A phlebotomist is planning to collect a specimen to measure a patient's serum cortisol level. Which of the following factors should the phlebotomist consider?

Choice A Reason:
The chain of custody form is crucial in the context of a toxicology drug screen for legal purposes. It is a document that records the sequence of custody, control, transfer, analysis, and disposition of physical and electronic evidence. It is particularly important in legal cases where the results of the toxicology screen can be used as evidence in court. The chain of custody ensures that the sample has been handled properly and that the integrity of the sample has been maintained throughout the testing process.

Choice B Reason:
A requisition form is used to request a specific test or service. While it is an essential document in the process of ordering a toxicology drug screen, it does not serve the same purpose as the chain of custody in terms of legal proceedings. The requisition form typically includes patient information, the tests ordered, and the reason for the test, but it does not track the handling of the sample.

Choice C Reason:
An encounter form, also known as a superbill, is used in medical billing to capture the services provided during a patient's visit. It includes information about the patient's diagnosis, the procedures performed, and the codes for billing purposes. However, it is not specifically related to the legal aspects of a toxicology drug screen.

Choice D Reason:
The CMS 1500 form is the standard claim form used by healthcare providers to bill Medicare and Medicaid services. It is also used by some private insurers and managed care plans. Like the encounter form, it is related to billing and not to the legal chain of custody required for a toxicology drug screen.

Choice A reason:
A 23-gauge needle is commonly used for venipuncture with a winged infusion set and a small volume syringe like a 5 mL syringe. This size provides a balance between patient comfort and the ease of drawing blood without causing hemolysis or excessive damage to blood cells. It is large enough to allow blood to flow easily into the syringe but small enough to minimize discomfort and the risk of bruising.

Choice B reason:
An 18-gauge needle is quite large and is typically used for situations requiring rapid administration of fluids or for blood donation where larger volumes are collected quickly. It is not ideal for a standard venipuncture, especially with a small syringe, as it can cause more pain and increase the risk of bruising.

Choice C reason:
A 25-gauge needle is on the smaller side and may be used for patients with very fragile veins or for pediatric patients. However, it may not be the best choice for a 5 mL syringe as it could make the blood draw process slower and more difficult, potentially leading to clotting in the needle or syringe.

Choice D reason:
A 27-gauge needle is very small and is typically used for subcutaneous injections, such as insulin injections, rather than for venipuncture. It would be too small for an efficient blood draw with a 5 mL syringe, as it would likely cause the blood to hemolyze or clot before the draw is completed.