A phlebotomist should instruct a patient to take which of the following actions when providing a sputum specimen?

Choice A reason:
Expired tubes may lose their vacuum, which is necessary to draw the correct volume of blood into the tube. The vacuum in blood collection tubes ensures that the correct amount of blood is drawn. If the vacuum is lost, the blood will not be drawn into the tube properly, which can lead to underfilling and affect the test results.

Choice B reason:
Hemoconcentration refers to an increase in the concentration of cells and solids in the blood, usually because of a loss of plasma. While this can occur due to prolonged tourniquet application or dehydration, it is not directly caused by the use of expired tubes.

Choice C reason:
Hemolysis is the destruction of red blood cells, which can release hemoglobin and other intracellular components into the plasma. It can be caused by physical damage, such as from a needle during blood draw, but is not a consequence of using expired tubes. However, if an expired tube causes improper blood draw due to loss of vacuum, it could indirectly lead to hemolysis due to multiple attempts to draw blood.

Choice D reason:
An elevation of the red blood cell count would not be directly caused by using expired tubes. The red blood cell count is determined by the body's production and destruction of red blood cells, not by the collection method or equipment used.

Choice A Reason:
The patient's condition is a critical factor as it can influence the ease of blood collection and the choice of collection site. For example, a dehydrated patient may have less accessible veins. Patient age is also important; pediatric and geriatric patients may require different approaches due to vein size and fragility. The blood volume required for testing must be considered to ensure sufficient sample size without compromising patient safety, adhering to guidelines that limit blood collection to a certain percentage of the patient's total blood volume.

Choice B Reason:
While patient height and gender may influence the choice of blood collection site, they are not as critical as the factors listed in choice A. Patient medications are important to consider, as some medications may affect coagulation or the integrity of the sample.

Choice C Reason:
The ordering physician's preferences may be considered, but they are not a primary factor in the method of collection. The number of tests ordered and the diagnosis can influence the volume of blood needed but are secondary to the patient's condition and safety considerations.

Choice D Reason:
The time of day and the timing of the specimen collection can be important for certain tests that are time-sensitive or influenced by diurnal variations. The test status, whether routine or stat, may affect the urgency of collection but not necessarily the method of collection.