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PMLS 2 FINALS > Capillary puncture, etc. > Flashcards

Capillary puncture, etc. Flashcards

1
Q

Superficial puncture of skin with sharp point
to draw small amount of blood

A

capillary puncture

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2
Q

capillary puncture is collected in

A

small calibrated glass tubes,
slides or reagent strips

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3
Q

capillary puncture advantage over venous blood sampling

A
  • Less invasive
  • Requires small amount of blood
  • Can be performed easily and quickly
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4
Q

CAPILLARY BLOOD IS COMPOSED OF

A

: of
blood from arterioles, venules, capillaries and
intracellular and interstitial (tissue) fluid (fluid
that forms within tissue layers and haps)

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5
Q

TEST REFERENCE VALUES OF CAPILLARY BLOOD

A
  • K, Ca and protein are lower
  • Glucose is typically higher
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6
Q

CAPILLARY PRICK COLLECTION SITE

A

may be on the heel or finger

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7
Q

is preferred site for capillary testing in
an adult patient

A

finger

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8
Q

in adult patients ???????????are sometimes used in mass
screening or research studies

A

earlobes

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9
Q

collection site is usually based on age and
weight of the patient

A

paediatric

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10
Q

In infants, what should not be punctured

A

fingers

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11
Q

capillary puncture in the heel is for

A

r paedia and neonatal patients

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12
Q

FINGER O HEEL PRICK
Birth to about
6 months

A

heel

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13
Q

FINGER O HEEL PRICK
Over 6 months

A

finger prick

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13
Q

FINGER O HEEL PRICK
3-10kg approx.

A

heel

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13
Q

FINGER O HEEL PRICK
greater than 10kg

A

finger-prick

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14
Q

FINGER O HEEL-PRICK
lANCET PLACEMENT IS ON the medial or lateral plantar surface

A

HEEL-PRICK

15
Q

FINGER OR HEEL PRICK

PLACE OF LANCET in the side of the
ball of finger perpendicular to the lines of the fingerprint

A

FINGER-PRICK

16
Q

RECCOMMENDED FINGER

A

Second and third
finger (i.e. middle
and ring finger);
avoid the thumb
and index finger
kase may calluses
and avoid little
finger kase
manipis tissue

17
Q

RECOMMENDED PUNCTURE SITE AND INCISION DEPTH

Premature
neonatesl
(up to 3kg

A

HEEL. 0.85mm

18
Q

INFANTS UNDER 6 MONTHS. RECOMMENDED PUNCTURE SITE AND INCISION DEPTH

A

Heel 2.0mm

19
Q

Child aged
6 months to
8 years

Recommended
puncture site AND Recommended
incision dep

A

Finger 1.5mm

20
Q

Child older
than 8 years
and adults

Recommended
puncture site AND Recommended
incision depth

A

Finger 2.4mm

21
Q

= skin, lips or nails turn b;ue die
to lack of oxygen in your blood whether due to
cold or lack of oxygen.

A

CYANOSIS EDEMA

22
Q

GENERAL CRITERIA FOR CAPILLARY PUNCTURE

A

GENERAL CRITERIA:CAPILLARY PUNCTURE SITE
- Skin is warm, normal color
- No scars, burns, bruises
- No rashes, cyanosis edema or infection

23
Q

ADULTS AND CHILDREN: CAPILLARY PUNCTURE
SITE

A
  • Middle of ring finger of non-dominant hand
  • Palmar surface
  • Distal or end segment
  • Central fleshy portion of the finge
24
Q

INFANTS: CAPILLARY PUNCTURE SITE

A
  • Medial or lateral surface of the heel
  • No more than 2.0mm deep
25
Q

CAPILLARY BLOOD:TEST APPLICATIONS

A
  • Point of care testing ( POCT, i.e. blood
    glucose monitoring)
  • CBC, hmeoglobin and haematocrit count
    (H&H)
  • PBS (manual slide for wbc differential)
  • Neonatal blood gases
  • Neonatal billilirubin
  • Neonatal screening (filter paper or blood
    spot testing
  • Electrolytes
26
Q

WHEN TO DO A CAPILLARY PUNCTURE

A
  1. Patients with a fragile superficial or difficult
    to access vein
  2. Patients where multiple unsuccessful
    venepuncture have already been performed. Especially if the tests requested
    requires only a small volume of blood
  3. Patients with burns or scarring in venous
    blood collection sites
  4. Extremely obese patients
  5. Patients requiring a frequent blood test
  6. Patients receiving IV therapy in both arms or
    hands
  7. Patients at risk for serious complications
    associated with venepuncture, venous
    thrombosis or deep venous puncture (e.g. deep vein puncture in infants,
    thrombophlebitis)
  8. Patients requiring only one blood test for which a capillary specimen is appropriate
  9. Patients whose veins are „reserved‟ for intravenous therapy or chemotherapy
  10. Point-of-care testing where only a few drops of blood are needed
27
Q

CAPILLARY PUNCTURE IS INAPPROPRIATE FOR

A
  • Severely dehydrated patient
  • Swollen finger
  • Poor pheiperal circulation
  • Coagulation studies requiring plasma
    specimen
  • Tests that require large volume of blood (i.e.
    ESR and blood culture)
27
Q

CAPILLARY PUNCTURE IS INAPPROPRIATE FOR

A
  • Severely dehydrated patient
  • Swollen finger
  • Poor pheiperal circulation
  • Coagulation studies requiring plasma
    specimen
  • Tests that require large volume of blood (i.e.
    ESR and blood culture)
28
Q

ORDER OF DRAW FOR SKIN (CAPILLARY)
PUNCTURE

A
  • Blood gases
  • EDTA tube
  • Other (BluGoGreLaBlaGraYe)
  • Serum tubes
29
Q

FINGERSTICK BLOOD COLLECTION INTO
MICROTAINER

A
  1. Iready na lahat on top of disposable pad.
    Iopen na lahat
  2. Put on gloves. Turn patient hand upward.
    Massage hand and lower part of finger to
    increase blood flow
  3. Scrub middle or ring finger with alcohol
    swab.dry with gauze
  4. Hold finger in upward position and the
    lance finger (Across the fingerpoint)
    between the side and the pad with the
    proper size lancet (adult/child). Press firmly
    on the finger when making the puncture,
    doing so will help you to obtain the amount
    of blood you need
  5. Apply slight pressure to start blood flow. Blot
    the first drop of blood on gauze pad and
    discard in appropriate biohazard manner
  6. Keep finger in a downward position and
    gently massage it (do no “milk” it) to
    maintain blood flow. Hold the microtainer
    of an angle at 30 degrees below the
    collection site and use the scoop on the
    microtainer to guide the drop into the vial.
    Do not scrape the skin. Fill the microtainer
    at 200-500 ul level.
  7. Cap microtainer then gently invert it 10
    times to prevent clot from forming
  8. Apply a sterile adhesive bandage over the
    puncture site
30
Q

HEEL STICK PROCESS

A
  • Pre-warming the infant‟s heel (42C for 3 to 5
    mins) is important to obtain capillary blood
    gas samples and warming also greatly
    increases the flow of blood for collection of
    other specimen
  • Clean the site to be punctured with an
    alcohol sponge. Dry the cleaned area with a
    dry cotton sponge. Hold the baby‟s foot
    firmly to avoid sudden movement.
  • Using a sterile blood lancet,, puncture the
    area of the heel that just off center from the
    very center of the heel
  • Wipe away the first drop of blood with a
    piece of clean, dry cotton
  • Fill the capillary tube or micro collection
    device as needed
  • When finished, elevate the heel, place a
    piece of clean, dry cotton on the puncture
    site and hold in in place until bleeding has
    stopped.
31
Q

COMPLICATIONS IN CAP PUNCT

A
  • Collapse of veins if the fibial artery is
    lacerated from puncturing the medial
    aspect of the heel:
  • Osteomyelitis of heel bone (calcaneus)
  • Nerve damage if the fingers of neonates are
    punctured
  • Haematoma and loss of access to the
    venous branch used:
  • Scarring
  • Localuzed or generalized necrosis (a longterm effect):
  • Skin breakdown from repeated use of
    adhesive strips (particularly in very young or
    very elderly patients) – this can be avoided if
    sufficient pressure is applied and the
    puncture site is observed after the procedure
32
Q

UNSUCCESSFUL ATTEMPTS IN PEDIATRIC PATIENTS

A
  • Adheres strictly to a limit on the number of
    timesa pediatric patient may be stuck
  • F no satisfactory sample has been
    ccollected after 2 attempts, seek a 2nd
    opinion to decide whether to further attempt
    or cancel the test

PMLS 2 FINALS (2 decks)

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