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