w8 safe blood collection Flashcards
who are skin puncture or capillary collections generally used for?
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
dermal puncture of finger or heal contains
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
what analyte results are different in a capillary sample compared to a venous sample
increased glucose
increase potassium
decrease in total protein
decrease in calcium
cold hand
blood stops flowing and hematocrit reading is significantly different
what does milking of site result in
hemolyzed specimen-falsely elevated potassium level and pain to person
when are capillary punctures used on older patients 7
- 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
Do not take blood from 9 areas
- 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
order of draw for microtainers
- EDTA
- other additives
- serum specimens
(blood gas first but we don’t collect those:
hematology specimens collected first in order to avoid blood clotting
ergonomics of capillary collection
position patient in a way during capillary collection that phlebotomist remains as upright as possible throughout procedure.
how to prepare patients hand for capillary puncture
-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.
which fingers to use for capillary collection
use middle or ring fingers -thumb index too calloused, pinky too close to bone. -never use finger for infant, always use heel
finger assessment
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
what equipment do you need for capillary collection
- 70%isopropyl alcohol
- gauze 3-4 piles
- microtainers
- bandage
- lancet
what does choice of lancet depend on?
size and age of patent and the size of their fingers
how to perform skin capillary skin puncture
- palm up
- engorge with blood
- warn pole
- align lancet across whorls
- press firmly until you feel lancet pierce and retract then dispose of it
- wipe frost drop away with gauze
- turn hand palm down
- firm gentle pressure, squeeze release allow drop to form and collect.
how to hold patients finger for capillary collection
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
how do hemolyzed samples occur during capillary collecitons
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
what to do if blood flow stops during capillary collection
repeat procedure at a different site using a fresh lancet, each phlebotomist gets two tries.
how many microtainers used for collection
3
what does vigorous crying result in?
an increased white cell count
what do neonatal intensive care units require?
clean gown worn
antiseptic soap
when is heel puncture used
infants less than one year of age, after age of one infants may be walking on heel
who do you identify yourself to?
the staff in the nursery and you identify say who you are, what you are here to do, why you are doing it
how to get consent for baby
parents give consent for baby
how to prepare heel for poke
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
ultraviolet light therapy
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
selecting site of heel puncture
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
if infant is crying a lot
wait 30 minutes before collection, increased white blood cell count, if still crying make a note on req
how to decrease drama for heel poke
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
important to remember
do not use device that will puncture more than 2mm deep
what can occur when heel of baby is punctured
osteomyelitis(inflammation of the bone marrow and adjacent bone)
osteochondritis (inflammation of the bone and cartilage or soft tissue damage
how to hold babies heel
put index finger over arch and thumb under heel then have the rest of the fingers on babies heel to prevent movement and kicking
why do you not scrape scoop
it will hurt patient just let it collect the drops of blood
what to do when heel collection complete
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
what to do if baby is bruised after heel poke
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
what does NMS stand for
newborn metabolic screening card
what is NMS
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
when is blood collected for NMS
24-72 hours of age as close to 24 hours as possible.
what can screening provide diagnosis to for NMS
17 treatable conditions:
14 metabolic conditions
2 endocrine conditions
cystic fibrosis
what is NMS also known for
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
infant who is hypothyroid
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
biotinidase deficiency
screened by NMS card
treated easily with biotin a b vitamin
how should NMS card be stored
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
labelling of NMS
black ink and printed not pre made
how to use NMS card
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
NMS card drying
allow to dry horizontally on a wire rack for 3 hours and dont touch anything.
TAT for NMS
once card received turn around time is 48-96 hours 2-4 days
abnormal result for NMS
sent directly to physician or midwife and its their responsibility to arrange further clinical assessment and diagnostic testing to confirm or exclude diagnosis
borderline or inadequate result for NMS
physician or midwife contacted immediately and a new test is ordered- collect within 96 hours of order
