Which of the following types of tests is a phlebotomist allowed to perform according to CLIA regulations?

Choice A reason:

Performing a heel stick on a 5-year-old patient is not an appropriate technique. Heel sticks are typically used for infants, particularly newborns, to minimize discomfort and because their finger pads may not be fully developed for finger sticks. By the age of 5, a child's veins are usually developed enough for venipuncture, which is the preferred method.

Choice B reason:

Performing a finger stick on a toddler patient is an appropriate technique for specimen collection. This method is commonly used for children who are not yet old enough for venipuncture but have outgrown the heel stick method. The finger stick is performed on the palmar surface of the distal phalanx, usually of the middle or ring finger, and is considered safe and effective for collecting small blood samples in toddlers.

Choice C reason:

Performing a thumb stick on an infant is not an appropriate technique. The thumb has a pulse and is more sensitive, which can cause unnecessary pain and distress to the infant. Additionally, the thumb's size and increased movement make it a less suitable site for specimen collection in infants.

Choice D reason:

Performing a thumb stick on a 5-year-old patient is also not an appropriate technique. As with infants, the thumb's sensitivity and the presence of a pulse make it a less desirable site for blood collection. For a 5-year-old, venipuncture or a finger stick on a non-thumb finger would be more appropriate and less distressing.

Choice A reason:
Wearing gloves is an important step in preventing the spread of infection, but it is not the first step. Gloves provide a barrier between the phlebotomist's hands and the patient, which can help prevent the transmission of pathogens. However, gloves can still become contaminated, and if hand hygiene is not performed before donning gloves, pathogens can be transmitted when gloves are changed or removed.

Choice B reason:
Hand hygiene is widely recognized as the single most important practice in preventing the spread of infections. It is the first line of defense against the transmission of infectious agents. Washing hands with antimicrobial soap and water mechanically removes pathogens, and the antimicrobial agents in the soap can kill or inhibit the growth of microorganisms. This step is crucial before any patient contact, especially before invasive procedures like venipuncture.

Choice C reason:
Applying antiseptic to the puncture sites prior to venipuncture is a critical step in the prevention of infection at the site of the blood draw. This practice is essential for eliminating skin flora that could potentially enter the bloodstream during venipuncture. However, this is not the first step, as effective hand hygiene should precede any patient contact or procedure.

Choice D reason:
Decontaminating equipment before use is a necessary step to ensure that no infectious agents are transmitted via medical instruments. This includes cleaning and sterilizing equipment that comes into direct contact with the patient. While this is a vital part of infection control, it follows hand hygiene in the sequence of steps a phlebotomist should take.