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2024 SEM 1 PMLS 2 (LAB) > venipuncture - butterfly, capillary and arterial puncture > Flashcards

venipuncture - butterfly, capillary and arterial puncture Flashcards

1
Q

Butterfly Needle (Winged Infusion Set) is also called

A

scalp vein set

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2
Q

what are the two varieties of the winged infusion set

A
  1. Lower adapter/ connector at the end of the tubing to connect the barrel of the syringe.
  2. Proper sheathed needle at the end of the tubing where you can attach the tube holder and can perform a closed system collection using your butterfly needle.

*Need to use small volume of evacuated tubes. Available but not in the Philippines. Why? Small evacuated tubes generate less vacuum pressure compared to larger tubes, reducing the likelihood of vein collapse.

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3
Q

what are the equipment needed for butterfly needle extraction

A

butterfly needle/ winged infusion set
evacuated tube
alcohol pads
tourniquet
gauze pad, cotton and micropore

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4
Q

wings of the butterfly needle

A

it has a rough and smooth side
smooth side must be facing you = bevel up
shld be feeling/ touching the rough side (fold it when holding it)

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5
Q

what is the purpose of the luer cap/ connecter of the butterfly needle

A

Attach the barrel of the syringe

and for the proper sheathed needle at the end of the tubing, it can be pulled off at the the white (middle of the needle and the upper white portion)

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6
Q

butterfly needle extraction procedure

A

transes

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7
Q

how do you position the hand

A

A support or armrest may be needed. Use tackle box

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8
Q

the site to puncture using butterfly needle

A

Should be the dorsal part (at the back) of the hand.

If you are going to consider an insertion of 10 degree or less, select a vein that is close to the skin or very prominent.
It is not advisable to use a butterfly needle if the vein is deep and needs to be more than 10 degrees.

Lightly clenched fist (Not too hard)

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9
Q

Why do we need to anchor the veins?

A

As our veins are prone to rolling. So magaslaw.

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10
Q

what is the ideal gauge for the needle

A

most of the hand veins are small

hence, ideal gauge is 23

Can also use 24 or 25 gauge. But expect that there will be a slow flow of blood during the collection.
DO NOT forcibly pull the plunger. If you do, you will hemolyze the specimen.

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11
Q

how do you anchor the veins

A

Pull the skin down using thumb
Anchor the vein by pulling at the fingers area not the surface of the site. Kase it is abalaa.
Afterwards, can see the back flow of the blood.

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12
Q

in step 13-14, what do you do if it is
ETS ended:
if syringe:

A

ETS ended:
Fill, remove and mix tubes.
Remove the needle, activate the safety device and apply pressure.

if syringe:
Fill barrel, remove needle, put a bandage, apply pressure, remove barrel from the connector & transfer blood to tubes.

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13
Q

Butterfly Needle Extraction Procedural Errors

A

Proper selection of needle gauge:
a 25-gauge needle is not recommended unless it has thin-wall technology.
Again, the ideal would be 23 gauge.

Angle of insertion:
Ideal: 10 degrees or less when the veins are close to the skin.

Use of evacuated tubes:
Small volume evac. Tubes should be selected.
Large volume tubes can collapse veins or hemolyze the specimen.

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14
Q

Butterfly Needle Extraction Order of Draw

A

same order of draw
HOWEVER,
When using a push button (“ETS-ended”) butterfly blood collection system for venipuncture and a coagulation tube is the first tube to be drawn, a discard tube should be drawn first.
The discard tube is used to fill the blood collection tubing dead space.
This assures maintenance of the proper anticoagulant/ blood ratio.
The discard tube can be another blue top tube or a plain, non clot activator vacutainer.

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15
Q

Why does the discard tube be drawn first if our test requires us to use a coagulation tube first?

A

If not, a citrate tube will contain a dead space coming from the tubing. Hence, it will alter the anticoagulant blood ratio.
The citrate tube is very sensitive.
The discard tube can be any tube. For example, serum tube (SST), red plain tube.

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16
Q

Butterfly Needle Extraction Disposal
barrel:
needle and tube:

A

Barrel - in infectious waste
Needle and tube - sharps container

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17
Q

capillary puncture is also known as

A

skin puncture

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18
Q

composition of Capillary Specimens

A

Mixture of arterial, venous & capillary blood
Interstitial & intracellular fluid (Aka tissue fluid)
More closely resembles arterial blood than venous

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19
Q

what happens when you are selecting capillary blood/ puncture or when you failed venipuncture but you only need a small amount of blood. For example, CBC

A

you can perform capillary puncture. But must state in the test request indicating that the specimen came from a capillary puncture or the sample is a capillary blood.

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20
Q

why do we have to state in the test request indicating that the specimen came from a capillary puncture or the sample is a capillary blood.

A

as the reference values are different from venous blood and capillary blood

Capillary reference values may differ from venous values
- Glucose concentrations are higher in capillary blood
- Total protein (TP), calcium (Ca2+) and potassium (K+) concentrations are lower in capillary blood.

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21
Q

how can you explain to kids about the pain when puncturing

A

tell them that it’s like a bite from an ant or like a sting from a bee.

*there are ways to distract them

22
Q

Used for blood films for hematology determinations

A

microscope slides

[It’s commonly used in hematology to make blood films, which are thin layers of blood spread across the slide. These films allow lab professionals to study blood cells closely for abnormalities, counts, or diseases like anemia and infections.]

23
Q

what is used to warm the site and how does it help

A

warming devices
Warming the site increases blood flow as much as 7 times
Other alternatives: massaging, can use warm towel (not too hot as u might burn the area)
Warming the site can cause vasodilation = allowing free flow of blood.

24
Q

Sterile, disposable, sharp-pointed or bladed instrument

A

Lancet/ Incision Devices

Punctures or cuts skin to obtain capillary blood specimen
Designed for either finger or heel puncture

25
Q

why are earlobes are not recommended for capillary puncture

A

because of the inadequacy of the blood sample that can be obtained from that site

*The earlobe was commonly used, but it is no longer recommended because reduced blood flow renders it unrepresentative of the circulating blood.

26
Q

Small plastic tubes used to collect tiny amounts of blood from capillary punctures

A

Microcollection Containers (different order of draw)

*Some contain anticoagulant, clot activators, gel separators
*Some come with narrow capillary tubes attached (“straw”)
*Have color-coded bodies or stoppers & markings for min/max fill levels
(When filling your microtubes, look at the indicator lines that will give u an idea on until where u can fill it up
Can fill up to 500uL of blood)

27
Q

What are the anticoagulants that are available for microcollection?

A

EDTA
Plain tube with clot activator
Gold top that has gel and clot activator
Gray
Sodium heparin and lithium heparin
Amber tubes for bilirubin testing
- Usually perform capillary puncture in neonates/infants
- Common test
- Amber tubes: as bilirubin is photosensitive = protect sample

28
Q

Disposable, narrow-bore plastic or plastic glass tubes

A

Microhematocrit Tubes
- Prone to break. Handle with care.
- Fill by capillary action

29
Q

Used primarily for hematocrit determinations

A

Microhematocrit Tubes

comes in 2 varieties:
Red ring is heparinized
Blue ring is plain glass

30
Q

how does the one end of the microhematocrit tube is sealed

A

with plastic or clay sealants

31
Q

what are the Capillary Blood Gas Equipment (CBG)

A

CBG collection tubes: narrow-bore plastic capillary tubes
Stirrers: metal filings or bars inserted into tube to mix
Magnet: used for mixing, in conjunction with stirrer
Plastic caps: used to seal tubes

32
Q

what are the indications for Capillary Puncture in Adults & Older Children

A

Available veins are fragile or must be saved for other procedures
Several unsuccessful venipunctures have performed
Patient has clot-forming tendencies
Patient is apprehensive or has an intense fear of needles
There are no accessible veins (IVs in both arms, scars, burns)
For POCT procedures such as glucose monitoring
If a patient can’t afford to have it drawn from the line.

33
Q

what are some reasons for capillary puncture in infants & very young children

A

Small blood volume & risk of anemia
Risk of cardiac arrest when large quantities of blood are removed
Venipuncture is difficult & may damage veins & surrounding tissues
Puncturing deep veins can cause hemorrhage, venous thrombosis, infection & gangrene
Risk of injury due to restraint needed for venipuncture
Capillary Blood is preferred specimen for some tests

34
Q

how much blood is allowed to take from the infants/ newborns

A

Concerned about the infants/ newborns is the volume of the blood.
Allowed to take 10% of the blood. This is being monitored as it might cause iatrogenic anemia.

35
Q

what is the order of draw for capillary specimen

A
  1. Blood gas specimens (CBGs)
  2. Slides
  3. EDTA specimens
  4. Other additive specimens
    -Heparin
    -Chloride
    -Oxalate
  5. Serum specimens -this is the last as the first few drops are a free flow and we do not want clotting.

*Coagulation tests are strictly not allowed. As citrate is not included in the order of draw.

36
Q

what happens if you overfill the tube (micro collection tube)

A

it may cause microclot

Need to follow the indicator lines.
Minimum volume is 250uL. Maximum volume is 500 uL

37
Q

when collecting capillary blood, why should we not scrape the skin

A

as it can cause hemolysis

*Care must be observed during the collection because it may cause elevation of potassium.

38
Q

what is the procedure for capillary puncture

A

transes

39
Q

in step no. 5: how do you position the patient for capillary puncture
Finger puncture:
Young child:
Infant heel puncture:

A

Finger puncture: are supported on firm surface, hand extended & palm down (gravity is your friend)
Young child: held in lap of parent or guardian
Infant heel puncture: supine position
Swaddling of infants/ newborns may be helpful in the collection. and Expose one foot as you’ll be collecting at the heel.

40
Q

how do you select the puncture, incision site for capillary puncture
general criteria:
adults & older children:
infants:

A

General criteria:
- Skin is warm, pink, normal color
- No scars, cuts, bruises, rashes, cyanosis, edema or infection

Adults & older children:
- Palmar surface of distal or end segment of middle or ring finger of nondominant hand (as the patient may use their dominant hand to write, carry stuff. Hence it may cause pain.)
- Central, fleshy portion of the finger
(as the patient may use their dominant hand to write, carry stuff. Hence it may cause pain.)
Central, fleshy portion of the finger

Infants:
- Medial or lateral plantar surface of the heel
- Lateral is the primary area of choice (CANNOT puncture at heel bone as it may cause osteomyelitis)
- Medial is where the posterior tibial artery is located (preterm)
- No more than 2.0 mm deep
(As deeper it might puncture the bone.)

41
Q

what happens when you puncture the bone

A

it may cause

Osteomyelitis:
Inflammation of the bone marrow and adjacent bone.

Osteochondritis:
Inflammation of bone and cartilage, as the result of infection

Fracture in calcaneus:
Heel bone

42
Q

where does the most significant capillary vessels are located

A

0.35 to 1.6 mm below the surface of the skin

43
Q

what is the distance of skin to bones and main nerves of infants

A

it is around 1.2 to 2.2 mm

44
Q

Recommended site & direction of finger puncture & infant heel puncture

A

○ 0.85 mm for preterm infants
○ 2 mm for full term infants

45
Q

why and how do we warm the site

A

○ Warming increases blood flow
up to sevenfold
○ Wrap site for 3 to 5 min, with a warm, moist washcloth, towel or diaper or warming device temp
not to exceed 42 degrees C
(108F)

46
Q

how do you puncture these following sites:
FINGER PUNCTURE
HEEL PUNCTURE

A

FINGER PUNCTURE
■ Grasp patient’s finger between non dominant thumb and index finger
■ Place lancet device flat against skin in central, fleshy pad

HEEL PUNCTURE
■ Grasp foot gently but firmly with nondominant hand
■ Encircle heel by wrapping your index finger around arch thumb around bottom & other fingers around top of foot
■ Place ancient flat against skin on medial or lateral plantar surface of heel

47
Q

why do we wipe away the first blood drop in capillary puncture

A

First drop is typically contaminated with excess tissue fluid

48
Q

in capillary puncture, why do we not we scoop/ scrape the blood

A

As it will cause hemolysis. Just bring the mouth of the container to assist the blood to shoot in the microcontainer.

49
Q

true or false:
Capillary blood should be free-flowing and may contain tissue fluid.

A

true

50
Q

in capillary puncture, what happens if there is an excessive squeezing of site

A

Excessive squeezing of the site while collecting blood can also lead to alteration in the composition of the blood and inaccurate results.

*Milking, scraping of microcontainers and excess pressure may cause hemolysis.

51
Q

what happens if an infant/ newborns is excessively crying

A

it will cause leukocytosis.
allow a few min. of rest before collection
(Hence. Let them rest for a few minutes before collecting. As we do not want a false increase in WBC. )

52
Q

how do we label the specimens for capillary puncture

A

Using a micropore

2024 SEM 1 PMLS 2 (LAB) (10 decks)

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