During a venipuncture, the needle is in the vein and blood flow is established. When the second tube is attached, blood flow stops. Which of the following actions should the phlebotomist take?

Choice A Reason:
Body temperature does not significantly affect serum cortisol levels and is not a factor that needs to be considered when planning to collect a cortisol specimen. Cortisol levels are regulated by the hypothalamic-pituitary-adrenal axis and not by body temperature.

Choice B Reason:
Time of day is a critical factor to consider when collecting a specimen for serum cortisol level measurement. Cortisol levels follow a diurnal pattern, peaking in the early morning hours and declining throughout the day, with the lowest levels typically occurring around midnight¹². This variation is known as the cortisol awakening response (CAR) and is important for accurately interpreting the results of the test.

Choice C Reason:
Alcohol consumption can affect cortisol levels; however, it is not typically a factor that a phlebotomist needs to consider immediately before specimen collection unless the patient is under the influence at the time of the test. Chronic alcohol use can lead to alterations in cortisol levels, but this is more of a consideration for the healthcare provider interpreting the results rather than the phlebotomist collecting the specimen.

Choice D Reason:
Prandial status, or the fed or fasting state of the patient, can influence cortisol levels, but it is not as significant a factor as the time of day. Cortisol levels can be slightly higher after eating, but this effect is generally considered minimal. The primary concern for prandial status would be if the cortisol test is being conducted alongside other tests that require fasting.

Choice A Reason:
Shoe covers are used to protect the shoes and prevent the spread of contaminants from one area to another. They are not specifically required for droplet precautions during blood glucose monitoring. Droplet precautions typically focus on protecting mucous membranes of the eyes, nose, and mouth from droplet spatter.

Choice B Reason:
Masks are essential when dealing with patients under droplet precautions. Droplets can transmit infections when a person coughs, sneezes, or talks, and a mask provides a barrier that prevents the inhalation of these potentially infectious droplets. For procedures like blood glucose monitoring, where close contact with the patient is necessary, wearing a mask is crucial to protect both the healthcare worker and the patient.

Choice C Reason:
A gown is used to protect the healthcare worker's skin and clothing from contamination with potentially infectious material. While it is an important piece of personal protective equipment, it is not the primary requirement for droplet precautions in the context of blood glucose monitoring, unless there is a risk of substantial splashing or spraying of bodily fluids.

Choice D Reason:
Goggles are used to protect the eyes from splashes of blood or other body fluids. They are important in procedures where there is a risk of splashing, but for blood glucose monitoring, the risk is minimal. Therefore, goggles are not the primary piece of equipment required for droplet precautions in this scenario.