MOD 7

• When the patient is a young child, he should be placed in the lap of his guardian. 
•    During finger puncture, the patient's arm should be placed in a firm surface. His arms should be extended, and his palms are facing up.
• the infant heel puncture should be performed with them in a supine position and his foot not lower than his torso.
• The skin of the incision site should be pink, normal in color, and warm. The selected area should be free from scars, cuts, bruises, rashes, cyanosis, edema, or infection.
• When the patient is an adult or an older child the palmar surface of the distal, end segment of the middle finger or ring finger of the non-dominant hand should be used. 
• For infants, the incision site should be less than 2.0 mm deep and to avoid bone damage the incision the recommended site should be in the plantar surface of the heel, or on the median or lateral edge.
• Warming the incision site increases the blood circulation in the area for up to seven times. Using a warm washcloth or towel, warm the site for 3 to 5 minutes. 
• When doing the finger puncture, the phlebotomist should hold the finger between the thumb and index finger of the non-dominant hand. He should then place the lancet flat against the central fleshy part of the incision site.
• For heel puncture, he should hold the foot gently but firmly and proceed to encircling the heel with the use of the index finger near the arch, the thumb should be placed in the bottom, and the rest of the fingers around the top portion of the foot. Then the lancet is positioned in the medial or lateral plantar of the heel.
• The Order of Draw should be Blood gas specimens (CBGs), EDTA specimens, other additive specimen and serum specimen.
• • Newborn/neonatal screening- determine inborn disorders such as phenylketonuria, hypothyroidism and galactosemia, and cystic fibrosis.
• • Newborn screening blood spot collection- determine disorders that are not apparent at birth that could lead to disability or even death.
• • Routine blood film/smear preparation is a blood test that is used to check abnormalities in the blood cells. 
• • Thick blood smear preparation is used to determine if the patient has malaria which is diagnosed by its presence in the peripheral blood smear.
• The Capillary blood specimen is a mixture of different blood and fluids which include the following: arterial blood, venous blood, capillary blood, interstitial fluid and intracellular fluid.
• The capillary reference values may vary from the venous values. The concentration of the glucose in the blood is higher, while the Total Protein (TP), Calcium (Ca2+), and potassium (K+) concentrations are lower.
• Advances in laboratory instrumentation and the popularity of point-of-care testing make it possible to perform a majority of laboratory tests on microsamples of blood obtained by dermal puncture on both pediatric and adult patients.
• Microcollection Containers -  a small plastic tube used which holds blood specimen collected in the capillary puncture. 
• Microhematocrit Tubes and Sealants - narrow bore tube that could be made of plastic or glass typically used for hematocrit determinations.
• • Capillary Blood Gas Equipment (CBG) - special equipment which contains CBG collection tubes, stirrers, magnet and plastic caps.
•  Capillary specimens could be a good alternative to venipuncture for infants and young children because:

  (1) health risks such as anemia, and cardiac arrest;

  (2) requires only a small volume of blood;

  (3) venipuncture could damage veins and tissues surrounding the site;

  (4) puncturing could result in hemorrhage, thrombosis, gangrene, and infection;

  (5) risk of injury because of the restraint needed in venipuncture; and

  (6) capillary blood is the preferred specimen.
• infant heel puncture should be performed with the baby in a supine position and his foot not lower than his torso.
• selected area should be free from scars, cuts, bruises, rashes, cyanosis, edema, or infection.