Which of the following should be collected first for tests including CBC, chemistry panel, lead, and a toxicology screen via capillary puncture?

Choice A Reason:
Povidone-iodine is an antiseptic used for skin disinfection before and after surgery. It has a broad spectrum of antimicrobial activity, but it is not the preferred choice for capillary blood collection due to the potential interference with certain laboratory tests. Povidone-iodine needs to be completely dried to avoid hemolysis of the sample, which can affect test results.

Choice B Reason:
Hand sanitizer is generally used for hand hygiene and not for the disinfection of the site for blood specimen collection. While it is effective in killing germs on the skin, it contains emollients and gelling agents that can contaminate the blood sample and interfere with laboratory tests.

Choice C Reason:
70% isopropyl alcohol is the most commonly used disinfectant for aseptic technique in capillary blood collection. It is effective against a broad range of microorganisms and evaporates quickly, leaving no residue that could contaminate the sample. It is important to allow the alcohol to dry completely before performing the puncture to prevent stinging and sample dilution.

Choice D Reason:
A 10% chlorine bleach solution is not typically used for skin disinfection in blood collection due to its harshness and potential to cause skin irritation and damage. It is more commonly used for disinfecting surfaces and equipment in healthcare settings.

Choice A reason:
The axillary vein is not commonly used for routine venipuncture due to its location in the armpit area, where it is more difficult to access and poses a higher risk of complications.

Choice B reason:
The median cubital vein is often the vein of choice for venipuncture due to its size and accessibility. However, in the case of a patient with bilateral scarring on the forearms, this vein may be compromised, making it a less suitable option.

Choice C reason:
The basilic vein, while also a common site for venipuncture, is located on the inner aspect of the arm and may be affected by the scarring on the patient's forearms. Additionally, it is closer to nerves and arteries, which increases the risk of complications.

Choice D reason:
The dorsal hand veins are a good alternative for venipuncture when the more common sites are not available, such as in the case of a patient with bilateral scarring on the forearms. These veins are usually more superficial and can be accessed with minimal risk of complications.