Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system

Katja Kemp Jacobsen*, Ida Brandt, Anne Vindahl Christensen, Bjørk Anine Rimsø, Camilla Julie Krøier, Michelle Sørensen, Julie Smith, Kathrine Overgaard Foss Jensen, Jeppe Madura Larsen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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BACKGROUND: Deviation in blood collection procedures is a central source of preanalytical variation affecting overall analytical and diagnostic precision. The order of draw of venous sampling is suspected to affect analytical results, in particular for coagulation analysis. Here we compare the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system.

METHODS: We collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public hospitals in Denmark. Procedures were compared to the international guidelines fromthe Clinical Laboratory Standards Institute (CLSI) and World Health Organization (WHO), and assessed in relation to department ISO 15189:2012 accreditation.

RESULTS: We observed seven different order of draw procedures related to citrate, serum, heparin, and EDTA tubes, and the use of discard tubes in relation to coagulation assays. 31 departments (63.3%) were found to adhere to CLSI and WHO guidelines. A majority of departments instructs the use of discard tubes before collection for coagulation assays in citrate tubes (44 departments; 89.8%). The citrate tube was the first sample tube to be drawn for most departments (35 departments; 75.5%); and the preferred order of non-citrate tubes was serum-heparin-EDTA (36 departments; 73.5%). Adherence to the CLSI and WHO guidelines was not associated with department ISO 15189:2012 accreditation (p = .57).

CONCLUSIONS: Venous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines.

Original languageEnglish
JournalClinical Biochemistry
Pages (from-to)113-116
Publication statusPublished - 20 Apr 2018


  • Venous blood sampling
  • Order of blood draw
  • Phlebotomy
  • Preanalytical phase
  • Preanalytical quality
  • Inter-laboratory variation


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