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The page below is a sample from the LabCE course Fundamentals of Hemostasis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Collecting Blood Specimens for Coagulation Testing

Venous blood specimens for coagulation assays should be collected into a tube containing 3.2% buffered sodium citrate tube (blue top tube), yielding a whole blood sample with a 9:1 blood to anticoagulant ratio. Inadequate filling of the collection tube will decrease this ratio, and may affect test results.
A blue top tube used for coagulation testing should be drawn before any other tubes containing additives. This includes tubes containing other anticoagulants and/or plastic serum tubes containing clot activators. A serum tube that does not contain an additive can be collected before the blue top tube.
If a winged blood collection set is used in drawing a specimen for coagulation testing, a discard tube should be drawn first. The discard tube must be used to fill the blood collection tubing dead space to assure that the proper anticoagulant/blood ratio is maintained, but the discard tube does not need to be completely filled. The discard tube should be a nonadditive or a coagulation tube.
If a blood specimen used for coagulation testing must be collected from an indwelling line that may contain heparin, the line should be flushed with 5 mL of saline, and the first 5 mL of blood, or 6 times the line volume (dead space volume of the catheter), be drawn off and discarded before the coagulation tube is filled.