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| Describe the recommended boundaries/area to perform capillary puncture from an infant patient | • Plantar surface of the heel, • Medial to an imaginary line extending from middle of big toe to the heel OR • Lateral to an imaginary line extending from between the 4th and 5th toe to the heel |
| What is the rationale for: Do not puncture fingers of children under one year old | Amount of skin between skin surface and bone is so small that bone injury is likely |
| What is the rationale for: Do not puncture the index finger | It is more sensitive, therefore more painful, and is more calloused |
| What is the rationale for: Do not puncture the thumb | It has a pulse and the skin is thick and calloused |
| What is the rationale for: Do not puncture the side or tip of the finger | The distance between skin and bone is half as much as the tissue between the fleshy central portion of the finger |
| What is the rationale for: Do not puncture parallel to the grooves of the finger prints | Makes blood collection difficult, as blood does not form a rounded drop |
| What is the rationale for: Do not puncture the “pinky”/ little finger | Tissue between skin and bone is thinnest in this finger, making bone injury more likely |
| Do not puncture the posterior curve of the heel because: | The bone can be as little as 1mm deep - bone injury |
| Do not puncture in the arch of the foot because: | Arteries, nerves and tendons may be damaged |
| List 4 blood tests that cannot be performed by skin puncture | • ESR • Blood culture • Coagulation studies • Tests requiring larger volumes of serum or plasma |
| Describe THREE ways you can prevent a capillary specimen from haemolysing during collection | Don't excessively squeeze or milk the puncture site to obtain blood. Allow alcohol to air dry completely before making a puncture. Don't prick a haematoma site or swollen site. Wipe away the first drop of blood to prevent tissue fluid contamination |
| Explain the technique errors that could make the collection of capillary blood difficult | •Didn't warm site •Didn't allow alcohol 2dry •Didn't make proper cut •Didn't squeeze correct •Didn't release 2 allow capillaries 2 fill •Didn't wipe away plts from edge of wound •Didn't cut across finger print •Didn’t lower heel to help blood flow |
| Explain rules to consider when collecting a dermal sample for a newborn metabolic screening test using a Guthrie card | •Filter paper mustn't touch heel •A large drop of blood must completely fill each of the demarcated circle •Blood to soak through both sides of paper •Allow specimen to air-dry before packing •Don't contaminate card with gloves, fingers, alcohol |
| List causes of how a phlebotomist could potentially infect a dermal puncture site | • Use of non-sterile or contaminated equipment • Poor aseptic technique • Using an infected site • Using a previously punctured site |
| Where would you perform a capillary puncture on an adult? | Palmer surface of the distal/ end segment, on the fleshy pad of the middle and ring finger of non-dominant hand perpendicular to whorls of the fingerprint |
| When doing a heel puncture: Do not puncture any deeper than 2mm because | Deeper punctures risk injuring bone even in the safest puncture areas |
| When doing a heel puncture: Do not puncture severely bruised areas | It is painful, and impaired circulation or by-products of healing can negatively affect the specimen |
| When doing a heel puncture: Do not puncture through previous puncture sites | This can be painful and can spread infection |
| When doing a heel puncture: Do not puncture a site that is swollen | Excess tissue fluid in the area could contaminate the specimen |
| When doing a heel puncture: Do not puncture areas between imaginary boundaries | The calcaneus may be as little as 2mm deep in that area |
| List nine finger prick sites that are not recommended and explain why the site is not recommended | •fingertip-close2bone •Parallel2fingerprints-no round drop •Index finger-hard skin, sensitive •Little finger-less tissue •Infantsfingers-less tissue •Thumb–pulse •Oedematous–tissue fluid •Previously punct–old blood •Infected–infect •Mastectomy- |
| Describe ways you can cause a capillary specimen to haemolyse during collection | •Excessive squeezing of puncture site or “milking” site to obtain enough blood. •The presence of Isopropyl 70% alcohol on the skin i.e. the skin was not allowed to dry before it was punctured •Pricking a haematoma site •Scraping tube against the skin |
| Describe a common cause of bruising a patient during a capillary puncture | Squeezing the site too hard |
| Name problems that may happen if you repeatedly collect capillary specimens from the same site | • The site may become infected • It is more painful for the patient • Old blood will get into the sample giving an incorrect result |
| Explain why you cannot collect capillary blood from an oedematous site | Because the tissue fluid will dilute the sample and give erroneous results |
| When obtaining a capillary sample for a newborn screening test, care must be taken not to contaminate the Guthri card with........? | Glove powder....Urine from the infants diaper.....Alcohol Residue |
| Why may coagulation studies not be performed on dermal blood? | Because puncturing the skin releases tissue thromboplastin which activates the coagulation process and will negatively affect coagulation results |
| List indications for dermal puncture in adults | • Fragile veins • POC • Intense fear of needles • No access to veins • Pt has clot forming tendencies • Several unsuccessful venipuncture’s |
| Briefly describe the composition of capillary blood | Is a mixture of both venous and arterial blood |
| What is the acceptable age group for doing dermal/heel prick on babies? | Birth to 1 year old |
| Explain how the patients arm needs to be positioned prior to dermal puncture | • the arm must be supported on a firm surface • with the hand extended and palm facing up |
| List the order of draw for the dermal puncture procedure | • Blood gas (if requested) • EDTA • Other additive tubes • Gel/ non additive tubes |
| Name one tube that may not be used in dermal puncture AND give your reason | • Citrate tube/ blue top tube • Because you may not obtain blood for coagulation studies by dermal puncture. As soon as a dermal cut is made, tissue thromboplastin will be released & activate the coagulation cascade - influencing any coagulation results |
| List items of equipment you would assemble in preparation for a dermal puncture procedure | •Warming device •70% Isopropyl alcohol •gauze •adhesive plaster •Capillary tubes •Lancet •Microtainer tubes •POC device |
| Why is it important to warm the site prior to dermal puncture? | Increases blood flow by 7 fold |
| Give the reason for wiping away the first drop of blood when doing a dermal puncture | • Prevents contamination of tissue fluid and residual alcohol |
| What could the consequence be to puncturing the heel bone of a baby? | Osteomyelitis/ osteochondritis |
| Where in relation to the whorls of the finger print must the puncture be made with the lancet? Give the reason for your answer | • Perpendicular to the whorls • To facilitate a rounded drop of blood to form, thus making collection easier |
| Explain rules to consider when collecting a dermal sample for a newborn metabolic screening test using a Guthrie card | •filter paper must not touch the heel •A large drop of blood must completely fill each demarcated circle •blood must soak through both sides of paper •specimen to air-dry before packing •Dont contaminate card with gloves, fingers, alcohol |
Why is it important for the lancet to be positioned to cut across?
To obtain the best capillary specimen using the finger, align the puncture device perpendicular (horizontal) to the whorls of the fingerprint. This cross-cut of the fingerprint whorls causes the blood to bead at the puncture site, allowing the phlebotomist to efficiently collect the drops of blood into the container.
When using a lancet How should the puncture be positioned on the finger?
Hold the finger in an upward position and lance the palm-side surface of the finger with 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.
Which is a correct location for finger puncture?
The distal end of the third or fourth finger is the most commonly used site. The very tip of the finger should not be punctured because there is a greater chance of puncturing bone as the bone is close to the skin surface. Puncture the fleshy pad on the end of the finger, slightly off center.
When performing an incision for a fingerstick collection the cut should be made?
The puncture should be made just off center and perpendicular to the fingerprint ridges. (A puncture parallel to the ridges tends to make the blood run down the ridges and hamper collection.)