Module 8

Question 1

What analytes may be different in skin puncture techniques compared to venous samples?

Answer 1

Glucose- higher

Potassium- lower

Total protein- lower

Calcium- lower

Question 2

When may hematocrit be different for skin puncture techniques?

Answer 2

If the site is cold or blood flow is slow.

Question 3

What can puncturing deep veins cause in children?

Answer 3

Cardiac arrest

Hemorrhage

Venous thrombosis

Reflex arteriospasm and gangrene of an extremity

Damage to surrounding organs

Infection

Injury from restraining patient

Question 4

What patients is skin skin puncture good for?

Answer 4

Extreme burns

Extremely obese

Have thrombotic tendencies

Are geriatric or have fragile veins

Perform tests at home

Receive point of care testing

Have veins reserved for treatments

Question 5

What is the procedure for skin puncture?

Answer 5

Check req

ID yourself and the patient

Prep patient- warm site for 3-5min

Position patient- site downwards

Select site- palmar surface of fingers or lateral/medial plantar surface of heel

Dispose of equipment

Check patient and clean up

Question 6

Where can’t blood be collected from?

Answer 6

Earlobe
Posterior curvature of heel
Fingers of patients

Question 7

Where are punctures performed on patients

Answer 7

Heel

Question 8

What is the max depth of puncture in infants?

Answer 8

2.00mm

Question 9

What site is used for skin puncture in patients >1yr?

Answer 9

Fleshy pad of finger.

Question 10

What types of lancets are there?

Answer 10

Microlance- blue and red (long)

Automated lancet BD microtainer contact activated- purple (low), pink (med), blue (high)

BD genie lancet- permanently retractable

BD quickheel lancet- permanently retractable, infant and preemie

Needle orange- glucose

Lancet blue- 2.0mm

Lancet green- 1.5mm

Lancet pink- 1.0mm

Tenderlett- adult, toddler, junior

Question 11

What are the colours of microtainers?

Answer 11

Red- serum

Gold- serum, polymer gel separator (SST)

Amber- serum, polymer gel separator (light sensitive)

Lavender- whole blood, EDTA

Question 12

What are capillary tubes used for?

Answer 12

Collection and transfer of the specimen.

Can be with or without heparin.

Large and small.

Question 13

Describe site prep for skin puncture.

Answer 13

Massage finger to enhance blood flow.

Hold palm up.

Disinfect.

Question 14

How is puncture performed?

Answer 14

Puncture across the finger print lines.

Must pass through the epidermis and dermis.

Use a 45° angle.

Discard lancet.

Wipe away first drop.

Question 15

How are the lancets for finger puncture used?

Answer 15

Microlance- hold between thumb and forefinger, insert up to guard

Safety flow- hold between index and middle finger, press trigger with thumb

Question 16

How is the specimen collected?

Answer 16

Squeeze and release the finger.

Collect drop.

Capillary tube- palm up

Microtainer- palm down, drops flow freely

Question 17

What is the order of fill?

Answer 17

Lavender- min fill 250um

Other additive tubes

Serum tubes

Question 18

When are slides made?

Answer 18

First, use capillary tube.

Question 19

Why is EDTA collected first with skin puncture?

Answer 19

To prevent clumping for hematology.

Question 20

What does milking result in?

Answer 20

Hemolysis or contaminated samples.

Question 21

How many repeats are allowed per collection trip?

Answer 21

One repeat.

Question 22

How long are samples stable for hematology?

Answer 22

2-4hrs

Question 23

What patients are never bandaged?

Answer 23

Infants

Question 24

What part of the heel is never used for puncture?

Answer 24

Posterior heel curvature

Question 25

How is bruising recorded?

Answer 25

Location Left = L Right = R ``` Degree None B+1 = slight B+2 = moderate B+3 = severe ```

Question 26

What can bone puncture result in?

Answer 26

Osteomyelitis

Question 27

What types of lancets are used for heel puncture?

Answer 27

Quickheel Quickheel infant Quickheel preemie

Question 28

How is the ankle held?

Answer 28

Forefinger around ankle and thumb over foot arch. Finger over foot arch and thumb below puncture site at the angle.

Question 29

How is a heel specimen collected?

Answer 29

Gently squeeze and release. Collect in capillary tube.

Question 30

What is done after heel puncture collection?

Answer 30

Elevate heel and apply pressure. If >10min get a nurse

Question 31

What does the neonatal metabolic screen test for?

Answer 31

PKU- detects problems with metabolism Phenylketonuria- deficiency in phenylalanine hydrolase, accumulation leads to retardation, prevented through diet Hypothyroidism- can develop cretinism, critical in first two yrs Biotinidase deficiency- treated with biotin 30+ disorders

Question 32

When is a PKU test performed?

Answer 32

24hrs-5 days

Question 33

What preparation has to be done for PKU cards?

Answer 33

Never exposed to bleach or formalin- falsely low results. Saturate each circle with blood. Make sure blood soaks through. Allow card to dry for an hour in the horizontal position. Allow to dry for an hour in the horizontal position.

Question 34

Where are early discharge and abnormal results sent?

Answer 34

To the physician from the U of A.

Question 35

What happens with repeat NMS testing?

Answer 35

Early discharge- collect as usual and check RT box Abnormal parameter- establish if repeat screen or qualitative test required

Question 36

When are skin puncture techniques traditionally used?

Answer 36

Paediatric patients and for small volumes.