MLT 112 Week 2 Media Lab Dermal Puncture and Capillary Blood Collection

A heel puncture that is performed on a small infant should not exceed what depth? 2.0 mm 2.5 mm 3.0 mm 3.5 mm

2.0 mm

A phlebotomist must perform a skin puncture to obtain CAPILLARY specimens for a complete blood count (CBC), a plasma-based chemistry test, and a serum-based immunology test. The microcollection containers that will be used are lavender top containing EDTA anticoagulant, green top containing heparin anticoagulant, and gold top containing no anticoagulant. Which of the containers should be collected FIRST? A. Lavender top B. Green top C. Gold top

LAVENDER: When performing a capillary draw, the lavender top container is obtained first. This decreases the possibility of clots in the container which would invalidate the results of the complete blood count test. After the lavender is drawn, other containers with anticoagulants would be collected, and containers without anticoagulants would be collected last.

Which area(s) are acceptable to puncture on the foot of a newborn for collection of a capillary blood specimen?

The areas that can be safely punctured on the foot of an infant are either side of the heel

Prior to collection of capillary blood specimens for routine laboratory tests, the first drop of blood that appears from the puncture site should be wiped away. True or false?

True -this prevents tissue fluid from contaminated the blood

When performing a fingerstick, the phlebotomist should puncture the extreme side, the side, the tip or the middle of the finger?

When performing a fingerstick, the phlebotomist should puncture either side of the fleshy pad of the middle or ring finger, but not the extreme side of the finger. The exact center of the fleshy pad or the tip of either finger should also be avoided.

If blood stopped flowing freely from the finger that was punctured for a capillary blood collection, what actions would be appropriate?

Wipe the site with sterile gauze to dislodge the blood clot, then gently massage the finger to get blood flowing.

Which of these pieces of personal protective equipment (PPE) is always required when a dermal puncture is performed to collect a capillary blood specimen?

gloves

Which fingers should be used for dermal puncture to obtain capillary blood specimens? #1 Thumb #2 Index finger #3 Middle finger #4 Ring finger #5 Little finger

#3 Middle finger #4 Ring finger The primary sites used to obtain a capillary specimen are the middle and ring fingers. The thumb is not used because it is often more calloused and has a pulse. The index finger is often very calloused and may cause more discomfort for the patient. The fifth or little finger often does not have enough fleshy pad and may lead to possible puncture of the bone.

A phlebotomist arrives in the blood draw area where a mother and her 3-year-old toddler have been seated. Prior to performing the capillary blood collection on the child, the phlebotomist asks the mother "Is this Amanda? " The mother says yes. The phlebotomist then proceeds to cleanse the child's middle finger with alcohol and allows the site to air dry before performing the finger puncture. The phebotomist punctures the side of the fleshy pad of the finger, wipes away the first drop, fills a lavender top microcollection container, caps it, inverts it several times and lays it on the table. She makes sure that the child's finger has stopped bleeding and then tells the mother that they can go. She then labels the specimen. For each of the following categories, choose whether the correct procedure was followed. - Positive patient identification - Patient interaction - Puncture site preparation - Labeling of specimen

- Incorrect procedure was followed - Positive patient identification - Incorrect procedure was followed - Patient interaction - Correct Procedure was followed - Puncture site preparation - Incorrect procedure was followed - Labeling of specimen In order to ensure positive patient identification, every patient MUST be identified using two patient identifiers. By suggesting the patient's name to the mother, the phlebotomist actually did not use any patient identifiers that would positively identify the patient.The phlebotomist did not explain the procedure and did not interact at all with the child. Speaking to children in terms they can understand will lead to more positive patient encounters.The phlebotomist correctly cleansed the finger with alcohol and allowed the alcohol on the puncture site to air dry.The specimen was not labeled in the presence of the patient. Letting the patient leave before labeling the specimen was an incorrect procedure.

An elderly female patient arrives at the outpatient clinic for a point-of-care whole blood glucose test. She has come directly to the laboratory from outdoors and her hands are very cold. Which of the following is an acceptable method for warming the patient's hand prior to performing the finger puncture? -Hold the patient's finger under hot running water -Wet a towel and warm it in the microwave oven for two (2) minutes. Apply the warmed towel directly to the patient's hands for three (3) minutes. -Ask the patient to immerse her hands in lukewarm water for several minutes. -Apply an infant heel warmer to the patient's hands for several minutes.

-Ask the patient to immerse her hands in lukewarm water for several minutes. -Apply an infant heel warmer to the patient's hands for several minutes

Order of draw Dermal Puncture

1. Capillary blood gas collection tubes (Heparin) 2. Blood smear 3. Lavender top (EDTA) 4. Green top (Li heparin) 5. Red or gold top (clot activator) 6. Red top (no additive)

specimen type: Capillary

1. method of collection: Dermal puncture of fingertip or heel 2. common use: Infants and young children, Elderly patients with fragile veins, Severly burned patients, Point-of-care testing

specimen type: Arterial

1. method of collection: Direct puncture of artery; vascular access device 2. common use: Arterial blood gases

Specimen type: Venous

1. method of collection: Direct puncture of vein by venipuncture; vascular access device 2. common use: Routine laboratory tests

Which of the following effects will happen if the phlebotomist fails to mix a specimen containing an anticoagulant by inverting the tubes several times? A. clots in the specimen B. hemolysis C. specimen diluted with tissue fluid D. decreased blood flow

A. clots in the specimen

Which of these methods should be used to verify the identification of an infant in the nursery prior to collecting a blood specimen? A - Check the name on the crib card and compare it against the blood test order. B - Read the name on the identification band attached to the baby and compare it against the name on the blood test order. C - Read the name and hospital/medical record number on the identification band attached to the baby and compare both identifiers against the blood test order. D - Ask the nurse which baby had an order for a blood test.

B - Read the name and hospital/medical record number on the identification band attached to the baby and compare both identifiers against the blood test order.

A mother and young child arrive at the outpatient laboratory with a physician's order for a lead test on the child. The phlebotomist decides to perform a dermal puncture (fingerstick). What procedure is important to implement when a test for lead is collected by finger puncture that would NOT be necessary prior to a venipuncture? A - asking the patient or child's parent to state his/her name and date of birth B - thoroughly washing patient's hands with soap and water C - cleansing the puncture site with alcohol and letting the alcohol air dry D - labeling the specimen with at least 2 patient identifiers

B - Thoroughly washing patient's hands with soap and water.

Which of these patients may NOT be a candidate for capillary blood collection by dermal puncture? Please select the single best answer A neonate B patient who is dehydrated C An elderly patient D a severely burned patient

B patient who is dehydrated

Which of the following effects will happen if the phlebotomist punctures the cleansed site before the alcohol is completely dry? A. clots in the specimen B. hemolysis C. specimen diluted with tissue fluid D. decreased blood flow

B. hemolysis

Which of the following devices is recommended when puncturing a finger for a capillary blood collection? A. metal lancet B. single use puncture device with a retractable needle/blade C. 21 gauge venipuncture needle D. surgical blade

B. single use puncture device with a retractable needle/blade

A lavender top microcollection container that has EDTA as an anticoagulant is used to collect a capillary hematology specimen for a complete blood count (CBC). If additional specimens are also collected with the same dermal puncture into a green top and a red top container, at what point should the lavender top for the CBC specimen be collected? A - After the red top that has no additives B - After the green top that contains heparin C - Lavender top should be the first specimen collected D - The order of collection doesn't matter

C - Lavender top should be the first specimen collected: For capillary blood collection from a dermal puncture, the lavender top containing EDTA should be the first specimen collected if the blood will be used for a blood count. The reason is to ensure a specimen that is free of clots that would alter a blood count. This order of draw is different from the recommended order for a venipuncture.

Which of the following effects will happen if the phlebotomist does not wipe away the first drop of blood prior to specimen collection? A. clots in the specimen B. hemolysis C. specimen diluted with tissue fluid D. decreased blood flow

C. specimen diluted with tissue fluid

A patient has an order for microhematocrit testing. Which of the following should be collected for this testing? A - A single plain glass capillary tube B - Two plain glass capillary tubes C - A single heparinized plastic capillary tube D - Two heparinized plastic capillary tubes

D - Two heparinized plastic capillary tubes: A minimum of two capillary tubes should be collected for testing. The tubes should be coated with an anticoagulant to prevent clotting. Plastic rather than glass should be used to prevent injury and possible exposure to bloodborne pathogens that could occur if the glass shattered.

Which of the following effects will happen if the phlebotomist holds the hand from which blood is being collected in an upward position (above the heart/head? A. clots in the specimen B. hemolysis C. specimen diluted with tissue fluid D. decreased blood flow

D. decreased blood flow

A phlebotomist can use a dermal puncture to obtain a blood specimen for every laboratory test. True or false?

FALSE: This statement is false. Collecting blood using a dermal puncture is a valuable alternative to venipuncture for the phlebotomist but cannot be used for every laboratory test. The dermal puncture is the most efficient way to obtain small quantities of blood from newborns and small children, obese patients, elderly patients and patients with severe burns. Many, but not all, blood tests analyzed in the laboratory and during point-of-care testing can be done using very small amounts of blood obtained via dermal puncture. However, some tests may require a greater volume of blood than can be obtained from a dermal puncture and some test results may be compromised by exposure to the air or tissue fluid during specimen collection. In these situations, a venipuncture is required.

If blood has stopped flowing from the finger puncture site, you should repuncture the same site to re-establish the blood flow. True or false?

FALSE: This statement is false. If a second puncture is necessary, the same site should NOT be used. To re-establish the blood flow, you could try re-wiping the puncture site with sterile gauze to dislodge a clot that may have formed. Then gently massage the finger intermittently.

When performing a fingerstick, the phlebotomist should puncture PARALLEL with the whorls of the fingerprint. True or false?

False - the puncture should be horizontal to the whorls of the fingertip for ease of collection. If the puncture is parallel to the whorls the blood may run down the channels of the fingerprint pattern.

The recommended finger for capillary blood collection is the index finger (finger next to the thumb). True or false?

Fasle - The index finger is not recommended for dermal puncture because it is often more sensitive or calloused than the middle or ring fingers ﴾the fingers that are recommended﴿.