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MEDL 330 > Module 8 > Flashcards

Module 8 Flashcards

1
Q

What analytes may be different in skin puncture techniques compared to venous samples?

A

Glucose- higher

Potassium- lower

Total protein- lower

Calcium- lower

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2
Q

When may hematocrit be different for skin puncture techniques?

A

If the site is cold or blood flow is slow.

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3
Q

What can puncturing deep veins cause in children?

A

Cardiac arrest

Hemorrhage

Venous thrombosis

Reflex arteriospasm and gangrene of an extremity

Damage to surrounding organs

Infection

Injury from restraining patient

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4
Q

What patients is skin skin puncture good for?

A

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

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5
Q

What is the procedure for skin puncture?

A

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

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6
Q

Where can’t blood be collected from?

A

Earlobe
Posterior curvature of heel
Fingers of patients

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7
Q

Where are punctures performed on patients

A

Heel

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8
Q

What is the max depth of puncture in infants?

A

2.00mm

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9
Q

What site is used for skin puncture in patients >1yr?

A

Fleshy pad of finger.

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10
Q

What types of lancets are there?

A

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

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11
Q

What are the colours of microtainers?

A

Red- serum

Gold- serum, polymer gel separator (SST)

Amber- serum, polymer gel separator (light sensitive)

Lavender- whole blood, EDTA

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12
Q

What are capillary tubes used for?

A

Collection and transfer of the specimen.

Can be with or without heparin.

Large and small.

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13
Q

Describe site prep for skin puncture.

A

Massage finger to enhance blood flow.

Hold palm up.

Disinfect.

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14
Q

How is puncture performed?

A

Puncture across the finger print lines.

Must pass through the epidermis and dermis.

Use a 45° angle.

Discard lancet.

Wipe away first drop.

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15
Q

How are the lancets for finger puncture used?

A

Microlance- hold between thumb and forefinger, insert up to guard

Safety flow- hold between index and middle finger, press trigger with thumb

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16
Q

How is the specimen collected?

A

Squeeze and release the finger.

Collect drop.

Capillary tube- palm up

Microtainer- palm down, drops flow freely

17
Q

What is the order of fill?

A

Lavender- min fill 250um

Other additive tubes

Serum tubes

18
Q

When are slides made?

A

First, use capillary tube.

19
Q

Why is EDTA collected first with skin puncture?

A

To prevent clumping for hematology.

20
Q

What does milking result in?

A

Hemolysis or contaminated samples.

21
Q

How many repeats are allowed per collection trip?

A

One repeat.

22
Q

How long are samples stable for hematology?

A

2-4hrs

23
Q

What patients are never bandaged?

A

Infants

24
Q

What part of the heel is never used for puncture?

A

Posterior heel curvature

25
Q

How is bruising recorded?

A

Location
Left = L
Right = R

Degree
None
B+1 = slight
B+2 = moderate
B+3 = severe
26
Q

What can bone puncture result in?

A

Osteomyelitis

27
Q

What types of lancets are used for heel puncture?

A

Quickheel

Quickheel infant

Quickheel preemie

28
Q

How is the ankle held?

A

Forefinger around ankle and thumb over foot arch.

Finger over foot arch and thumb below puncture site at the angle.

29
Q

How is a heel specimen collected?

A

Gently squeeze and release.

Collect in capillary tube.

30
Q

What is done after heel puncture collection?

A

Elevate heel and apply pressure.

If >10min get a nurse

31
Q

What does the neonatal metabolic screen test for?

A

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

32
Q

When is a PKU test performed?

A

24hrs-5 days

33
Q

What preparation has to be done for PKU cards?

A

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.

34
Q

Where are early discharge and abnormal results sent?

A

To the physician from the U of A.

35
Q

What happens with repeat NMS testing?

A

Early discharge- collect as usual and check RT box

Abnormal parameter- establish if repeat screen or qualitative test required

36
Q

When are skin puncture techniques traditionally used?

A

Paediatric patients and for small volumes.

MEDL 330 (13 decks)

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