PMLS 2 - Capillary Puncture Equipment and Procedure

Skin Puncture

Also known as Capillary Puncture

Capillary Puncture

Method that uses a lancet to make a small incision into the capillary bed of the skin to obtain a small volume of blood specimen

Lancet/Incision device

Sterile and sharp instruments that are intended for one time use only

Lancet/Incision device

Designed for use in making cutes in the skin for finger or heel puncture

Laser lancet

Type of lancet that produces a small hole in the skin by vaporizing water on the skin

Sharp

Lanser lancet eliminates the risk of _____ injury because cauterizing the skin is not necessary

Finger Puncture Lancet and Heel Puncture Lancet

Two types used in Capillary Puncture

Microtube

Also known as microcollection container

Microcollection container

A small plastic tube to hold blood specimen collected in the capillary puncture

Minimum and Maximum

Microcollection container has markings on the side that show the _____ fill levels and occasionally comes with a narrow capillary tube

Microhematocrit tubes and sealants

Narrow bore tubes typically used for hematocrit determination and are made of either plastic or glass

50 to 75

Microhematocrit tubes and sealants can hold _____ microliters and filled by capillary action

Microscope slides

Used for blood films for hematology determination

Warming devices

Used to increase the blood flow seven-fold by warming the puncture site

Capillary Blood Gas

CBG stands for

Capillary Blood Gas equipment (CBG equipment)

Special equipment used for collecting CBG specimen

Blood and Fluid

Capillary blood specimen is a mixture of

Arterial, Venous, and Capillary

Capillary blood specimen contains the following blood:

Interstitial fluid and Intracellular fluid

Fluid mixture in Capillary Blood Specimen

Arterial blood

- The oxygenated blood in the circulatory system
- Bright red blood found in the Pulmonary vein, Left chamber of the heart, and Arteries

Venous blood

- The deoxygenated blood in the circulatory system
- Dark red blood travels from the Peripheral veins, Right chamber of the heart, and Veins

Capillary blood

- Extracted from the venules and arterioles found in the capillary bed
- Preferred specimen for infants, young children, elderly patient and patient with severe burns

Interstitial fluid

Fills the spaces around the cells, filtered form the blood capillaries, and drained away as lymph

Intracellular fluid

Facilitates the movement of fluid in the membrane and blocks the entrance of unwanted materials

Venous values

Capillary reference value may vary from

Higher

Glucose in the blood has higher or lower concentration?

Lower

Total Protein (TP), Calcium (Ca4+), Potassium (K+) has higher or lower concentration?

Capillary Specimen

Preferred method for infants and young children and a good alternative to venipuncture for adults and older children

Fragile

A good alternative to venipuncture for adults and older children under the following circumstances:

Veins are _____ and not accessible because of scars and burns

Procedure

A good alternative to venipuncture for adults and older children under the following circumstances:

Veins are reserved for another _____ such as chemotherapy

True

True or False: Clotting tendencies is one of the reasons why capillary specimen is a good alternative to venipuncture for adults and older children.

False

True or False: Extreme fear of syringe is one of the reasons why capillary specimen is a good alternative to venipuncture for adults and older children.

Glucose

A good alternative to venipuncture for adults and older children under the following circumstances:

Veins will be used for POCT such as _____ monitoring or oral _____ tolerance test (OGTT)

Point Of Care Testing

POCT stands for

Oral Glucose Tolerance Test

OGTT stands for

True

True or False: Health risks such as anemia and cardiac arrest is one of the reasons why capillary specimen is the preferred method for infants and young children.

Small

Preferred method for infants and young children because of the following reasons:

Requires _____ volume of blood

Damage

Preferred method for infants and young children because of the following reasons:

Venipuncture could _______ veins and tissues surrounding the site

Puncturing

Preferred method for infants and young children because of the following reasons:

_____ could result in hemorrhage, thrombosis, gangrene, and infection

Injury

Preferred method for infants and young children because of the following reasons:

Risk of _____ because of the restraint needed in venipuncture

Capillary

Preferred method for infants and young children because of the following reasons:

_____ blood is preferred specimen

Erythrocyte sedimentation rate methods, Blood cultures, Plasma

Capillary Puncture should not be used for _____, _____ and studies that need _____ specimen or have large volume specimen requirement

Order of Draw

Refers to the specific sequence with which blood must be drawn and collected in tubes to avoid cross-contamination of additives between the tubes

2431

The order of draw should be:
1. Serum specimens
2. Capillary Blood Gas Specimens (CBGs)
3. Other additive specimens
4. EDTA specimens

[e.g. 1234]

Test request

Step 1: Review and check accession _____

2

Step _____: Approach, identify, and prepare the patient

Diet, Latex

Step 3: Verify _____ restrictions and _____ sensitivity

Gloves

Step 4: Sanitize hands and put on _____

5

Step _____: Position the patient

6

Step _____: Select the puncture or incision site

Warm

Step 7: _____ the site, if necessary

8

Step _____: Clean and air-dry the site

Equipment

Step 9: Prepare the _____

10

Step _____: Puncture the site and discard the lancet

First blood drop

Step 11: The _____ should be wiped away because it may be contaminated with excess tissue fluid

12

Step _____: Fill and mix tubes or containers in the order of draw

Pressure, Elevated

Step 13: Place gauze and apply _____. Keep the incision site _____

Label, Observe

Step 14: _____ specimen and _____ special handling instructions

Bandage

Step 15: Check the site and apply _____

Dispose

Step 16: _____ of used and contaminated materials

17

Step _____: Thank patient, remove gloves, and sanitize hands

18, Transport

Step _____: _____ specimen to the lab

Clay or Plastic

One end is sealed with sealants made of __________

CBG collection tubes, Stirrers, Magnet, and Plastic caps

What does a Capillary Blood Gas (CBG) equipment contains?

Order of Draw for Capillary Blood Collection

Refers to the specific sequence with which blood must be drawn and collected in tubes to avoid cross-contamination of additives between the tubes

Finger puncture

During __________, the patient's arm should be placed on a firm surface. His/her arms should be extended, and his/her palms are facing up

Young child

If the patient is a __________, he/she should be placed on the lap of his/her guardian. The infant heel puncture should be performed with the baby in a supine position and his/her foot not lower than his/her torso

General criterion

As a __________, the skin of the incision site should be pink, normal in color, and warm

Scars, Cuts, Bruises, Rashes, Cyanosis, Edema, or Infection

The selected area should be free from _____, _____, _____, _____, _____, _____, or _____

Adult or an older child

If the patient is an __________, the palmar surface of the distal, end segment of the middle finger or ring finger of the non-dominant hand should be used. The center or the fleshy portion of the finger should be used

Increases; 7

Warming the incision site __________ the blood circulation in area for up to _______ times

Warm washcloth or towel

With a __________, the site should be warmed for 3 to 5 minutes. Warming is usually done when the specimen for pH or blood gas specimen collection.

2.0 mm

For infants, the incision site should be less than _____ deep. To avoid bone damage, the incision recommended site should be on the plantar surface of the heel, or on the median or lateral edge.

Antiseptic; 70% isopropyl alcohol

The incision site should be cleaned sand sanitized using _________ or __________

Gloves

The phlebotomist must wear __________ before arranging the sterilized collection devices and placing them in an area that is easy to reach

Opened

Packages should be ________ in front of the patient

Finger puncture

When doing the __________, the phlebotomist should hold the finger between the thumb and index finger of the non-dominant hand. He/she should then place the lancet flat against the central fleshy part of the incision site.

Heel puncture

For _________, he/she should hold the foot gently but firmly and proceed to encircling the heel using the index finger near the arch. Then the lancet is positioned in the medial or lateral plantar of the heel.

Bottom; Medial or lateral plantar

The thumb should be placed at the __________, and the rest of the fingers around the top portion of the foot. Then the lancet is positioned in the __________ of the heel.

Collection of slides, Platelet counts, Hematology specimens

The phlebotomist should prioritize __________, _________, and other __________ the to avoid clumping and clotting

Serum specimens

The anticoagulant containers should be followed by __________. Do not forget to collect drops of blood into the collection tube/device.

Routine blood film/smear preparation

Blood test that is used to check abnormalities in the blood cells

Routine blood film/smear preparation

A small drop of blood is placed near the frosted end of the glass side; Another slide is used to spread the blood in a thin film over the slide, then air-dried and stained

Thick blood smear preparation

Used to determine if the patient has malaria, which is diagnosed by its presence in the peripheral blood smear

2

The procedure starts by placing a large drop of blood in the center of the slide; The blood drop is spread until it is about the size of a dime, using cover slip or another slide, then air-dried for at least _____ hours before staining

Capillary Blood Gas Specimen by Heel Puncture

Recommended for infants and small children

Capillary Blood Gas Specimen by Heel Puncture

The blood samples are collected on the same site as routine capillary puncture specimens

Neonatal Bilirubin Collection

Used to determine any liver disorder in infants

Neonatal Bilirubin Collection

Collected with a heel stick

Amber-frosted tube, 5 mL (T192)

Neonatal Bilirubin Collection

Specimen Required:

Supplies: __________

2 Serum gel microtainers; 2 Red-top microtainers

Neonatal Bilirubin Collection

Specimen Required:

Collection Container/Tube
- Preferred: __________
- Acceptable: ________

Amber vial (T192)

Neonatal Bilirubin Collection

Specimen Required:

Submission Container/ Tube: __________

0.5 mL

Neonatal Bilirubin Collection

Specimen Required:

Specimen Volume: __________

2 hours

Serum gel microtainers should be centrifuged within ___________ of collection

2 hours

Red-top microtainers should be centrifuged and aliquoted within __________ of collection

Newborn/Neonatal Screening

Routine check for infants to determine inborn disorders such as phenylketonuria, hypothyroidism and galactosemia, and cystic fibrosis

24 to 48 hours

Newborn Screening Blood Spot Collection is done _________ after the baby is born

Heel stick

Few drops of blood are collected through __________ to determine disorders that are not apparent at birth and could lead to disability or even death

Infants, children, and adults

Capillary Puncture can be used for

Microcollection Method

Collection of Small Amounts of Blood