A coagulation screen is ordered on a patient who is a difficult draw. A 5-mL blue top tube is drawn but fills only halfway. What would be the appropriate next step?
a. Draw another half-filled 5-mL blue top tube, and combine the two tubes.
b. Discard the first tube, and attempt to draw a filled 5-mL blue top tube.
c. Draw a red top tube, and add blood to completely fill the blue top tube.
d. Send the half-filled blue top tube to the coagulation laboratory.
ANS: B
The ratio of anticoagulant to blood is critical for valid coagulation testing; thus the blue top tube must be filled. Combining two half-filled blue top tubes will result in twice as much anticoagulant. Sending the half-filled tube to the laboratory also results in too much anticoagulant for the volume of blood; thus both of these will invalidate coagulation tests, prolonging results. As soon as blood is drawn into a red top tube, it begins to clot and this will result in an activated specimen when it is added to the blue top tube, also invalidating results.
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