PRMLSP 2

• Lancet/Incision Devices


  Sterile, disposable, sharp-pointed or bladed instrument that punctures or cuts skin to obtain capillary blood specimen, designed for either finger or heel puncture

  
• Laser Lancet


  Vaporizes water in skin to produce a small hole without cauterizing capillaries, no risk of accidental sharps injury, no need for sharps disposal
• Capillary Puncture Equipment


  • Lancet/Incision Devices
  • Laser Lancet
  • Microcollection Containers
  • Microhematocrit Tubes and Sealants
  • Microscope Slides
  • Warming devices

  
• Microcollection Containers


  Small plastic tubes used to collect tiny amounts of blood from capillary punctures, some come with narrow capillary tubes attached, have color-coded bodies or stoppers & markings for min/max fill levels

  
• Microhematocrit Tubes and Sealants


  Disposable, narrow-bore plastic or plastic-clad glass tubes that fill by capillary action, used primarily for hematocrit determinations, one end sealed with plastic or clay sealants
• Microhematocrit Tube Components


  • CBG collection tubes: narrow-bore plastic capillary tubes
  • Stirrers: (fleas) metal filings or bars inserted into tube to mix
  • Magnet: used for mixing, in conjunction with stirrer
  • Plastic caps: used to seal tubes
• Microscope Slides


  Used for blood films for hematology determinations
• Warming devices


  Warming the site increases blood flow as much as 7 times
• Capillary Puncture Specimen Composition

  Mixture of arterial, venous, & capillary blood, interstitial & intracellular fluid, more closely resembles arterial blood than venous
• Capillary Reference Values


  May differ from venous values, glucose concentrations are higher, total protein (TP), calcium (Ca2+), and potassium (K+) concentrations are lower
• Indications for Capillary Puncture in Adults & Older Children

  • Available veins are fragile or must be saved for other procedures
  • Several unsuccessful venipunctures have been performed
  • Patient has clot-forming tendencies
  • Patient is apprehensive or has an intense fear of needles
  • There are no accessible veins (IVs in both arms, scars, burns)
  • For POCT procedures such as glucose and protime monitoring – If pt can't afford to have a waste drawn from line

  
• Reasons for Capillary Puncture in Infants & Very Young Children

  • Small blood volume & risk of anemia
  • Risk of cardiac arrest when large quantities of blood are removed
  • Venipuncture is difficult & may damage veins & surrounding tissues
  • Puncturing deep veins can cause hemorrhage, venous thrombosis, infection, & gangrene
  • Risk of injury due to restraint needed for venipuncture
  • Capillary blood is preferred specimen for some tests

  
• Tests That Cannot Be Collected by Capillary Puncture


  • Most erythrocyte sedimentation rate methods
  • Coagulation studies that require plasma specimens
  • Blood cultures
  • Tests that require large volumes of serum or plasma
• Order of Draw


  • Blood gas specimens (CBGs)
  • EDTA specimens
  • Other additive specimens
  • Serum specimens
• Over filling tube can cause microclot formation
• Capillary Puncture Steps


  Review & accession test request

  2. Approach, identify, & prepare patient

  3. Verify diet restrictions & latex sensitivity

  4. Sanitize hands & put on gloves

  5. Position Patient

  6. Select the Puncture/Incision Site

  7. Select the Puncture/Incision Site

  8. Warm the Site if Applicable

  9. Clean and Air-Dry Site

  10. Prepare Equipment

  11. Puncture the Site and Discard Lancet

  12. Wipe Away the First Blood Drop

  13. Fill and Mix Tubes/Containers in Order of Draw

  14. Place Gauze and Apply Pressure

  15. Label Specimen and Observe Special Handling Instructions

  16. Check the Site and Apply Bandage

  17. Dispose of Used and Contaminated Materials

  18. Thank Patient, Remove Gloves, and Sanitize Hands

  19. Transport Specimen to the Lab

  
• Special Capillary Puncture Procedures

  • Capillary blood gas specimen by heel puncture
  • Neonatal bilirubin collection
  • Newborn/neonatal screening: Phenylketonuria (PKU), Galactosemia, Hypothyroidism, Cystic fibrosis

  
• Blood smear preparation


  A very large drop of blood is placed in center of glass slide

  2. Drop is spread with corner of another slide or cover slip until it is the size of a dime

  3. Allow to dry for a minimum of 2 hours before staining

  4. Must be taken from tube within 1 hour of drawing

  5. "Feather": the thinnest area of a blood film

  
• Capillary Puncture Procedure for Adult Patients

  • Prepare the skin

  2. Puncture the skin with one quick, continuous and deliberate stroke

  3. Wipe away the first drop of blood

  4. Avoid squeezing the finger or heel too tightly

  5. Apply firm pressure to the site to stop the bleeding

  6. Collect specimens in order: hematology, chemistry, blood bank

  
• Capillary Puncture Procedure for Pediatric and Neonatal Patients


  • Immobilize the child

  2. Prepare the skin

  3. Puncture the skin

  4. Take steps to improve ease of obtaining blood

  5. Avoid excessive massaging or squeezing of fingers

  
• Sealing of Capillary Tubes

  Cover one end with index finger

  2. Dip the other end in clay 2-3 times

  3. Apply paraffin seal
• Obtaining blood by finger-prick in pediatric and neonatal patients

  1. Ask the parent to rhythmically tighten and release the child's wrist

  2. Keep the child warm by removing as few clothes as possible, swaddling an infant in a blanket, and having a mother or caregiver hold an infant, leaving only the extremity of the site of capillary sampling exposed

  
• Avoid excessive massaging or squeezing of fingers because this will cause haemolysis and impede blood flow
• Sealing of capillary tubes


  1. Cover one end of the capillary tube with the index finger

  2. Gently dip the other end of the tube in clay 2 – 3 times, ensure that the clay is securely tight in the tube

  3. Follow it up with a paraffin seal. Similar to clay, make sure that the paraffin seal is secured tightly
• Requirements


  • Draw the different areas where capillary blood can be collected as indicated above. Identify the recommended sites to where the puncture is made
  • Perform the finger prick. Collect a substantial amount of blood, approximately ¾ of a red tip capillary tube and a heparinized tube
  • Seal one tip of the capillary tube with clay then followed by paraffin
  • Document the proper procedures done in capillary puncture

  
• Describe some ways of comforting and reassuring pediatric patients after the collection of blood
• Download pictures of the different types of autolancets in the market
• Tabulate common sources of errors made in skin puncture

  
• Objectives


  • To properly collect specimen for special laboratory tests
  • To properly collect specimen for point-of-care-testing
  • To know the different tests that uses blood samples
  • To understand the principles and precautions in point-of-care-testing
• Specimen requirements for blood bank specimens

  • Lavender- or pink-top EDTA tubes
  • Non additive glass red-top maybe used
• Identification & labeling requirements for blood bank specimens

  • Patient's full name
  • Patient's hospital ID# or SS#
  • Patient's date of birth
  • Date & time of collection
  • Phlebotomist's initials
  • ID bracelet w. self-carbon adhesive label for specimen
  • Blood ID-band with linear bar-coded BBID #'s
  • Siemens Patient Identification Check-Blood Administration
• Laboratory procedures


  • Type, Screen, and Cross-Match
  • Blood Donor Collection
  • Blood Cultures
  • Coagulation Specimens
  • 2-Hour Postprandial Glucose
  • Glucose Tolerance Test (GTT)
  • Lactose Tolerance Test
  • Paternity/Parentage Testing
  • Therapeutic Drug Monitoring
  • Toxicology Specimens
  • Trace Elements
  • Point-of-Care Testing
  • Bleeding-Time Test Procedure
  • Arterial Blood Gases and Chemistry Panels
• Type, Screen, and Cross-Match

  • Blood type (ABO) & Rh factor (+ or -) & screen
  • Cross-match to determine compatibility between patient & donor
• Blood Donor Collection


  • Collected for transfusions, not diagnostic testing
  • Collected in "units" from volunteers
  • Requires special training & skills
• Donor eligibility


  • Between ages 17 & 66 years
  • Weight at least 110 lbs
  • Physical exam & medical history required
  • Written permission from donor required
• Lookback program


  • All blood components of unit must be traceable to donor
  • Requires notification to all blood recipients when a donor is shown to be positive for a transmissible disease
• Autologous donation


  Person donates blood for his/her own use (e.g., for elective surgeries)
• Cell salvaging


  • Patient's blood can be salvaged, washed, & reinfused
  • Salvaged blood must be tested for residual free hemoglobin
• Blood Cultures


  • Determine presence & extent of infection
  • Identify type of organism responsible & best antibiotic to use
• Specimen requirements for blood cultures

  • 2 blood culture sets
  • Drawn 30 to 60 min. apart (unless patient in critical condition)
  • Collected in special bottles, one aerobic & one anaerobic