Module 8 Flashcards
What analytes may be different in skin puncture techniques compared to venous samples?
Glucose- higher
Potassium- lower
Total protein- lower
Calcium- lower
When may hematocrit be different for skin puncture techniques?
If the site is cold or blood flow is slow.
What can puncturing deep veins cause in children?
Cardiac arrest
Hemorrhage
Venous thrombosis
Reflex arteriospasm and gangrene of an extremity
Damage to surrounding organs
Infection
Injury from restraining patient
What patients is skin skin puncture good for?
Extreme burns
Extremely obese
Have thrombotic tendencies
Are geriatric or have fragile veins
Perform tests at home
Receive point of care testing
Have veins reserved for treatments
What is the procedure for skin puncture?
Check req
ID yourself and the patient
Prep patient- warm site for 3-5min
Position patient- site downwards
Select site- palmar surface of fingers or lateral/medial plantar surface of heel
Dispose of equipment
Check patient and clean up
Where can’t blood be collected from?
Earlobe
Posterior curvature of heel
Fingers of patients
Where are punctures performed on patients
Heel
What is the max depth of puncture in infants?
2.00mm
What site is used for skin puncture in patients >1yr?
Fleshy pad of finger.
What types of lancets are there?
Microlance- blue and red (long)
Automated lancet BD microtainer contact activated- purple (low), pink (med), blue (high)
BD genie lancet- permanently retractable
BD quickheel lancet- permanently retractable, infant and preemie
Needle orange- glucose
Lancet blue- 2.0mm
Lancet green- 1.5mm
Lancet pink- 1.0mm
Tenderlett- adult, toddler, junior
What are the colours of microtainers?
Red- serum
Gold- serum, polymer gel separator (SST)
Amber- serum, polymer gel separator (light sensitive)
Lavender- whole blood, EDTA
What are capillary tubes used for?
Collection and transfer of the specimen.
Can be with or without heparin.
Large and small.
Describe site prep for skin puncture.
Massage finger to enhance blood flow.
Hold palm up.
Disinfect.
How is puncture performed?
Puncture across the finger print lines.
Must pass through the epidermis and dermis.
Use a 45° angle.
Discard lancet.
Wipe away first drop.
How are the lancets for finger puncture used?
Microlance- hold between thumb and forefinger, insert up to guard
Safety flow- hold between index and middle finger, press trigger with thumb
How is the specimen collected?
Squeeze and release the finger.
Collect drop.
Capillary tube- palm up
Microtainer- palm down, drops flow freely
What is the order of fill?
Lavender- min fill 250um
Other additive tubes
Serum tubes
When are slides made?
First, use capillary tube.
Why is EDTA collected first with skin puncture?
To prevent clumping for hematology.
What does milking result in?
Hemolysis or contaminated samples.
How many repeats are allowed per collection trip?
One repeat.
How long are samples stable for hematology?
2-4hrs
What patients are never bandaged?
Infants
What part of the heel is never used for puncture?
Posterior heel curvature
How is bruising recorded?
Location
Left = L
Right = R
Degree None B+1 = slight B+2 = moderate B+3 = severe
What can bone puncture result in?
Osteomyelitis
What types of lancets are used for heel puncture?
Quickheel
Quickheel infant
Quickheel preemie
How is the ankle held?
Forefinger around ankle and thumb over foot arch.
Finger over foot arch and thumb below puncture site at the angle.
How is a heel specimen collected?
Gently squeeze and release.
Collect in capillary tube.
What is done after heel puncture collection?
Elevate heel and apply pressure.
If >10min get a nurse
What does the neonatal metabolic screen test for?
PKU- detects problems with metabolism
Phenylketonuria- deficiency in phenylalanine hydrolase, accumulation leads to retardation, prevented through diet
Hypothyroidism- can develop cretinism, critical in first two yrs
Biotinidase deficiency- treated with biotin
30+ disorders
When is a PKU test performed?
24hrs-5 days
What preparation has to be done for PKU cards?
Never exposed to bleach or formalin- falsely low results.
Saturate each circle with blood.
Make sure blood soaks through.
Allow card to dry for an hour in the horizontal position.
Allow to dry for an hour in the horizontal position.
Where are early discharge and abnormal results sent?
To the physician from the U of A.
What happens with repeat NMS testing?
Early discharge- collect as usual and check RT box
Abnormal parameter- establish if repeat screen or qualitative test required
When are skin puncture techniques traditionally used?
Paediatric patients and for small volumes.
