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Questions and Answers
What can large quantities of blood removal in pediatric patients have?
What can large quantities of blood removal in pediatric patients have?
serious consequences
Capillary collection is useful for whom?
Capillary collection is useful for whom?
pediatric patients
What is a sterile, disposable sharp pointed bladed instrument that punctures or makes an incision in the skin?
What is a sterile, disposable sharp pointed bladed instrument that punctures or makes an incision in the skin?
lancet
What vaporizes water in the skin to produce a small hole in the capillary bed?
What vaporizes water in the skin to produce a small hole in the capillary bed?
There is no risk of sharps injury with laser lancets.
There is no risk of sharps injury with laser lancets.
What are special small plastic tubes used to collect capillary puncture specimens?
What are special small plastic tubes used to collect capillary puncture specimens?
What are disposable narrow bore plastic or plastic clad tubes used for?
What are disposable narrow bore plastic or plastic clad tubes used for?
Microhematocrit tubes are primarily used for what purpose?
Microhematocrit tubes are primarily used for what purpose?
What type of microhematocrit tubes are coated with ammonium heparin used for?
What type of microhematocrit tubes are coated with ammonium heparin used for?
When are plain microhematocrit tubes used?
When are plain microhematocrit tubes used?
What does StatSpin Inc. provide for pediatric patients?
What does StatSpin Inc. provide for pediatric patients?
Venous blood may have different reference ranges than what?
Venous blood may have different reference ranges than what?
What are long thin narrow bore capillary tubes called?
What are long thin narrow bore capillary tubes called?
C B G tubes usually contain what?
C B G tubes usually contain what?
What are small metal filings or metal bars inserted into the tube after collection of a C B G called?
What are small metal filings or metal bars inserted into the tube after collection of a C B G called?
What is used to move the stirrer for mixing in a C B G tube?
What is used to move the stirrer for mixing in a C B G tube?
What do plastic caps on C B G tubes maintain?
What do plastic caps on C B G tubes maintain?
Warming devices are used to increase blood flow, especially in whom?
Warming devices are used to increase blood flow, especially in whom?
What is the composition of capillary specimens?
What is the composition of capillary specimens?
What is fluid in the tissue spaces between cells called?
What is fluid in the tissue spaces between cells called?
What is fluid within the cells referred to as?
What is fluid within the cells referred to as?
Capillary blood contains a higher proportion of what?
Capillary blood contains a higher proportion of what?
Capillary blood most resembles what?
Capillary blood most resembles what?
In which type of blood is the concentration of glucose normally higher?
In which type of blood is the concentration of glucose normally higher?
Total protein, calcium, and potassium concentrations are lower in what?
Total protein, calcium, and potassium concentrations are lower in what?
Tissue fluid contamination and hemolysis can falsely increase what?
Tissue fluid contamination and hemolysis can falsely increase what?
If a patient has fragile veins and is scheduled for chemotherapy, what method should be used for specimen collection?
If a patient has fragile veins and is scheduled for chemotherapy, what method should be used for specimen collection?
What is the appropriate method of specimen collection on a patient with thrombotic tendencies?
What is the appropriate method of specimen collection on a patient with thrombotic tendencies?
Capillary puncture should be performed on patients with a fear of needles.
Capillary puncture should be performed on patients with a fear of needles.
Point of Care Testing (POCT) for glucose is performed with what?
Point of Care Testing (POCT) for glucose is performed with what?
If a patient has no accessible veins due to burns and IVs, how should a specimen be collected?
If a patient has no accessible veins due to burns and IVs, how should a specimen be collected?
Capillary puncture is the preferred method of obtaining blood from whom?
Capillary puncture is the preferred method of obtaining blood from whom?
Why is capillary puncture preferred for infants and small children?
Why is capillary puncture preferred for infants and small children?
Capillary puncture should not be performed on patients with what conditions?
Capillary puncture should not be performed on patients with what conditions?
Shock can cause what?
Shock can cause what?
What tests cannot be run on capillary specimens?
What tests cannot be run on capillary specimens?
Light blue top microtubes should not be used for what?
Light blue top microtubes should not be used for what?
The order of draw for capillary specimens is different than what?
The order of draw for capillary specimens is different than what?
What happens when puncturing skin releases tissue thromboplastin?
What happens when puncturing skin releases tissue thromboplastin?
Capillary specimens must be collected quickly to minimize what?
Capillary specimens must be collected quickly to minimize what?
Why are hematology tests drawn first for capillary puncture?
Why are hematology tests drawn first for capillary puncture?
Why are serum specimens collected last for capillary puncture?
Why are serum specimens collected last for capillary puncture?
What is the CLSI order of draw for capillary puncture?
What is the CLSI order of draw for capillary puncture?
Specimens for newborn screening tests should be collected in what manner?
Specimens for newborn screening tests should be collected in what manner?
What is the preferred site for capillary puncture on adults and children over 1 year?
What is the preferred site for capillary puncture on adults and children over 1 year?
Where should the puncture site on a finger be located?
Where should the puncture site on a finger be located?
Finger pricks should not be performed on whom?
Finger pricks should not be performed on whom?
Why is a bone injury likely with finger pricks on babies under a year?
Why is a bone injury likely with finger pricks on babies under a year?
What should be done before performing finger pricks on the side of a mastectomy?
What should be done before performing finger pricks on the side of a mastectomy?
Where should you never perform a finger prick?
Where should you never perform a finger prick?
Why should the index finger not be pricked?
Why should the index finger not be pricked?
Never puncture the thumb because it indicates an artery.
Never puncture the thumb because it indicates an artery.
Why should you never puncture the very tip or the side of a finger?
Why should you never puncture the very tip or the side of a finger?
What is inflammation of the bone marrow and adjacent bone called?
What is inflammation of the bone marrow and adjacent bone called?
What is inflammation of the bone and cartilage referred to as?
What is inflammation of the bone and cartilage referred to as?
What can puncture of the bone cause?
What can puncture of the bone cause?
What is the heel bone called?
What is the heel bone called?
What is the back of the heel called?
What is the back of the heel called?
Why are deeper punctures more painful?
Why are deeper punctures more painful?
What is the CLSI proper heel puncture site?
What is the CLSI proper heel puncture site?
How deep should you never puncture the heel?
How deep should you never puncture the heel?
What antiseptic is recommended for capillary puncture site?
What antiseptic is recommended for capillary puncture site?
Why should povidone iodine not be used to clean capillary puncture sites?
Why should povidone iodine not be used to clean capillary puncture sites?
What does BURPP stand for?
What does BURPP stand for?
What can residual alcohol on a venipuncture or capillary puncture site cause?
What can residual alcohol on a venipuncture or capillary puncture site cause?
What is a puncture that opens when pressure is applied called?
What is a puncture that opens when pressure is applied called?
What should you always wipe away after puncturing?
What should you always wipe away after puncturing?
Some POCT instruments may allow use of the first drop.
Some POCT instruments may allow use of the first drop.
How does a microhematocrit or narrow bore capillary tube fill automatically?
How does a microhematocrit or narrow bore capillary tube fill automatically?
What happens when scraping a capillary collection tube scoop against the skin?
What happens when scraping a capillary collection tube scoop against the skin?
What can overfilling an anticoagulant collection tube cause?
What can overfilling an anticoagulant collection tube cause?
How should capillary blood gas specimens always be transported?
How should capillary blood gas specimens always be transported?
What does ice slurry prevent?
What does ice slurry prevent?
What screening tests are required by law in 50 states?
What screening tests are required by law in 50 states?
What is PKU?
What is PKU?
What can PKU result in?
What can PKU result in?
What is hypothyroidism?
What is hypothyroidism?
What is galactosemia?
What is galactosemia?
What is cystic fibrosis?
What is cystic fibrosis?
When are most newborn screenings performed?
When are most newborn screenings performed?
How many different disorders can be detected in blood spot collection forms?
How many different disorders can be detected in blood spot collection forms?
Blood smears made from EDTA tube should be made within how long?
Blood smears made from EDTA tube should be made within how long?
What does LAP test stand for?
What does LAP test stand for?
At what angle should the pusher slide in a blood smear be held?
At what angle should the pusher slide in a blood smear be held?
What is the DIFF SAFE?
What is the DIFF SAFE?
What is required for detecting malaria?
What is required for detecting malaria?
What is the absence of a feather in a blood smear due to?
What is the absence of a feather in a blood smear due to?
What can cause holes in the smear?
What can cause holes in the smear?
What is ridges or uneven thickness in a smear usually due to?
What is ridges or uneven thickness in a smear usually due to?
What can a smear too thick be due to?
What can a smear too thick be due to?
What can a smear too short be due to?
What can a smear too short be due to?
What can a smear too long be due to?
What can a smear too long be due to?
What can a smear too thin be due to?
What can a smear too thin be due to?
What can streaks in the feathered edge of a smear be due to?
What can streaks in the feathered edge of a smear be due to?
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Study Notes
Key Terms and Definitions
- Pediatric Blood Removal: Large quantities can lead to serious consequences for pediatric patients.
- Capillary Collection: Particularly useful for pediatric patients, minimizing risk and discomfort.
- Lancet: A sterile, disposable instrument used for skin punctures.
- Laser Lancet: Vaporizes skin water, creating small holes in the capillary bed without damaging delicate capillaries.
Collection Tools and Techniques
- Microcollection Containers: Plastic tubes used for collecting capillary specimens.
- Microhematocrit Tubes: Narrow bore tubes used for hematocrit counts and collecting blood for specific tests.
- C B G Tubes: Contain sodium heparin and require stirrers for mixing with collected blood samples.
Blood Composition Insights
- Capillary Specimens: Composed of a mixture of arterial, venous, capillary blood, and interstitial fluid, resembling arterial blood.
- Glucose Concentration: Normally higher in capillary blood compared to venous blood.
- Potassium Levels: Can be falsely elevated due to tissue fluid contamination or hemolysis.
Patient Considerations
- Capillary Puncture Preference: Recommended for patients with fragile veins, burns, IVs, and fear of needles; preferred method for infants due to their small blood volume.
- Dehydration Risks: Capillary puncture should not be performed on dehydrated patients or those with poor circulation.
- Needle Phobia: Capillary puncture is ideal for anxious patients.
Capillary Puncture Techniques
- Order of Draw: Different from venipuncture; hematology tests drawn first due to sensitivity to clotting.
- Heel Puncture Site: Should be on the medial or lateral plantar surface, not to exceed 2mm in depth.
- Skin Preparation: 70% isopropanol is the recommended antiseptic; avoid povidone iodine for certain tests.
Newborn Screening Tests
- Required Tests: Include phenylketonuria, galactosemia, hypothyroidism, and cystic fibrosis, typically performed between 24 and 72 hours after birth.
- Detection of Disorders: Up to 30 disorders can be identified through blood spot collection forms.
Blood Smear Preparation
- Timing: Blood smears from EDTA tubes should be prepared within 1 hour to prevent cell distortion.
- LAP Test: Requires fresh blood smears for accurate results.
- Common Errors: Thicker smears occur due to large blood drops; streaks and holes may indicate contamination or improper technique.
Health Risks and Injury Prevention
- Bone Injury Risks: Especially prevalent in infants due to thin tissue; punctures can lead to osteomyelitis or osteochondritis.
- Avoiding Sensitivity: Thumbs and calloused fingers should not be pricked due to sensitivity and potential discomfort.
- Contamination Management: Importance of wiping the first drop of blood and managing residual alcohol at the puncture site.
Transport and Analysis
- Capillary Blood Gases: Always transport specimens horizontally in ice slurry to maintain pH stability.
- Microclots: Can occur from overfilling anticoagulant tubes, affecting sample quality.
Summary of Conditions
- Galactosemia: Inherited disorder leading to milk sugar metabolism issues and potential starvation.
- Cystic Fibrosis: Genetic disorder that affects the lungs and pancreas, resulting in mucus buildup.
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