cases should be treated specially

For the collection of aerobic and anaerobic blood culture, straight needle vacuum blood collection is usually used, and the aerobic bottle should be the first bottle; If the butterfly wing needle is used for collection, the aerobic bottle should also be the first bottle. At this time, the air in the butterfly wing needle connecting pipe is introduced into the aerobic bottle; However, if the syringe is used for collection, the anaerobic bottle should be the first bottle, because when the blood in the syringe is injected into the blood culture bottle, the air bubbles will rise due to light air. At this time, there is a high possibility of gas in the blood at the upper part of the syringe, and the introduction of oxygen into the anaerobic bottle should be avoided.

Finally, both the sequence recommended by the specification and the manufacturer's use guide are general rules under normal circumstances. In case of special test items, special needs, use of different blood collection materials and blood collection needles, the sampling sequence should be re evaluated.