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Capillary Puncture Flashcards

1
Q

the process of collecting a drop of blood for testing by puncturing or making an incision in the dermal layer is called?

A

capillary puncture

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2
Q

other term for capillary puncture?

A

skin puncture

may be on heel, fingers, or earlobe

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3
Q

capillary puncture may be performed on who?

A
  1. newborns, pedia pxs, pxs less than 1 yr old
  2. adult patients severely burned
  3. patients under therapy
  4. obese patients

malarial smear too

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4
Q

capillary puncture may be performed on who?

A
  1. newborns, pedia pxs, pxs less than 1 yr old
  2. adult patients severely burned
  3. patients under therapy
  4. obese patients

malarial smear too

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5
Q

Identify the equipment in skin puncture

sterile, one-time use bleeding instruments that are used on either heel or finger

A

lancets

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6
Q

Identify the equipment in skin puncture

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

A

microcollection tubes

may also be called microtubes

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7
Q

Identify the equipment in skin puncture

disposable, narrow-bore plastic, or plastic-clad glass capillary tubes that fill by capillary action

A

microhematocrit tubes

Capillary action, also called capillary attraction, is the ability of a liquid to flow into a narrow space or thin tube without the use of (or even in opposition to) an external force such as gravity.

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8
Q

microhematocrit tubes that have samples directly from a capillary puncture has what additive as its coating?

A

Ammonium Heparin

Heparin tubes are usually Red or Green

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9
Q

microhematocrit tubes that have samples directly from a lavender-top tube has what additive as its coating?

A

plain; no coating

plain microhematocrit tubes are blue

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10
Q

microhematocrit tubes that have samples directly from a lavender-top tube has what additive as its coating?

A

plain; no coating

plain microhematocrit tubes are blue

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11
Q

how much volume of blood do microhematocrit tubes hold?

A

50-75 uL

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12
Q

in what area to you add the sealant in a microhematocrit tube?

A

in the band area

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13
Q

Identify the equipment in skin puncture

tube used in CBG speciments

A

Capillary blood gas tube

mix these only using the rule of 8

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14
Q

Identify the equipment in skin puncture

used to make blood films

A

microscopic slides

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15
Q

Identify the equipment in skin puncture

used to increase blood flow in the puncture site

A

Warming devices

these increase blood flow for up to 7 times

warm site less than 42oC for 3-5 mins

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16
Q

capillary specimens are a mixture of what types of blood?

A

mixture of arterial and venous blood w/ interstitial fluid

higher arterial than venous because arterial blood enters capillaries due to pumping pressure of the heart

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17
Q

What analyte is higher in capillary blood specimens?

A

Glucose

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18
Q

What analytes are lower in capillary blood specimens?

A
  • Bilirubin
  • Calcium
  • Chloride
  • Sodium
  • Potassium
  • Total protein

BiCaNaKTP is lower in capillary blood; glucose is higher

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19
Q

What analytes are lower in capillary blood specimens?

A
  • Bilirubin
  • Calcium
  • Chloride
  • Sodium
  • Potassium
  • Total protein

BiCaNaKTP is lower in capillary blood; glucose is higher

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20
Q

In infants, for every 10mL of blood, how much iron is removed?

A

4mg of iron every 10mL blood

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21
Q

Indicators for capillary puncture

A
  1. Fragile veins, difficult to access, or must be saved for other procedures
  2. Several unsuccessful venis + test may be collected thru skin puncture
  3. Px has thrombotic or clot-forminng tendencies
  4. Px has intense fear of needles
  5. Px is obese & veins are difficult to find
  6. Px has no accessible veins (IV, scarred, burned)
  7. For POCT
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22
Q

how much blood is removed in order for an infant to possibly have a cardiac arrest?

A

10% of blood volume = life threatening

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23
Q

What are the tests that cannot be collected by capillary puncture?

A
  1. ESR
  2. Coag tests
  3. Blood culture
  4. Large amounts of serum/plasma
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24
Q

Order of draw for capillary puncture

A
  1. Blood Gas Specimen (CBG)
  2. EDTA
  3. Other Additives
  4. Serum specimen

If may smear, then PBS & CBG are interchangeable

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25
where is the recommended site of capillary puncture for adults & children older than 1 year old?
- palmar surface of the distal end of the ring or middle finger & must be perpendicular to the whorls
26
recommended puncture site for infants lesser than 1 year old?
- medial or lateral portions of the plantar surfaces of the heel
27
disease that may be acquired through bone puncture that is characterized by inflammation in the bone marror and adjacent bone
osteomyelitis
28
bone puncture disease that is characterized as inflammation of bone and cartilage due to infection
osteochondritis
29
the primary blood flow/supply in a newborn's heel has a depth of what to what?
0.35 mm to 1.6mm
30
what antiseptic is recommended for site cleaning in capillary puncture?
70% isopropanol
31
what should you do to the first blood drop after skin puncture?
wipe it away as it contains excess tissue fluid & to remove alcohol residue which may hemolyze specimen
32
what is used to perform manual differential count?
Peripheral blood film on microscopic slides ## Footnote these must be collected first in skin puncture to avoid platelet clumping
33
how many blood smears are normally prepared and submitted for testing?
two blood smears | this is accdg to book
34
considering the order of draw in skin puncture specimens, where should we put peripheral blood smear?
first; blood smears should be collected first to avoid effects of platelet clumping
35
in peripheral blood smears, how large should the drop of blood be in diameter?
1-2mm in diameter | place this on the centered portion adjacent to the frosted end 1-1/2 in
36
how many degrees should you hold the pusher or spreader slide to create a smear?
30 degrees
37
If bleeding persists beyond how many minutes should you inform the physician?
If bleeding persists beyond 5 minutes
38
if preparing a smear from EDTA specimen, for how many minutes must it be mixed first?
a minimum of 2 mins ## Footnote this is to ensure a uniform specimen
39
if preparing a smear from EDTA specimen, for how many minutes must it be mixed first?
a minimum of 2 mins ## Footnote this is to ensure a uniform specimen
40
characteristics of a good smear
1. smooth transition from thick to thin when held up to the light 2. "**feather**" is present 3. covers 1/2 to 3/4 of the surface of the slide 4. must have no holes, lines, or jagged edges
41
what do you call the most important area in a blood film because that is where a differential count is performed?
feather
42
characteristics of a bad smear
1. uneven, too long, short, thick 2. presence of holes, lines, or ragged edges
43
before collecting blood gas specimens on infants, how many minutes should you warm the site first?
5-10 minutes
44
how should you mix CBG specimens?
rule of 8
45
what should you do after collecting blood on capillary blood gas tubes?
seal both ends to avoid exposure to air | then mix w/ magnet or rule of 8
46
where should you place CBG specimens for transport?
in ice
47
what analyte is compromised if exposed to light?
bilirubin
48
what do you call the brain dysfunction caused by toxic levels of bilirubin?
kernicterus
49
what do you call the treatment used to jaundiced infants who are placed under special lights to lower their bilirubin levels?
phototherapy
50
in what tubes are bilirubin specimens usually collected?
in amber-colored microcollection containers
51
what do you call the state-mandated testing of newborns to detech certain genetic, metabolic, hormonal, and functional disorders or conditions that can cause severe mental handicaps?
Newborn/Neonatal Screening (NBS) | odiba parang national bookstore lng
52
how many hours after birth should NBS be performed on infants?
24-72 hours after birth
53
what is the law for expanded newborn screening?
RA 8892
54
is a genetic disorder characterized by a defect in the enzyme that breaks down the amino acid phenylalanine, converting it into the amino acid tyrosine.
Phenylketonuria
55
a disorder that is characterized by insufficient levels of thyroid hormones.
hypothyroidism
56
an inherited disorder characterized by lack of the enzyme needed to convert the milk sugar galactose into glucose needed by the body for energy.
Galactosemia
57
a genetic disorder caused by one or more mutations in the gene that causes the body to produce thick, sticky mucus secretions that build up in the lungs (leading to pulmonary infections) and other organs
Cystic Fibrosis
58
Which of the following tests requires an arterialized specimen? a. Bilirubin b. Blood gases c. Electrolytes d. Glucose
b. blood gases
59
Capillary puncture supplies include all the following except a a. gauze pad. b. lancet. c. microcollection device. d. povidone-iodine pad.
d. povidone-iodine pad
60
Capillary puncture blood contains a. arterial blood. b. interstitial fluids. c. venous blood. d. all of the above.
d. all of the above
61
The concentration of which substance is higher in capillary blood than in venous blood? a. Blood urea nitrogen b. Carotene c. Glucose d. Total protein
c. glucose
62
Capillary puncture is typically performed on adults when a. no accessible veins can be located. b. patients have thrombotic tendencies. c. veins are saved for chemotherapy. d. all of the above.
d. all of the above
63
If collected by capillary puncture, which of the following is collected first? a. CBC b. Electrolytes c. Glucose d. Phosphorus
b. electrolytes
64
Which of the following conditions disqualifies a site for capillary puncture? a. Cyanotic b. Edematous c. Swollen d. All of the above
d. all of the above
65
Which of the following is the least hazardous area of an infant’s foot for capillary puncture? a. Central area of the heel b. Lateral plantar heel surface c. Medial area of the arch d. Posterior curvature of the heel
b. lateral plantar heel surface
66
According to CLSI, a heel puncture lancet should puncture no deeper than a. 1.5 mm. b. 2.0 mm. c. 2.5 mm. d. 3.0 mm.
b. 2.0 mm
67
Which of the following is a proper capillary puncture procedure? a. Clean the site thoroughly with povidone-iodine. b. Milk the site to keep the blood flowing freely. c. Puncture parallel to fingerprint grooves. d. Wipe away the first drop of blood.
d. wipe away the first drop of blood
68
When making a routine blood smear, the “pusher slide” is normally used at an angle of how many degrees? a. 15 b. 30 c. 45 d. 60
b. 30 degrees
69
The blood specimen for which test is placed in circles on special filter paper? a. Bilirubin b. CBGs c. PKU d. Malaria
c. PKU ## Footnote PKU stands for phenylketonuria which is a disorder detected by NBS
70
Which of the following fingers is the best choice for a capillary puncture? a. Index b. Middle c. Pinky d. Thumb
b. middle
71
Which test cannot be collected by capillary puncture and taken to the laboratory for processing and testing? a. Bili b. Hgb c. Lead d. PTT
d. PTT
72
Capillary action is a term used to describe how a. arterial blood enters the capillaries. b. blood fills a microhematocrit tube. c. cells spread across a blood smear. d. warming can increase blood flow.
b. blood fills a microhematocrit tube
73
Fluid in the spaces between the cells is called a. interstitial fluid. b. intracellular fluid. c. lymphatic fluid. d. peritoneal fluid.
a. interstitial fluid
74
Correct newborn screening test collection or handling includes a. applying blood drops to both sides of the filter paper. b. hanging a specimen slip to dry in a vertical position. c. layering successive blood drops in a collection circle. d. using one large drop to entirely fill a collection circle.
d. using one large drop to entirely fill a collection circle
75
Strong repetitive pressure, such as squeezing or milking a site during capillary specimen collection a. can hemolyze and contaminate specimens. b. improves the accuracy of CBC test results. c. increases venous blood flow into the area. d. is necessary to obtain adequate blood flow.
a. can hemolyze and contaminate specimens
76
Neonatal screening is the testing of a. babies for contagious diseases. b. infants with certain symptoms. c. newborns for certain disorders. d. pregnant women for diseases.
c. newborns for certain disorders
77
In an infant’s heel, the primary blood supply is located a. between 0.35 and 1.6 mm deep. b. from 1.00 mm to 2.00 mm deep. c. in the top layer of the epidermis. d. starting at around 2.4 mm deep.
a. between 0.35 and 1.6mm deep

PMTP2 (8 decks)

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