L2: Capillary Puncture Flashcards
Capillary Puncture is a mixture of arterial, venous, and capillary blood with ______ and _____
interstitial fluid and intracellular fluid
Capillary Puncture: obtaining drops of blood from puncturing or making an incision in the ______
capillary bed
Preferred sites for capillary puncture
- lateral plantar heel surface
- palmar surface of fingers (3rd and 4th)
- plantar surface of big toe
- earlobe (least site)
sites not recommended for capillary puncture
- central arch area of an infants heel
- fingers of newborns and infants, 1yr old
- scarred area
- fingers on the same side of mastectomy
TRUE OR FALSE
one indications for capillary puncture is that large amounts of blood are acceptable to use for testing
FALSE, small amounts of blood
Why is capillary puncture the preferred methods for infants and very young children (6)
- infants have a small blood volume
- large quantities of blood removed can result to cardiac arrest
- venipuncture may damage veins and surrounding tissues
- restraning method can injure and infant or child
- preferred specimen for some tests (NBS)
capillary puncture is not appropriate for patients who are ___ or have _____
dehydrated, poor circulation with lower extremeties
person who can benefit with this method of collection (4)
pediatric patients, obese patients, burn patients, chemotherapeutic patients
order of filling microsampling for capillary puncture:
____ -> _____ -> _____
EDTA -> other additives -> Serum
Tests that cannot be performed by Cpillary puncture (4)
- ESR
- Blood Cultures
- Coagulation studies
- tests that require large volume of plasma / serum
What Capillary Puncture Equipment?
- sterile and disposable
- sharp pointed or bladed instrument
lancet / incision device
OSHA required lancet safety feature should have a ________ or _____ to reduce risk of sharps injury
permanent retractable blade or needle point
Capillary puncture’s depth of incision:
infants & children : ___
adults: _____
< 2.0 mm
< 2.5 mm
distance from skin surface to bone or cartilage:
1.5 - 2.4 mm
punctures should not be made more than ___ dep for infants; for adults ____ deep
2.5 mm; 2-3mm
- perforating skin with a laser instead of sharp instrument
- usually used on fingers for adults and children 5 years of age and older
laser lancet
- special small plastic tubes used to collect the iny amounts of blood obtained from capillary puncture
- color coded bodies or stopper
microcollection containers
In term of order of draw for capillary puncture
- skin releases ______
- which specimen if first?
- which specimen is last?
- CLSI order of draw for capillary specimen
- tissue thromboplastin
- hematology
- serum
CLSI ORDER OF DRAW:
1. Blood Gas Specimen
2. EDTA specimen
3. other additie specimen
4. serum specimens
arrange the following additives based on its order of draw and how many inversion:
Blood Gas specimen, serum - no additive, lithium heparin, EDTA, serum - clot activator - sodium fluoride/ potassium oxalate, lithium heparin w gel separator
- Blood Gas Specimen
- EDTA (10)
- Lithium Heparin (10)
- Lithium Heparin w gel separator (10)
- Sodium Fluoride/ Potassium Oxalate (10)
- Serum - clot activator (5)
- serum w no additive (0)
- disposable, narrow-bore plastic or plastic-clad glass capillar tubes
Microhematocrit tubes
microhematocrit tubes is coated with _____ or _____
ammonium heparin (red or green) or plain (blue)
- plastic or clay
- dry end of tube was inserted into the clay to plug it
sealants
long thin narrow - bore capillary tubes
CBG collection tubes
small metal fillings for CBG Equipment
stirrers
making blood films for hematology determinations
microscope slides
- temperature that dies not exceed 42 degree celsius
- towel or diaper dampened with warm tap water
warming devices
how to position patient during capillary puncture
- Adult: patient’s arm supported on a firm surface with hand extended and palm up
- Children: held in the lap by a parent or guardian, restrains child with one arm and holds the child
- Infant: supine (lying face up) with foot lower than torso
best site for capillary puncture
fingers of adults and heels of infants
puncture / incision site for adults
central, fleshy portion, slightly to the side of center and perpendicular to the grooves in the whorls of the finger print
puncture/ incision site for infants
heel
TRUE or FALSE
capillary puncture must not be performed on the fingers or earlobes of newborns or other infants under 1 year of age.
TRUE
TRUE OR FALSE
you can puncture the sid or vey tip of the finger
FALSE
___ fibers increase in abundance below the capillary bed, so deeper punctures are more ____.
PAIN; PAINFUL
TRUE OR FALSE
you may puncture deeper than 2.0 mm in heel
FALSE
TRUE OR FALSE
You may not puncture in the arch and any areas of the foot other than the heel
TRUE
Warming the site dilates _____ therefore increasing _____ on the site
capillaries; blood flow
when doing finger puncture:
Grasp the patient’s finger between the _____ and ____
non-dominant thumb and index finger
TRUE OR FALSE
WHen doing finger puncture in young children, it is usually best to grasp three or four of the child’s fingers
TRUE
Warn the patient about the ouncture and activate ___ to trigger puncture
release mechanism
when doing heel puncture, incision should be made at ____ angle to create ____ puncture
90 degree; gap
first drop of blood contains?
- interstitial fluid
- alcohol
____ position of the site to encourage blood flow
downward
Do not squeeze, use strong ___ prssure or “milk” the site as it can result to ______ and _____ contamination.
repetitive; hemolysis, tissue fluid
To fill a microcollection container or microtube, hold it ___ just below the blood drop
upright
A microhematocrit or narrow-bore capillary tube will fill automatically by ____
capillary action
TRUE OR FALSE
You can use a scooping motion against the surface of the skin and attempt to collect blood as it flows down the finger
FALSE
if the bleeding has stopped, apply bandage and advise patient to keep it for atleast ____ minutes
15
Do not apply bandages to infants and children _____ years of age because they pose a ___ hazard
2; choking
3 ways to transport specimen to lab
personal deivery, courier service, pneumatic tube system
Warming the site before collecting capillary gases helps ____ the blood and increase blod flow of the site. how many mins?
arterialize; 5-10 mins
detection and monitoring of an increase bilirubin levels due to overproduction or impaired excretion. sample is collected by ____
Neonatal Bilirubin Collection; heel puncture
High levels of bilirubin results in ___
jaundice
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/ Neonatal Screening
diseases for Newborn/ Neonatal Screening
Phenylketonuria
Hypothyroidism
Galactosemia
Homocystinuria
Maple Syrup Urine disease
Sickle cell
Cystic fibrosis
Biotinidase deficiency
Congenital adrenal hyperplasia
Newborn/ Neonatal Screening is ideally performed ____ to ___ hours old
It is performed by ____ and requires a ______
24-48
heel puncture; state form
- few drops obtained from heel puncture
- blood drops absorbed into circles printed on a special type of filter paper
Blood Spot Collection
TRUE OR FALSE
In blood SPot collection, touch paper to the surface of the heel
FALSE
In Newborn/ Neonatal Screening, after collection, air dry in an elevated, horizontal position away from heat or sunlight.
TRUE OR FALSE
TRUE
a drop of blood spread thin on a microscope slide
BLOOD FILM/ SMEAR
Blood smears prepared from EDTA specimens should be made within __ hour of collection to eliminate _____ caused by ____
1; CELL DISTORTION; anticoagulant
TEST THAT REQUIRES BLOOD/ FILM SMEAR
- Differential count
- LAP stain or score
when doing Routine blood film/smear preparation Procedure, rest the second slide in front of the drop at an angle of approximately ____ degrees
30
In preparing smear manually from EDTA specimen:
- EDTA tube must be mixed for __ minutes (minimum)
- ____ or ____ is used for dispensing blood onto the slide
2
plain capillary tube; pipette
What is an acceptable blood smear
½ to ¾ of the slide
No holes, lines or jagged ends
Smooth transition from thick to thin when held up in the light
With feathery edge (where differential count is performed)
probable cause: spreader slide lifted before the smear was completed
problem?
absence of feather
probable cause:
- dirty slide
- fat globules in the blood
- blood contamination with glove powder
problem?
holes in the smear
probable cause:
too much pressure applied to spreader slide
roblem?
ridges/ uneven thickness
probable cause:
- blood drop too large
- spreader slide angle to steep
- patient has high RBC count
problem?
smear is too thick
probable cause
- blood drop is too small
- spreadr slide angle too steep
- spreader slide pushed too quickly
- patient has high RBC count
problem?
smear is too short
probable cause:
- blood drop too large
- spreader slide angle too shallow
- spreader slide pushed too slowly
- patient has low hemoglobin
problem?
smear is too long
probable cause:
- blood drop too small
- spreader slide angle too shallow
- patient has low hemoglobin
problem?
smear is too thin
probable causes:
- blood drop strated to dry out
- edge of spreader slide dirty or chipped
- spreader slide pushed through blood drop
- uneven pressure applied to spreader slide
problem?
streaks or tails in feathered edge
THICK BLOOD SMEAR IS COMMONLY USED TO DETECT ____
MALARIA
In doing thick blood smear preparation, dry it for minimum of ___ hours before staining
2
