Capillary puncture, etc.

Question 1

Superficial puncture of skin with sharp point
to draw small amount of blood

Answer 1

capillary puncture

Question 2

capillary puncture is collected in

Answer 2

small calibrated glass tubes,
slides or reagent strips

Question 3

capillary puncture advantage over venous blood sampling

Answer 3

• Less invasive
• Requires small amount of blood
• Can be performed easily and quickly

Question 4

CAPILLARY BLOOD IS COMPOSED OF

Answer 4

: of
blood from arterioles, venules, capillaries and
intracellular and interstitial (tissue) fluid (fluid
that forms within tissue layers and haps)

Question 5

TEST REFERENCE VALUES OF CAPILLARY BLOOD

Answer 5

• K, Ca and protein are lower
• Glucose is typically higher

Question 6

CAPILLARY PRICK COLLECTION SITE

Answer 6

may be on the heel or finger

Question 7

is preferred site for capillary testing in
an adult patient

Answer 7

finger

Question 8

in adult patients ???????????are sometimes used in mass
screening or research studies

Answer 8

earlobes

Question 9

collection site is usually based on age and
weight of the patient

Answer 9

paediatric

Question 10

In infants, what should not be punctured

Answer 10

fingers

Question 11

capillary puncture in the heel is for

Answer 11

r paedia and neonatal patients

Question 12

FINGER O HEEL PRICK
Birth to about
6 months

Answer 12

heel

Question 13

FINGER O HEEL PRICK
Over 6 months

Answer 13

finger prick

Question 13

FINGER O HEEL PRICK
3-10kg approx.

Answer 13

heel

Question 13

FINGER O HEEL PRICK
greater than 10kg

Answer 13

finger-prick

Question 14

FINGER O HEEL-PRICK
lANCET PLACEMENT IS ON the medial or lateral plantar surface

Answer 14

HEEL-PRICK

Question 15

FINGER OR HEEL PRICK

PLACE OF LANCET in the side of the
ball of finger perpendicular to the lines of the fingerprint

Answer 15

FINGER-PRICK

Question 16

RECCOMMENDED FINGER

Answer 16

Second and third
finger (i.e. middle
and ring finger);
avoid the thumb
and index finger
kase may calluses
and avoid little
finger kase
manipis tissue

Question 17

RECOMMENDED PUNCTURE SITE AND INCISION DEPTH

Premature
neonatesl
(up to 3kg

Answer 17

HEEL. 0.85mm

Question 18

INFANTS UNDER 6 MONTHS. RECOMMENDED PUNCTURE SITE AND INCISION DEPTH

Answer 18

Heel 2.0mm

Question 19

Child aged
6 months to
8 years

Recommended
puncture site AND Recommended
incision dep

Answer 19

Finger 1.5mm

Question 20

Child older
than 8 years
and adults

Recommended
puncture site AND Recommended
incision depth

Answer 20

Finger 2.4mm

Question 21

= skin, lips or nails turn b;ue die
to lack of oxygen in your blood whether due to
cold or lack of oxygen.

Answer 21

CYANOSIS EDEMA

Question 22

GENERAL CRITERIA FOR CAPILLARY PUNCTURE

Answer 22

GENERAL CRITERIA:CAPILLARY PUNCTURE SITE
- Skin is warm, normal color
- No scars, burns, bruises
- No rashes, cyanosis edema or infection

Question 23

ADULTS AND CHILDREN: CAPILLARY PUNCTURE SITE

Answer 23

- Middle of ring finger of non-dominant hand - Palmar surface - Distal or end segment - Central fleshy portion of the finge

Question 24

INFANTS: CAPILLARY PUNCTURE SITE

Answer 24

- Medial or lateral surface of the heel - No more than 2.0mm deep

Question 25

CAPILLARY BLOOD:TEST APPLICATIONS

Answer 25

- Point of care testing ( POCT, i.e. blood glucose monitoring) - CBC, hmeoglobin and haematocrit count (H&H) - PBS (manual slide for wbc differential) - Neonatal blood gases - Neonatal billilirubin - Neonatal screening (filter paper or blood spot testing - Electrolytes

Question 26

WHEN TO DO A CAPILLARY PUNCTURE

Answer 26

1. Patients with a fragile superficial or difficult to access vein 2. Patients where multiple unsuccessful venepuncture have already been performed. Especially if the tests requested requires only a small volume of blood 3. Patients with burns or scarring in venous blood collection sites 4. Extremely obese patients 5. Patients requiring a frequent blood test 6. Patients receiving IV therapy in both arms or hands 7. Patients at risk for serious complications associated with venepuncture, venous thrombosis or deep venous puncture (e.g. deep vein puncture in infants, thrombophlebitis) 8. Patients requiring only one blood test for which a capillary specimen is appropriate 9. Patients whose veins are „reserved‟ for intravenous therapy or chemotherapy 10. Point-of-care testing where only a few drops of blood are needed

Question 27

CAPILLARY PUNCTURE IS INAPPROPRIATE FOR

Answer 27

- Severely dehydrated patient - Swollen finger - Poor pheiperal circulation - Coagulation studies requiring plasma specimen - Tests that require large volume of blood (i.e. ESR and blood culture)

Question 27

CAPILLARY PUNCTURE IS INAPPROPRIATE FOR

Answer 27

- Severely dehydrated patient - Swollen finger - Poor pheiperal circulation - Coagulation studies requiring plasma specimen - Tests that require large volume of blood (i.e. ESR and blood culture)

Question 28

ORDER OF DRAW FOR SKIN (CAPILLARY) PUNCTURE

Answer 28

- Blood gases - EDTA tube - Other (BluGoGreLaBlaGraYe) - Serum tubes

Question 29

FINGERSTICK BLOOD COLLECTION INTO MICROTAINER

Answer 29

1. Iready na lahat on top of disposable pad. Iopen na lahat 2. Put on gloves. Turn patient hand upward. Massage hand and lower part of finger to increase blood flow 3. Scrub middle or ring finger with alcohol swab.dry with gauze 4. Hold finger in upward position and the lance finger (Across the fingerpoint) between the side and the pad with the proper size lancet (adult/child). Press firmly on the finger when making the puncture, doing so will help you to obtain the amount of blood you need 5. Apply slight pressure to start blood flow. Blot the first drop of blood on gauze pad and discard in appropriate biohazard manner 6. Keep finger in a downward position and gently massage it (do no “milk” it) to maintain blood flow. Hold the microtainer of an angle at 30 degrees below the collection site and use the scoop on the microtainer to guide the drop into the vial. Do not scrape the skin. Fill the microtainer at 200-500 ul level. 7. Cap microtainer then gently invert it 10 times to prevent clot from forming 8. Apply a sterile adhesive bandage over the puncture site

Question 30

HEEL STICK PROCESS

Answer 30

- Pre-warming the infant‟s heel (42C for 3 to 5 mins) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimen - Clean the site to be punctured with an alcohol sponge. Dry the cleaned area with a dry cotton sponge. Hold the baby‟s foot firmly to avoid sudden movement. - Using a sterile blood lancet,, puncture the area of the heel that just off center from the very center of the heel - Wipe away the first drop of blood with a piece of clean, dry cotton - Fill the capillary tube or micro collection device as needed - When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site and hold in in place until bleeding has stopped.

Question 31

COMPLICATIONS IN CAP PUNCT

Answer 31

- Collapse of veins if the fibial artery is lacerated from puncturing the medial aspect of the heel: - Osteomyelitis of heel bone (calcaneus) - Nerve damage if the fingers of neonates are punctured - Haematoma and loss of access to the venous branch used: - Scarring - Localuzed or generalized necrosis (a longterm effect): - Skin breakdown from repeated use of adhesive strips (particularly in very young or very elderly patients) – this can be avoided if sufficient pressure is applied and the puncture site is observed after the procedure

Question 32

UNSUCCESSFUL ATTEMPTS IN PEDIATRIC PATIENTS

Answer 32

- Adheres strictly to a limit on the number of timesa pediatric patient may be stuck - F no satisfactory sample has been ccollected after 2 attempts, seek a 2nd opinion to decide whether to further attempt or cancel the test