Which of the following is caused by excessive shaking of a tube?

Choice A Reason:
Explaining the procedure to both the parent and the child is crucial. It helps in preparing the child psychologically and ensures that the parent is informed and can provide support during the process. Clear communication can reduce anxiety and make the child more cooperative. It is also a part of informed consent, where the parent understands what the procedure entails and why it is necessary¹².

Choice B Reason:
Choosing not to tell the child when the needle insertion is coming might seem like a way to avoid causing them anticipatory anxiety. However, this approach can lead to mistrust. Children need to be prepared for what to expect, and surprising them can be more traumatic in the long run. It is better to be honest and use age-appropriate language to describe the sensation as a 'quick pinch' or 'poke'¹².

Choice C Reason:
Obtaining a heel stick is a common method for blood collection in infants, particularly newborns, as their veins are not as developed. However, for preschoolers, venipuncture is usually the preferred method because they have more developed veins, and it allows for a larger volume of blood to be collected if needed³.

Choice D Reason:
Obtaining a thumb stick is not a standard practice for blood collection in preschoolers. The thumb has bones and tendons close to the surface, which can increase the risk of injury. The preferred sites are the antecubital fossa of the arm or the back of the hand where the veins are more accessible and there is less risk of hitting bone³.

Choice A reason:
Asking another phlebotomist to obtain the specimen is a prudent step after multiple unsuccessful attempts. It can reduce the patient's discomfort and anxiety. A fresh perspective from another professional might increase the chances of a successful draw, especially in challenging situations like small, fragile veins often found in diabetic patients.

Choice B reason:
Performing the draw on a foot is not typically recommended due to the increased risk of infection and complications, especially in diabetic patients who may have reduced sensation and slower healing in their extremities. This option should only be considered when other more proximal sites have been deemed unsuitable.

Choice C reason:
Repeating the draws until successful is not advisable as it can cause undue stress to the patient and increase the risk of hematoma or vein damage. It is essential to minimize the number of attempts to prevent patient discomfort and potential complications.

Choice D reason:
Performing the draw on a leg is another option that is generally avoided unless absolutely necessary, due to similar reasons as drawing from a foot—risk of infection and complications. Additionally, it can be an uncomfortable position for the patient.