Unit+5-Lecture+3-Dermal+Puncture

Unit Overview

  • Course: Unit 5 - Lecture 3

  • Institution: Auburn University Montgomery

  • Focus: Medical Technology/Clinical Laboratory Science

Phlebotomist Preparation

  • Ensure requisition form is complete with patient identification.

  • Clearly indicate on the request that the sample is a capillary stick.

Blood Collection on Babies

General Procedure

  • Sanitization: Wash hands and put on gloves.

  • Preparation: Assemble necessary equipment and materials.

  • Site Selection: Choose the puncture site carefully.

  • Cleansing: Cleanse the puncture site with alcohol prep and allow it to air dry.

Puncture Types for Babies

Heel Sticks

  • Requirement: Performed on infants who have not yet begun walking.

  • Method: Skin puncture technique to collect blood.

Performing the Puncture

  • Ensure the heel or finger is well supported and firmly held without squeezing the site.

  • First Drop Protocol: Wipe away the first drop of blood with sterile gauze to prevent contamination from residual alcohol and tissue fluid.

Blood Collection by Finger Puncture

Initial Steps

  • Sanitization: Wash hands and put on gloves.

  • Preparation: Assemble equipment and explain the procedure to the patient.

  • Site Selection & Cleansing: Select and cleanse the puncture site with alcohol prep, allowing it to air dry.

  • Positioning: Hold the skin taut with one hand and the lancet with the other.

Performing the Finger Puncture

  • Activate the lancet against the patient’s finger.

  • Wipe the first drop of blood away.

  • Production: Massage the finger gently to produce the second drop of blood.

  • Fill capillary tubes to 2/3 to 3/4 full.

  • Apply pressure to the puncture site after collection.

  • Safely dispose of the lancet in a sharps container and discard gauze properly.

Post-Puncture Care

  • Clean and return all equipment to proper storage.

  • Use disinfectant to clean the work area.

  • Remove gloves and dispose of them in biohazard autoclave bags.

  • Wash hands thoroughly.

Patient Identification and Preparation

  • Identify the patient as in venipuncture.

  • Ensure an arm band is attached to the patient’s arm or ankle.

  • Approach pediatric patients cautiously to avoid causing distress.

  • Allow the mother to stay with the baby during the procedure.

  • If necessary, warm the area with warm water for fingersticks or heelsticks.

Site Selection Considerations

  • Primary Danger: Risk of accidental contact with bone leading to infection (osteomyelitis).

  • Recommended sites include the heel and distal segments of the third and fourth fingers.

  • Avoid areas that are callused, scarred, bruised, edematous, or infected.

Order of Draw for Dermal Punctures

  • Procedure: Tests to evaluate platelets should be drawn first.

  • First Steps: Prepare the smear before collecting the purple top tube.

Order of Draw Breakdown

  • SST

  • Sodium

  • Heparin

  • PST

  • EDTA

  • SA Phlebotomy

  • Oxalate

  • ACDA

  • Fluoride

  • ACDB