Compliancy

Infant Heel Stick

Procedure to obtain a blood micro collection sample for children under 1 year old, ensuring proper site selection and depth of capillary puncture.

Capillary Puncture Depth

Ranges from 0.85 mm for premature infants to 2 mm for full-term infants, ensuring adequate blood sample collection without injury.

Sample Labeling

Each sample must have a label with the test name, patient's complete name, hospital number, and unique identifier for proper identification and tracking.

Order of draw

1. Blood culture tube or bottle or yellow-stoppered blood culture tubes

2. Light blue (coagulation tubes)

3. Red/black (plastic or glass) or SST (serum tubes with out without clot activator or gel serum separator)

4. Green (heparin tubes with or without gel plasma separator)

5. Lavender (EDTA tubes)

6. Gray  (oxalate/fluoride, glycolytic inhibitor tubes) 

What is the order of drawing for capillary blood samples?

1. Blood gasses

2. Lavender stoppered (EDTA) microcollection container

3. Green stoppered (sodium heparin) microcollection container

4. Other additive microcollection container

5. Red stoppered (nonadditive) microcollection container

For infants the site should be ____ surface ____to the line drawn posteriorly from the middle of the heat toe or ____ between the fourth and fifth toes to the teel.

plantar; medial; lateral

True of false: Puncture shouldn’t be done at a previous puncture site because of the possible infection.

true

Don’t puncture in the central arch of the foot as this can cause damage to the _________

nerves, tendons, and cartilage.

The optimal depth of capillary puncture from which an adequate blood sample can be obtained without injury varies from ____ for premature infants to _____ for full-term infants

0.85 mm; premature infant; 2 mm full-term infants

The capillary bed of the preterm to full-infant is ____ to ___ beneath the skin surface.

0.35-1.6mm

True or false: Puncture of the fingers of infants less than 1 year of age should be done only after other options are considered

True

Supplies need for infant heel stick:

• Gloves

• Sterile gauze

• 70% propyl alcohol

• capillary tubes,

• micro collection containers

• calibrated pipettes

• sharps container

• disposable sterile puncture device

Steps for infant heel stick:

1. Preform hand hygiene and apply gloves

2. Identify the patient

   • Inpatient check with nurse and verify via the identification bracelet and hospital number on the computer/requisition information.

3. Verify collection orders

4. Choose a heel for a puncture site that isn’t cold or edematous

5. Warm the foot for 3 minutes with a warm washcloth or heel warmer

6. Select the appropriate containers for blood collection

7. Clean the puncture site with alcohol and let it air dry

8. Prepare the puncture device for use. Turn off any light that might be over the infant.

9. Puncture the heel with the disposable puncture device. Dispose of the device in a sharps container.

10. Wipe away the first drop of blood with a sterile dry gauze pad

11. Collect the sample. Only touch the tip of the tube to the drop of blood. Don’t allow the collection container to make direct contact with the incision site.

    • Blood flow is encouraged if the puncture site is held in a downwards angle and a gentle pressure applied to the foot.

12. Seal the sample container. Protect any bilirubin sample from light or collect them in an amber collection device.

13. Anticoagulant samples should be mixed 8-10 times for micro containers.

14. Hold gauze to the puncture site until bleed has stopped. Don’t use a bandage on an infant.

15. Label the collection containers.

16. If an insufficient sample has been obtained, the puncture may be repeated at a different site. A new sterile lancet must be used and steps 4 to 15 must be repeated.

17. Inform the patient’s nurse of the amount of blood collected so the amount can be documented on the patient’s chart.

18. Perform hand hygiene after completion of the procedure.

Purpose of Bleed time test

To measure the functional integrity of the small blood vessels and the ability of platelets to form hemostatic plugs to stop bleeding. AKA to determine the length of time a patient take to stop bleeding. This time is indicative of possible bleeding tendencies in the patient.

Supplies for bleed time test

• Blood pressure cuff

• bleeding time device

• filter paper

• stopwatch

• alcohol wipes

• gauze pads

• wound closure strip

• gloves.

Steps for bleed time test

1. Identify the patient

2. Perform hand hygiene and then apply gloves before any patient contact.

3. Place the patient’s arm on a steady support with the volar surface exposed. The incision is best performed over the lateral aspect, volar surface of the forearm, parallel to and 5 centimeters below the antecubital crease. Avoid surface scars, bruises, surface veins, and edematous areas.

4. Place the blood pressure cuff on the patient’s upper arm

5. Clean the outer surface of the patient’s forearm with alcohol, allow to air dry.

6. Remove the bleeding time device from the pack, being careful not to contaminate the instrument by touching or resting the blade-slot end on any unsterile surface.

7. Observe the patient’s forearm for superficial veins. Determine a location away from any superficial veins. Gently rest the device on the patient’s forearm at the location selected, and apply minimal pressure so both ends of the device are lightly touching the skin. The incision is best performed parallel to the antecubital crease

8. Gently push the trigger and start the stopwatch simultaneously.

9. Remove the device from the patient’s forearm immediately after triggering.

10. Blot the blood with the filter paper at regular 30-second intervals. Do not touch the paper directly to the incision so as not to disturb the platelet plug.

11. Wick the blood every 30 seconds from then on until blood no longer stains the paper. Stop the timer. Bleeding time is determined to the nearest 30 seconds.

12. Remove the blood pressure cuff, and cleanse the area with an alcohol swab. Potential scarring and keloids can be reduced by closing the edges of the incision with a wound closure strip for 24 hours. Inform the patient that there will be a small scar present after healing.

13. Dispose of the bleeding time device in a sharps container.

14. Perform hand hygiene after procedure completion.

15. Document the time on the laboratory form and in the computer

If the patient continues to bleed after ____ minutes, stop the test and apply pressure to the wound. The patient’s nurse or physician should be notified of any bleeding that lasts longer than ___ minutes.

15; 15

Sample Prep

• Each sample must have its own label attached to the sample’s primary container.

• Each sample must have on the label the name of the test to be performed (e.g., complete blood cell count [CBC], cholesterol).

• Labels must have the patient’s complete name and hospital number or unique identifier.

• The sample must be collected within the time limits requested.

• Samples in syringes must have needles removed and the syringe capped before transport.

• Urine samples must have the label on the container and not on the lid.

• The appropriate anticoagulant must be used for samples requiring an anticoagulant.

• Anticoagulated blood collection tubes must be at least 75 percent full. All coagulation tubes must be at least 90 percent full.

• Tubes may not be used beyond the expiration date.

• Certain samples may not be exposed to light.

• Delays in centrifuging or processing a sample will invalidate the results.

• Anticoagulated blood samples must be free of clots.

• Certain tests require samples to be free of hemolysis and lipemia.

• Blood samples drawn above an intravenous (IV) injection site are unacceptable.

• The sample must be re-collected if the results are not consistent with previous results on the patient.

True or false: The phlebotomist, a transporter person, or a pneumatic tube system usually does transportation within the facility

True

The _____container is the container in which the sample was collected. When a sample is transported, this _____container must be placed in a ______container so any leakage or breakage of the primary container is contained.

primary; primary; secondary

A ______ is sufficient as the secondary container for most samples. Whatever secondary container is used, the ______ must be attached

plastic self-sealing bag; biohazard emblem

A single sample or multiple samples from one patient can be placed in the bag and then the bag sealed shut. Samples from different patients should not be placed in the same bag

All labels must be attached to the sample tubes before they are placed in the bag. For large numbers of samples, the samples can be placed in racks to avoid spillage or breakage, and the entire rack placed into a bag or leakproof box

Most laboratories have _______ who pick up samples. They have been trained in how to handle blood-borne pathogens and have special containers to transport the samples to the laboratory

local couriers

The self-sealing bags for these specimens have two compartments:

• One compartment is for the sample and the other compartment is for the requisition.

• Separate compartments prevent the requisition from being contaminated if the sample tube should leak

The primary container is wrapped in________ and placed in a secondary container. This secondary container is then placed in a ______. The outside of the shipping container must have the biohazard emblem and wording that the container holds an etiologic agent

absorbent package material; shipping container

etiologic agent

viable microorganism or its toxin that causes or may cause human disease

The Federal Aviation Administration (FAA) and other government agencies regulate the shipment of etiological agents. Anyone packaging and shipping these agents must have special documented training in the regulations.

The Federal Aviation Administration (FAA) and other government agencies regulate the shipment of etiological agents. Anyone packaging and shipping these agents must have special documented training in the regulations.

All serum and plasma should be ______ from the cells before transporting. Any sample that is left in a car should be placed in a _____ to prevent extremes in temperature.

removed; cooler

Purpose of Pediatric Bag urine collection:

Method to collect urine for urinalysis or culture in children, involving proper attachment of the bag, urine collection, and labeling for lab processing.

Materials for pediatric bag urine collection

1. Gloves

2. hand disinfectant

3. sterile pediatric urine container

4. antiseptic wipes

5. label and requisition

Steps for pediatric bag urine collection

1. Remove the urine bag from the packaging

2. Clean the front of the body with an antiseptic wipe where the bag will attach. Discard the wipe.

3. Allow the skin surface to dry.

4. Attach the bag to the front of the child with the adhesive. Check that the adhesive is in contact with the skin.

5. Don’t fold or roll the bag while placing the diaper back on the child.

6. Wait until the child has urinated.

7. Carefully remove the bag, keeping the urine in the bottom of the bag.

8. Place the urine bag into another sealing container or bag. Label the container and send it to the lab.

Purpose of throat culture

To obtain secretions from the nasopharynx and tonsillar area for identifying pathogenic organisms, emphasizing proper swabbing technique and labeling of samples.

Materials for throat culture:

1. Gloves

2. hand disinfectant

3. tongue depressor

4. commercial culture tube with applicator swab

5. label and requisition form

Procedure for throat culture:

1. Assemble equipment consisting of a commercial collection set and a tongue blade

2. Use a tongue blade to hold the tongue down. Using the swab, take the sample directly from the back of the throat. Be careful not to touch the tongue, cheeks, or teeth at any time during or after collection.

3. The throat should be swabbed with enough force to remove organisms adhering to the throat membrane. Especially swab any red, raw, or white patches for optimum streptococcal isolation. If a rapid strep test is ordered use two swabs to swab the throat.

4. The collection swab for culture is inserted back into the swab holder, and the swab is placed in contact with the transport media. The swab for the rapid strep test is placed in the applicator wrapper.

5. label all samples