When performing a blood smear, which of the following actions should a phlebotomist take to ensure a quality result?

Choice A reason:
The high pressure in the arterial system is not a factor in the filling of blood collection tubes during venipuncture. Arterial blood is not typically collected using evacuated tubes; these are used for venous blood collection, where the pressure is lower.

Choice B reason:
While the venous system does have pressure that aids in blood flow, it is not the high pressure that causes blood collection tubes to fill. Venous pressure is relatively low compared to arterial pressure, and on its own, it is not sufficient to fill the vacuum tubes used in venipuncture.

Choice C reason:
The positive pressure created by the tourniquet can help engorge the veins, making them easier to access, but it does not directly cause the blood collection tubes to fill. The tourniquet's role is to assist in vein visualization and palpation rather than in the filling of the tube.

Choice D reason:
The negative pressure within the tube is the correct factor that causes blood collection tubes to fill during venipuncture. When the needle punctures the patient's vein and then the tube stopper, the vacuum in the tube pulls blood into it until the vacuum is exhausted or the tube is filled. This is why it is essential not to allow the tube contents to contact the stopper, as backflow into the venous system can cause adverse reactions.

Choice A reason:
Reporting the exposure to the supervisor is the immediate and required action after experiencing a needlestick injury. The supervisor will then guide the phlebotomist through the institution's post-exposure protocol, which includes immediate care of the wound, evaluation of the exposure, and initiation of post-exposure prophylaxis (PEP) if necessary. This step is crucial to ensure that the risk of HIV transmission is minimized and that the phlebotomist receives appropriate medical attention and follow-up.

Choice B reason:
Reporting the exposure to the Centers for Disease Control and Prevention (CDC) is not the immediate action required. The CDC provides guidelines and recommendations for handling such incidents, but the initial report and response are managed at the healthcare facility level. The CDC may be involved in the tracking of such incidents on a larger scale or providing statistical data, but they are not the first point of contact.

Choice C reason:
Sending the patient for further sexually transmitted infection (STI) testing is not an immediate action required following a needlestick injury. The patient's HIV status is already known, and the focus should be on the treatment and protection of the healthcare worker who experienced the needlestick. Any additional testing of the patient would be unrelated to the immediate management of the injury.

Choice D reason:
Saving the collection device for future evaluation is not a standard procedure. While the device may be retained as part of the incident investigation to determine how the injury occurred and to improve safety measures, the immediate concern is the treatment of the injured healthcare worker. The device itself does not play a role in the post-exposure management of the worker.