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201 patient services > w8 safe blood collection > Flashcards

w8 safe blood collection Flashcards

1
Q

who are skin puncture or capillary collections generally used for?

A

paediatric patients, infants and children
reasoning: venipuncture collections from infants can be challenging and damaging - paediatric patients have max blood draw volumes per 24-hour period which is monitored and based on their weight

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2
Q

dermal puncture of finger or heal contains

A

blood from arterioles, capillaries, venues as well as interstitial and intracellular fluid.
-more arterial blood than venous blood because of increased pressure in arteries – this creates a more red colour

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3
Q

what analyte results are different in a capillary sample compared to a venous sample

A

increased glucose
increase potassium
decrease in total protein
decrease in calcium

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4
Q

cold hand

A

blood stops flowing and hematocrit reading is significantly different

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5
Q

what does milking of site result in

A

hemolyzed specimen-falsely elevated potassium level and pain to person

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6
Q

when are capillary punctures used on older patients 7

A
  • severe burns
  • extremely obese
  • thrombotic tendencies
  • geriatric patients or anyone who has inaccessible, superficial or fragile veins
  • who perform tests at home
  • point of care testing
  • veins reserved for therapeutic treatments
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7
Q

Do not take blood from 9 areas

A
  • earlobe
  • central area of infants foot(arch) curvature of heel
  • swollen oedematous or previously punctured site
  • blue/cyanotic areas
  • inflamed, infected areas
  • scarred areas
  • bruised areas
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8
Q

order of draw for microtainers

A
  1. EDTA
  2. other additives
  3. serum specimens

(blood gas first but we don’t collect those:
hematology specimens collected first in order to avoid blood clotting

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9
Q

ergonomics of capillary collection

A

position patient in a way during capillary collection that phlebotomist remains as upright as possible throughout procedure.

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10
Q

how to prepare patients hand for capillary puncture

A

-increase blood flow to area by WARMING, this can be done at a sink or using the commercially available heat warmers or cover with warm, moist towel
42 degrees for 3-5
*less patient trauma and better quality
-position patient so you are comfortable and so that you can have their hand held downward.

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11
Q

which fingers to use for capillary collection

A

use middle or ring fingers -thumb index too calloused, pinky too close to bone. -never use finger for infant, always use heel

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12
Q

finger assessment

A

select puncture site by grasping patients middle and ring finger and engorge them with blood, look for previous puncture sites or bruising. heat cold fingers

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13
Q

what equipment do you need for capillary collection

A
  • 70%isopropyl alcohol
  • gauze 3-4 piles
  • microtainers
  • bandage
  • lancet
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14
Q

what does choice of lancet depend on?

A

size and age of patent and the size of their fingers

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15
Q

how to perform skin capillary skin puncture

A
  1. palm up
  2. engorge with blood
  3. warn pole
  4. align lancet across whorls
  5. press firmly until you feel lancet pierce and retract then dispose of it
  6. wipe frost drop away with gauze
  7. turn hand palm down
  8. firm gentle pressure, squeeze release allow drop to form and collect.
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16
Q

how to hold patients finger for capillary collection

A

non-dominant hand, place index finger under patients finger, supporting it just behind the first joint so that it dangles over your finger. place your thumb on the top of the patients finger so you can press on their nail

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17
Q

how do hemolyzed samples occur during capillary collecitons

A

excessive milking
to much pressure
if site is wet with water or alcohol
newborns blood is more likely to hemolyze due to high hematocrits and increased red blood cell fragility

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18
Q

what to do if blood flow stops during capillary collection

A

repeat procedure at a different site using a fresh lancet, each phlebotomist gets two tries.

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19
Q

how many microtainers used for collection

A

3

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20
Q

what does vigorous crying result in?

A

an increased white cell count

21
Q

what do neonatal intensive care units require?

A

clean gown worn

antiseptic soap

22
Q

when is heel puncture used

A

infants less than one year of age, after age of one infants may be walking on heel

23
Q

who do you identify yourself to?

A

the staff in the nursery and you identify say who you are, what you are here to do, why you are doing it

24
Q

how to get consent for baby

A

parents give consent for baby

25
Q

how to prepare heel for poke

A

heat foot not exceeding 42 degrees for at least 3 minutes (not more than 10)
-infants must always be placed in a bassinet lying up with their foot lower than their heart to help blood flow
NICU neonatal intensive care unit- can’t be moved must adjust to them

26
Q

ultraviolet light therapy

A

used on nursery infants with elevated bilirubin levels. -turn uv light off when collecting. check infants eye protection is okay and turn light off before you leave

27
Q

selecting site of heel puncture

A

proximity of bone to skin is of major importance for site selection of skin punctures, the heel bone may be as close as 2.4mm below surface for preemie.

  • newborns major blood vessels located at dermal subcutaneous junction 0.35- 1.6mm below skins surface (this is arch of foot)
  • to not use posterior curve of heel
  • medial and lateral planter heel surface is safe for collection
  • *no bruising or inflammation - record presence of bruising
28
Q

if infant is crying a lot

A

wait 30 minutes before collection, increased white blood cell count, if still crying make a note on req

29
Q

how to decrease drama for heel poke

A

keep baby warm and comforted -also improves flow and quality of specimen.
keep infant swaddled and only expose what is needed to maintain body temperature

30
Q

important to remember

A

do not use device that will puncture more than 2mm deep

31
Q

what can occur when heel of baby is punctured

A

osteomyelitis(inflammation of the bone marrow and adjacent bone)
osteochondritis (inflammation of the bone and cartilage or soft tissue damage

32
Q

how to hold babies heel

A

put index finger over arch and thumb under heel then have the rest of the fingers on babies heel to prevent movement and kicking

33
Q

why do you not scrape scoop

A

it will hurt patient just let it collect the drops of blood

34
Q

what to do when heel collection complete

A

elevate heel above body and press a clean gauze pad or cotton ball on site until bleeding stops. if patient bleeds for more than 5 minutes inform nurse, do not leave a bleeding child
**do not put a bandaid on child. they may choke and it could hurt their sensitive skin

35
Q

what to do if baby is bruised after heel poke

A 
document collection and bruised site
1. location - L or R heel
2. degree of bruising 
none 
b+1 slight
b+2 moderate
b+3 severe 
the site of collection is circled so 
(L) RB+1 this means the left foot was collected on and there was a slit bruise on the right heel
36
Q

what does NMS stand for

A

newborn metabolic screening card

37
Q

what is NMS

A

a blood test done on all newborn abbies within the first few days of leave and it screens for conditions that can be treated early to prevent health issues and save the life of the infant *test is voluntary

38
Q

when is blood collected for NMS

A

24-72 hours of age as close to 24 hours as possible.

39
Q

what can screening provide diagnosis to for NMS

A

17 treatable conditions:
14 metabolic conditions
2 endocrine conditions
cystic fibrosis

40
Q

what is NMS also known for

A

PKE phenylketonuria- amino acid defect. caused by deficiency in enzyme phenylalanine hydrolase- required to metabolize phenyl aline into tyrosine. – if not present accumulation of phenylalanine occurs and related organic acids —-oberall resulting in intellectual disability and reduced growth- brain damage can occur and irreversible but if this condition is diagnosed early on brain damage can be prevented by using a diet without phenylalanine

41
Q

infant who is hypothyroid

A

could develop cretinism=mental and physical abnormalities -thyroid hormone can be replaced with proper medication – critical in first two years of life because of brain development
screened by NMS card

42
Q

biotinidase deficiency

A

screened by NMS card

treated easily with biotin a b vitamin

43
Q

how should NMS card be stored

A

away from heat sunlight and water, filter paper should never be touched especially with bleach because bleach causes falsely low results – also don’t expose to formalin

44
Q

labelling of NMS

A

black ink and printed not pre made

45
Q

how to use NMS card

A

saturate area of each circle of front side by touching card against drop of blood on heel. make sure blood soaks through.
do not reapply after blood has started to dry -not enough blood second puncture
-try and get 4 spots, minimum of 2 okay

46
Q

NMS card drying

A

allow to dry horizontally on a wire rack for 3 hours and dont touch anything.

47
Q

TAT for NMS

A

once card received turn around time is 48-96 hours 2-4 days

48
Q

abnormal result for NMS

A

sent directly to physician or midwife and its their responsibility to arrange further clinical assessment and diagnostic testing to confirm or exclude diagnosis

49
Q

borderline or inadequate result for NMS

A

physician or midwife contacted immediately and a new test is ordered- collect within 96 hours of order

201 patient services (27 decks)

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