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Phlebotomy Ch.10: Lecture 1 (Procedure (Complete procedure (apply bandage…
Phlebotomy Ch.10: Lecture 1
Dermal Puncture
is an alternative procedure when small amounts of blood are needed or a venipuncture is not advised or possible
it is a usual procedure for infants and children under 2 yrs old
also for a bleeding time, ancillary blood glucose, and obese patients testing
used for geriatric patients, risk for venous thrombosis, and those with burns or scars over venipuncture sites
also for pts with only one test ordered, those receiving IV therapy, frequent blood tests, and those who are at risk for injury from restrains that might be needed for venipuncture
procedure can't be used for blood cultures, sed rates, and coagulation tests
not done for dehydrated pts, shock, on sites that are swollen, circulation is compromised
Venous v. Capillary
capillary blood is a mix of arterial blood, venous blood, and tissue fluid
hemoglobin and glucose values are higher in capillary blood
K, Ca, and total protein values are higher in venous blood
Puncture devices
microsample containers
come in microcollection tubes, capillary tubes, and micropipets
the puncture devices come in different types and sizes to meet different needs
meet safety regulations
devices contain retractable blades that lock to prevent being used again
warm devices will increase capillary circulation and blood flow
wash cloths/commercial heel warmers can be used to
the temperature should not exceed 42 degrees Celsius and applied for 3-5 minutes
Width and depth
depth should not exceed 2.0 mm in infant heels and 0.65 to 0.85 mm in premature infants
care should be taken not to puncture the heel bone
wider puncture cut will increase blood flow but puncture width should not exceed 2.4 mm
puncture should be done on the palmer surface of the distal segments of middle or ring finger of non dominant hand
punctures with blades should be made perpendicular to the ridges in the fingers to keep the blood from flowing into the grooves.
Dermal on infants
under one years old and not walking
use medial or lateral portion on the plantar (bottom) surface of heel
follow standard precautions making sure to wash hands and put on gloves
always greet patient and parents, if present, obtain consent, identify pt's as would
on pt's infants the armband may be on ankle
Procedure
Document on the requisition that you are performing a dermal puncture
Assemble Equipment
use pt age, size, tests ordered to determine puncture device needed
Select and clean the site warming first, then cleaning with 70% isopropyl alcohol
hold the finger firmly to prevent moving during the puncture
Make puncture
count to two before lifting blade to make sure blade has made a complete puncture and retracted
dispose of lancet in sharps container
prepare to collect sample
wipe away first drop with clean gauze to prevent tissue fluid contamination of specimen
keep finger in downward motion applying a "squeeze and release" pressure to the finger
Collect sample
Touch the scoop of the tube to the drop, allowing it to run into the tube; make sure to mix the # of times required by manufacturer
hold the capillary tube horizontally without touching the skin so to prevent tissue fluid contamination
order of collection
slides first to minimize effects of platelet clumping
lavender tubes for CBC's
other tubes with anticoagulants serum tubes last
Complete procedure
apply bandage after bleeding has stopped
do not bandage children under 2 years since they could remove it and choke on teh bandage
Make sure equipment has been equipment has been picked up and bed rails are up
label specimen, remove gloves, and wash hands
thank pt