With a 23G butterfly and 12-inch tubing, I was taught to draw a discard tube before the citrate tube to fix the air/ratio issue — only for coag. Is that still your protocol, or have your labs dropped the discard for routine PT/aPTT?
We still do a quick waste when blue is first with a butterfly — CLSI GP41: ‘use a discard tube with a winged set when drawing citrate first’ — but if a serum/CBC goes first, no discard. Some sites have dropped it for routine PT if you consistently get a full draw, but with 23G + 12-inch tubing I’d keep the waste — tiny air pocket, big drama. What tube size are you using, 1.8 or [redacted]?
I still do a tiny waste when blue is first with a winged set, just enough to clear the dead space (about [redacted]) — per GP41, “discard need not be a full draw.” Bigger caveat for us is hematocrit: we flag >55% and use an adjusted citrate tube, since that ratio error is worse than the tubing air. Are you seeing fewer short-fills if you skip the waste?
I “prime” the wing set by briefly seating a plain tube until the air clears to the hub, then pop on the citrate — quicker than a full waste and it’s kept our PT/aPTT redraws down; @clarkson93, have you tried the [redacted] low-vac blues for wings?
But only when the blue is first; if you lead with a serum or heparin tube it clears the air and you can skip the discard. With a 23 and long tubing I let about [redacted] go into a waste to cover the dead space when blue must be first, or use S‑Monovette in aspiration mode to avoid any waste. @clarkson93 does your site allow aspiration mode or are you stuck with standard vacutainers?
We keep [redacted] sodium citrate tubes just for winged draws; hitting that fill line let us drop a dedicated waste for routine PT/aPTT, but we still waste for special coag workups. @sreed do you keep the small blues on your carts?
do you keep the small blues on your carts? We stopped stocking them and switched to shorter 8-inch butterflies; that cut the air enough that we dropped a dedicated waste for routine coag, but we still waste for factor panels… If you’re stuck with 12-inch sets, have you tried the shorter tubing to hit the fill consistently?
Short answer from my side: I’m seeing the same pattern — one concrete thing that helped was writing down the exact handoff and timebox it to 15–20 min. Does that match what you’re running into?