Capillary Puncture Flashcards
1
Q
These are examples of what: Skin Puncture, Dermal Puncture, Microsampling
A
capillary puncture
2
Q
A
2
Q
Obtaining drops of blood from puncturing or making an incision in the capillary bed
A
capillary puncture
3
Q
A mixture of arterial, venous, and capillary blood with interstitial fluid and intracellular fluid
A
capillary puncture
4
Q
Reference value of capillary is different from what type of blood?
A
venous blood
5
Q
Give the 4 preferred sites for capillary puncture
A
◦ Lateral plantar heel surface
◦ Palmar surfaces of the fingers (3rd and 4th)
◦ Plantar surface of the big toe
◦ Earlobes-least site
6
Q
Give the 5 sites that are not recommended or should be avoided for capillary puncture
A
◦ Central arch area of an infants heel
◦ Fingers of newborn or infant , 1 y.o
◦ Thumb, index and 5th fingers
◦ Fingers on the side of mastectomy
◦ With scarred areas
7
Q
______ (large/small) amounts of blood are acceptable to be use for testing
A
Small
8
Q
6 conditions which indicates that capillary puncture is suitable?
A
Fragile veins
Unsuccessful venipuncture
Patient has thrombotic or clot-forming tendencies
Patient is apprehensive or has fear of needles
No accessible veins
POCT procedures
9
Q
CAPILLARY PUNCTURE IS NOT APPROPRIATE FOR PATIENTS WHO ARE _______ OR HAVE _____
A
DEHYDRATED OR HAVE POOR CIRCULATION TO THE EXTREMITIES
10
Q
Infants have a small blood volume (anemia)
Large quantities of blood removed can result to cardiac arrest
Venipuncture may damage veins and surrounding tissues
Puncturing deep veins can result to hemorrhage, venous thrombosis, infection, and gangrene
Restraining method can injure an infant or child
Preferred specimen for some tests (NBS)
A
Preferred method for infants and very young children
11
Q
4 types of people who can benefit from capillary puncture
A
Pediatric children - sample volume limited
Obese patients
Chemotherapeutic patient
Burn patients
12
Q
Order of filling microsampling?
A
- EDTA
- Other additive tubes
- Serum tubes
13
Q
4 tests that cannot be performed by capillary puncture
A
ESR
Coagulation studies
Blood cultures
Tests that require large volumes of serum or plasma
14
Q
7 equipment needed for capillary puncture
A
Blood collection supplies and equipment (general)
Lancets/Incision device/Laser lancets
Microcollection containers
Microhematocrit tubes and sealants
Capillary Blood Gas equipment
Microscope Slides
Warming devices
15
Q
Length of lancet
A
1.75 mm
16
Q
Depth of incision for infants and children
A
<2.0 mm
17
Q
depth of incision for adults
A
<2.5 mm
18
Q
Distance from skin surface to bone or cartilage
A
1.5 - 2.4 mm
19
Q
PUNCTURES SHOULD NOT BE MADE MORE THAN _____ DEEP FOR INFANTS; FOR ADULTS DEEP
A
2.5 mm, 2-3 mm
20
Q
Usually used on fingers for adults and children 5 years of age and older
A
laser lancets
21
Q
Microtubes
Special small plastic tubes used to collect the tiny amounts of blood obtained from capillary puncture
“Bullets”
Color coded bodies or stopper
Markings for minimum and maximum fill levels (uL)
Lot numbers and expiration date on tube
A
Microcollection tubes
22
Q
NOT THE SAME AS FOR VENIPUNCTURE
Skin releases _____
______ specimen first
____ specimen last
A
- tissue thromboplastin
- Hematology
- Serum
23
Q
CLSI Order of Draw for Capillary Specimen
A
Blood Gas Specimen (BCG)
EDTA specimens
Other additive specimens
Serum specimens
* NBS (collected separately)
24
* This is ______
Disposable, narrow-bore plastic or plastic-clad glass capillary tubes
Can hold ___ to ___ uL
Uses?
Coated with ______ (red or green) or ____ (blue)
* Microhematocrit tubes
* 50 to 75uL
* ammonium heparin, plain
25
* long thin narrow-bore capillary tubes
100mm in length, 100 uL capacity
Color-coded band (green for sodium heparin)
CBG collection tubes
26
* small metal fillings
Small metal bars, “flea”
Purpose?
Stirrers
27
Use of magnets in CBG
mixing the specimen
28
Purpose: sealing of CBG tubes and maintaining anaerobic condition
Plastic caps
29
Making blood films for hematology determinations
Microscope slides
30
Purpose? Temperature that does not exceed 42oC
Towel or diaper dampened with warm tap water
warming devices
31
1-9 capillary puncture procedure
1. Review and accession test request
2. Approach, identify, and prepare patient
3. Verify diet restrictions and latex sensitivity
4. Sanitize hands and put on gloves
5. Position patient
6. Select the puncture/incision site
7. Warm site if applicable
8. Clean and air-dry site
9. Prepare equipment
32
10 - 18 Capillary puncture procedure
10. Puncture the site and discard lancet
11. Wipe away the first drop of blood
12. Fill and mix tubes/containers in order of draw
13. Place gauze and apply pressure
14. Label specimen and observe special handling instructions
15. Check the site and apply bandage
16. Dispose of used and contaminated materials
17. Thank patient, remove gloves, and sanitize hands
18. Transport specimen to the lab
33
Position patient:
* Adult
patient’s arm supported on a firm surface with hand extended and palm up
34
Position patient:
* Children:
held in the lap by a parent or guardian, restrains child with one arm and holds the child
35
Position patient:
* Infant
supine (lying face up) with foot lower than torso
36
Best site for adults and infants
Fingers of adults, heels of infants
37
Adult and Children older than 1yo
_____ surface of the distal or end segment of the ____ or _____ finger of ____ hand
Site: ____, fleshy portion, slightly to the side of center and perpendicular to the ______
* Palmar
* middle or ring, non-dominant
* central, grooves in the whorls of the finger print
38
Infants
_____(plantar surface of the heel, medial or lateral)
Not to puncture the ____(osteomyelitis, osteochondritis)
* Heel
* bone
39
According to CLSI, capillary puncture must not be performed on the ______ of newborns or other infants under ___ year of age
fingers or earlobes, 1
40
Key point: _____ increase in abundance below the ______, so deeper punctures are more painful
Pain fibers, capillary bed
41
Heel puncture Precautions:
Do not puncture any deeper than _______
Do not puncture areas between the ______.
Do not puncture in the ______ and any areas of the foot other than the heel.
Do not puncture _______.
Do not puncture the ______ of the heel.
Do not puncture through _____.
Do not puncture a site that is ___
* 2.0mm
* imaginary boundaries
* arch
* severely bruised areas
* posterior curvature
* previous puncture sites
* swollen
42
Warming the site _____ therefore increasing blood flow on the site
dilates capillaries
43
Warming the site _____- therefore increasing blood flow on the site
“Arterialized”
_______ minutes with a washcloth, towel, or diaper
Commercial heel warming device
Caution: The temperature of the material used to warm the site must not exceed _____
* dilates capillaries
* 3-5
* 42oC (108oF)
44
Clean and air-dry site
_____ alcohol
Not _____ (Bilirubin, uric acid, phosphorus and potassium)
Allow site to air dry to ensure maximum ______ and minimize chance of alcohol contamination of the specimen
Stinging sensation and hemolysis
Glucose testing
* 70% isopropanol or 70% isopropyl
* povidone iodine
* antiseptic action
45
Prepare _______
Depends on the _______
Place them within ______
Prepare in ______
New, sterile _______
Intact ______
Open in _______
Not _______
* equipment
* tests requested
* easy reach
* view of patient or guardian
* lancet/incision device
* packaging
* aseptic manner
* touching/brushing any surface
46
Finger puncture
Grasp the patient’s finger between the __________
Place the lancet device flat against the skin in the ______ of the finger, slightly to the side of _______
Key point: In young children, it is usually best to grasp _______
* non-dominant thumb and index finger
* {central, fleshy pad}, {center and perpendicular to the fingerprint’s whorls}
* three or four of the child’s fingers
47
Heel puncture
Grasp the foot gently but firmly with the _________
Wrap ____ around the arch
Thumb around the _____
Other fingers around the ______
Incision should be made at _____ angle to create “gap” puncture
* non-dominant hand
* index finger
* bottom
* top of the foot
* 90 degrees
48
Wipe away the _____
_______ position of the site to encourage blood flow
Wipe away first drop of blood with a _______
Contains _______
Contains ________ (hemolyzed sample and unable to produce a good drop of blood)
Key point: Some POCT instruments may allow the use of _____
* first drop of blood
* Downward
* dry gauze pad
* interstitial fluid
* alcohol
* first drop of blood
49
Fill and mix tubes/containers in _______
______ to enhance blood flow
Gentle, intermittent _____
CAUTION: Do not squeeze, use strong repetitive pressure or “milk” the site, as _____ and _______ can result.
Always follow correct _______
You may need to ____ microtubes every now and then to let the blood settle at the bottom
Invert ___ times (depends on the manufacturer)
CAUTION: Pay strict attention to ____ of microtubes containing anticoagulants.
* order of draw
* Downward
* pressure
* hemolysis and tissue fluid contamination
* order of draw
* tap
* 8-10
* fill levels
50
To fill a collection tube or device, touch it to the _____ formed on the surface of the skin
If making a blood film, touch the appropriate area of the ___ to the blood drop
A microhematocritor narrow-bore capillary tube will fill automatically by capillary action
To fill a microcollection container or microtube, hold it ____
CAUTION: Do not use a ____ motion against the surface of the skin and attempt to collect blood as it flows down the finger
* drop of blood
* slide
* upright just below the blood drop
* scooping
51
Place gauze and apply ____
Apply pressure until ____ stops
Keep site _____
* pressure
* bleeding
* elevated
52
Label specimen and observe ______
Label same as for _______
Label in _______
Affix labels directly to ______
_______ - place in a nonadditive tube or appropriately sized aliquot tube, then label
Follow any ________ if applicable
* special handling instructions
* Venipuncture
* view of patient/guardian
* microcollection containers
* Microhematocrit tubes
* special handling instructions
53
Check the site and apply ____
Check to verify if bleeding stops
If yes, apply bandage and advise patient to keep it for at least ___ minutes (older child and adult)
CAUTION: Do not apply bandages to infants and children __ years of age because they pose a choking hazard
If bleeding is ____ minutes, notify nurse or physician
* bandage
* 15
* < 2
* >5
54
Capillary Blood Gases
_____ (BGA)
Same site as ____
“Arterialized” by warming site for ______. Also, to increase blood flow of the site
Follows the same procedure as the ______
Metal stirrer bar or metal fillings (fleas)- _____
___ - runs thru back and forth the full length of the tube for several times to aid in mixing
Handling: ___
* Blood gas analysis
* routine capillary puncture
* 5-10 minutes
* routine skin/capillary puncture
* homogenous mixture
* Magnet
* ice
55
______
Detection and monitoring of an increased bilirubin levels due to overproduction or impaired excretion
High levels of bilirubin results in ______
Sample is collected by ____
Protected from _____
Collected using _____
Not _____
* Neonatal Bilirubin Collection
* jaundice
* heel puncture
* light
* amber-colored microcollection container
* hemolyzed
56
the state mandated testing of newborns for the presence of certain genetic (inherited), metabolic (chemical changes within living cells), hormonal, and functional disorders that can cause severe mental handicaps or other serious abnormalities if not detected and treated early.
Newborn screening/neonatal screening
57
Diseases:
Phenylketonuria
Hypothyroidism
Galactosemia
Homocystinuria
Maple Syrup Urine disease
Sickle cell
Cystic fibrosis
Biotinidase deficiency
Congenital adrenal hyperplasi
Newborn screening/neonatal screening diseases
58
Newborn Screening/Neonatal Screening
Ideally performed: ______
Early collection: less than ______
Performed by _____ and requires a state form
* 24 to 48 hours old
* 24 hours old
* heel puncture
59
Few drops obtained from heel puncture
Blood drops adsorbed onto circles printed on a special type of filter paper
Perform heel puncture, wipe away first drop of blood, filter paper close to heel, large drop of blood is applied to the center of the circle
Blood spot collection
60
Newborn Screening/Neonatal Screening
CAUTION: Do not contaminate the filter paper circles by _______ or _____.
After collection, air dry in an elevated, ____ position away from heat or sunlight.
Not be hung to dry or _____
* touching them with or without gloves or allowing any object or substance to touch them before, during or after specimen collection
* horizontal
* stacked together
61
a drop of blood spread thin on a microscope slide
blood film or smear
62
Manually prepared (bedside) or get blood collected from EDTA tube
Routine blood film/smear preparation
63
2 tests that requires blood film/smear
Differential count
LAP stain or score
64
_____ prepared from EDTA specimens should be made within 1 hour of collection to eliminate cell distortion caused by anticoagulant
Blood smears
65
Routine blood film/smear preparation Procedure
1. Perform ____
2. Wipe away the _____
3. Touch a slide the _______
The drop should be ___ in diameter
Centered on the slide ________ or ______ of plain slide
* capillary puncture
* first drop of blood
* next drop of blood
* 1-2 mm
* adjacent to the frosted end or ½ to 1 inch from one end
66
Routine blood film/smear preparation Procedure
4. Hold the blood drop slide between _____. With the other hand, rest the second slide in front of the drop at an angle of approximately _____
* thumb and index finger of non-dominant hand.
* 30 degrees
67
Routine blood film/smear preparation Procedure
5. Pull the ____ back to the edge of the blood drop. Stop it as soon as it touches the drop, and allow the blood to spread along its ___
* spreader slide
* width
68
Routine blood film/smear preparation Procedure
6. Push the spreader slide away from the drop in one smooth motion, carrying the _____ and off the end of the blood drop slide
* entire length
69
Routine blood film/smear preparation Procedure
7. Place the drop of blood for the second smear on the ______. Use the slide with the first smear as the spreader slide for the second smear and make it in the same manner as the first one.
8. Place gauze over the wound and ask the patient to _____
9. Label frosted blood slides by ________. If using preprinted label, attach it over the writing or in the empty space at the blood drop end if it is a plain slide
* spreader slide
* apply pressure.
* writing the patient information in pencil on the frosted area
70
Routine blood film/smear preparation Procedure
10. Allow the blood films to ______ and place them in a secondary container for transport.
11. Thank patient, remove gloves, and sanitize hands.
12. Transport specimen to the laboratory.
* air-dry
71
In preparing smear manually from EDTA specimen:
EDTA tube must be mixed for _____ (minimum)
Plain capillary tube or pipette is used for _____
* 2 minutes
* dispensing blood onto the slide
72
CAUTION: ____ are considered infectious or biohazardous until they are stained or fixed
Blood smears
73
What is an acceptable blood smear?
___ of the slide
No holes, lines or _____ends
Smooth transition from thick to thin when held up in the ____
With _____ (where differential count is performed)
* ½ to ¾
* jagged
* light, feathery edge
74
Thick Blood Smear Preparation
Detection of _____
How to make a thick blood smear?
_______ is placed in the center of a glass slide and spread with the corner of another slide or cover slip until it is a size of a dime
Dry for minimum of ____ before staining
Stain used: _______
* Malaria
* Very large drop of blood
* 2 hours
* fresh Giemsa stain
