A phlebotomist needs to collect a PT (Prothrombin Time) from a patient with a difficult vein. Which of the following is the best tube for the draw?

Choice A Reason:
Covering the spill until maintenance arrives is not an appropriate response to a blood spill. This action does not neutralize any potential pathogens present in the blood, which could pose a risk of infection to others. Immediate cleanup is necessary to prevent the spread of infectious diseases, and simply covering the spill does not meet the Occupational Safety and Health Administration (OSHA) guidelines for bloodborne pathogens, which require the spill to be cleaned with an appropriate disinfectant.

Choice B Reason:
Pouring bleach on the spill and allowing it to soak for 60 seconds is the recommended action because bleach is a powerful disinfectant that can kill a wide range of pathogens, including those that might be present in venous blood. The Centers for Disease Control and Prevention (CDC) recommends a 1:10 dilution of household bleach for effectively disinfecting blood spills. After pouring the bleach, it is important to let it soak for an adequate amount of time, usually around 10 minutes, to ensure that all pathogens are killed.

Choice C Reason:
Evacuating the laboratory is not a necessary action for a blood spill unless the spill is extensive and poses additional risks that cannot be mitigated by standard cleanup procedures. In most cases, following the proper spill cleanup protocol, which includes wearing personal protective equipment (PPE) and using an EPA-registered disinfectant, is sufficient to handle the situation without needing to evacuate the area.

Choice D Reason:
Applying a liquid thickening agent on top of the spill is not a standard practice for blood spill cleanup. While a thickening agent might contain the spill, it does not disinfect the area. The priority in such situations is to disinfect and remove any potential infectious agents. Therefore, the use of a thickening agent would not be in compliance with the recommended procedures for blood spill cleanup by OSHA and the CDC.

Choice A reason:
When performing a capillary blood collection, such as a fingerstick, the lancet should be positioned perpendicular to the fingerprint grooves. This orientation helps to ensure that the incision is made across the ridges of the fingerprint, which can facilitate a better blood flow and make it easier to collect an adequate sample without needing to squeeze the finger excessively, which could hemolyze the sample.

Choice B reason:
Positioning the lancet parallel to the nail bed is not recommended because it can result in a cut that runs along the length of the fingerprint grooves, which may not bleed as freely and could also be more painful for the patient.

Choice C reason:
Using the lancet along the lateral portion of the first digit is not part of the standard aseptic technique protocol for capillary blood collection. The first digit, or thumb, has a pulse and should generally be avoided because it can be more sensitive and is more prone to bruising.

Choice D reason:
The medial portion of the fifth digit, or the little finger, is also not a recommended site for capillary blood collection with a lancet. The little finger is typically smaller and may not provide an adequate site for blood collection, and similar to the thumb, it can be more sensitive and prone to injury.