MODULE 5 Capillary Flashcards by Jillian Gardose

Why do we not must puncture any deeper than 2mm?

Deeper punctures risk injuring the bone, even in the safest puncture areas

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Why do we NOT puncture areas between the imaginary boundaries?

The calcaneus may be as little as 2.4mm deep in this area

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Why do we not puncture bruised areas?

Because it can be painful, and impaired circulation or byproducts of the healing process can negatively affect the specimen

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Why do we not puncture in the arch and any other areas of the foot other than the heel?

Arteries, nerves, tendons, and cartilage in these areas can be injured

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Why do we not puncture sites that are swollen

Excess tissue fluid in the area could contaminate the specimen

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Why do we not puncture the posterior curvature of the heel?

The bone can be as little as 1mm deep in this area

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Why do we not puncture through previous puncture sites?

This can be painful and can spread undetected infection

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What are the safest areas to puncture?

Enumerate based on the safest to least

Medial
Lateral
Plantar
Heel

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Why do we warm the site of puncture?

Warming increases blood flow up to sevenfold

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Inflammation of the bone marrow and adjacent bone

osteomyelitis

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Inflammation of the bone and cartilage due to infection

Osteochondritis

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Why do we not puncture fingers of infants and children under 1 year of age

The amount of tissue and skin surface is too small that could lead to gone injury easily.

Also can leas to gangrene and infection

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Why do we not puncture fingers on the same side of mastectomy without permission from the patient’s physician

The arm is susceptible to infection, and effects of lymphostasis can lead to erroneous results.

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Why do we not puncture parallel to the grooves or lines of the fingerprint?

It makes blood collection difficult and the blood will run down the finger rather than form a rounded drop that is easier to collect

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Why must not puncture the fifth/little/pinky finger?

The tissue between the skin surface is the thinnest and can lead to bone injury easily

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Why must not puncture the index finger?

It is Usually more calloused and harder to puncture, more sensitive so the puncture can be more painful. It is usually used more and the patient may notice pain longer

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Why do we not puncture the side or very tip of the finger?

Because it is in the central fleshy portion of the finger

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Why do we not puncture the thumb?

Because it has pulse, indicating an artery in the puncture area, and the skin is generally thicker and more calloused, making it difficult to obtain a good specimen

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What is/are the common tests performed using microhematocrit tubes?

Manual Hct or packed cell volume (PCV)

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What is coated to the tube for collecting Hct tube directly from a capillary puncture?

Ammonium heparin

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What is coated to the tube when Hct tube is filled with blood from a lavender-top tube?

Plain or none

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What color do the non-additive tubes have?

Blue

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How man uL can microhematocrit tubes fill?

50uL to 75uL

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What type of patients does capillary specimen collection is especially useful?

Pediatric

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Why is capillary specimen collection useful for pediatric patients

Removing large quantities of blood can have serious consequences

Often referred as “bullets”

Microtubes or microcollection tubes

What are the types of sealants are used?

Plastic Clay Wax-type

Ability of a liquid to flow into a narrow space or thin tube without the use of external force such as gravity

Capillary action

What is the common capacity of CBG?

100uL

What additive is found in CBG?

Heparin

Warming device must not exceed to what temperature?

42C or 108F

What are the composition of capillary specimens?

Interstitial fluid Intracellular fluid Arterial blood Venous blood Capillary blood

Why is capillary blood contains a higher portion of arterial blood than venous blood?

Because arterial blood enters the capillaries under great pressure than the venous pressure at the exit of capillaries

Warming the site can increase what type pf composition of blood of capillaries will increase its flow?

Arterial

Tissue fluid from spaces between the cells?

Interstitial fluid

Fluid within the cells

Intracellular fluid

concentration of what is higher in capillary blood specimen?

Glucose

What analyte concentrations are lower in capillary blood

Bilirubin Calcium Chloride Sodium Potassium Total protein

What are the following circumstances capillary puncture is appropriate choice for older children and adults?

Available veins are fragile, difficult to access, or must be saved for other procedures such as chemotherapy. • Several unsuccessful venipunctures have been performed and the requested test can be collected by capillary puncture. • The patient has thrombotic or clot-forming tendencies. • The patient is apprehensive or has an intense fear of needles, and capillary collection is acceptable. • The patient is extremely overweight, and veins are difficult to find. • There are no accessible veins (e.g., the patient has intravenous [IV] lines in both arms or the only acceptable sites are in scarred or burned areas). • To obtain blood for point-of-care testing (POCT) procedures such as glucose monitoring

For every 10mL of blood, ____ of iron is removed

4mg

Life may be threatened if more than ____ of blood volume is removed at once

10%

Aside for manual Hct, capillary blood is the preferred specimen for some tests, such as?

Newborn screening tests

True or false Capillary puncture is appropriate for patients who are dehydrated or have poor circulation to the extremities than Venipuncture

False. It is not appropriate because it could cause shock since specimens may be hard to obtain and may not be representative of blood elsewhere

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

Erythrocyte Sedimentation Rate (ESR) Rate Methods Coagulation studies (requiring plasma specimens) Blood cultures Tests requiring large volumes of serum or plasma

What is the order of draw for capillary puncture?

Blood gas specimen EDTA specimen Other additive specimen (Heparin) Serum Specimen

Why is EDTA specimen collected first than other additive specimens?

Because other additive specimens can affect EDTA specimen by clotting

Why is CBG collected first?

To minimize exposure pf the blood to air and because clots in the specimen is not acceptable

Heelstick is used for?

Infants less than a year old

What is the position of infant for heel puncture?

Should be supine with the foot lower than the torso so the force of gravity can assist blood flow

Bluish in color usually from a shortage of oxygen in the blood

Cyanotic

Swollen with fluid, infected, or a recent previous puncture sites

Edematous

Puncture site must be free from:

Scar Bruise Rashes Cyanotic Edematous

What is the cite to puncture for adults and older children?

Palmar surface of the distal segment of the middle finger or ring finger

What is the puncture site for burned patients?

Earlobes

What is the puncture site for infants?

Heel

Safest area for heel puncture?

Most medial and lateral portion of the plantar surface of the heel

Warming the site can be accomplished by wrapping the site for how many minutes?

3-5 minutes

What is the CLSI recommended antiseptic for cleaning a capillary puncture site?

70% isopropanol

What antiseptic is not recommended to use to clean the site? And why?

Povidone iodine. Because it can greatly interferes with some tests- uric acid, phosphorus, and potassium

What tests will be affected when using povidone-iodine as antiseptic for cleaning the site?

Uric acid Phosphorus Potassium

What happens when we squeeze or use strong repetitive pressure?

Can result to hemolysis and tissue fluid contamination

Why do we not apply bandages to infants and children under 2 years of age?

They pose to choking hazard

What age is not recommended to use bandages?

Infants and children under 2 years of age

Brain dysfunction caused by toxic levels of bilirubin

Kernicterus

A treatment used for jaundice infants that can be placed under special lights to lower their bilirubin levels

Phototherapy

Testing of newborns to detect certain genetic, metabolic, hormonal, and functional disorders or conditions that can cause severe mental handicaps or other serious problems if not detected and treated early

Newborn/Neonatal Screening

What puncture is preferred for newborn screening?

Heel puncture

Disorder that is characterized by insufficient levels of thyroid hormones

Hypothyroidism

Inherited disorder characterized by lack of enzyme needed to convert milk sugar galactose into glucose needed by the body for energy

Galactosemia

Why must not the paper touch the surface of the heel for newborn screening?

It could allow smearing, blotting, and stoppage of blood flow and incomplete penetration of blood through the paper

Blood smears prepared from EDTA specimens should be made within ____ of collection to eliminate cell distortion caused by anticoagulants

1 hour

The drop of blood to the slide should be _____ in diameter?

1-2mm

What is the angle of spreader slide?

30 degrees

Probable cause: Absence of feather

Spreader slide lifted before the smear was completed

Probable cause: Holes in the smear

Dirty slide Fat globules in the blood

Probable cause: Ridges or uneven thickness

Too much pressure applied to the spreader slide

Probable cause: Smear too thick

Blood drop too large Spreader slide angle too steep Patient has high red blood cell count

Probable cause: Smear too short

Blood drop too small Spreader slide angle too deep Spreader slide pushed too quickly

Probable cause: Smear too long

Blood drop too large Spreader slide angle too shallow Spreader slide pushed too slowly

Probable cause: Smear is too thin

Blood drop too small Spreader slide angle too shallow Patient has a low hemoglobin

Probable cause: Streaks or tails in feathered edge

Blood drop started to dry out Edge of. spreader slide dirty or chipped Spreader slide pushed through blood drip Uneven pressure applied to spreader slide

True or false: Blood smears are considered non biohazardous or infectious until they are stained or fixed

False. They are biohazardous or infectious until they are stained or fixed

What species caused malaria

Plasmodia

Thick blood smear is used for

Test for malaria

Progressive destruction of red blood cells in certain types of malaria causes?

Severe anemia

Type of specimen preferred for infants, young children, elderly patients, and patients with severe burn

Capillary blood

MODULE 5 Capillary Flashcards

(86 cards)