Phlebotomy Chapter 10 MTC 110 Dermal Puncture

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Dermal Puncture

ancillary blood glucose test

bedside test to determine blood glucose level, performed by dermal puncture

bleeding time test

a test that measures the length of time required for bleeding to stop after an incision is made.

BURPP

bilirubin, uric acid, phosphorus, and potassium

calcaneus

heel bone

capillary tubes (microhematocrit tubes)

small plastic tubes used primarily for hematocrit tests.

diluent

liquid for dilution

microcollection tubes

small tube used to collect dermal puncture samples; "bullet"

micropipets (Caraway or Natelson pipets)

large glass capillary tube

osteochondritis

painful inflammation of the bone or cartilage

osteomyelitis

bone infection

venous thrombosis

formation of a blood clot within a vein

ABG

arterial blood gas-tests that determine the concentrations of oxygen and carbon dioxide in arterial blood and the pH of the blood.

BT

bleeding time

BURPP

bilirubin, uric acid, phosphorus, and potassium

CBC

complete blood count

IV

intravenous

OSHA

Occupational Safety and Health Administration

Name two sites commonly used for adult capillary collection.

Sites commonly used for adult capillary collection are the palmar surface of the distal segments of the third and fourth fingers or the big toe

Explain why it is best to perform a dermal puncture rather than a venipuncture on children

Dermal puncture is preferred in children because the young child's smaller veins and lower volume make standard venipuncture difficult and potentially dangerous.

List six types of patients, other than infants, in who dermal puncture may be advisable.

Dermal puncture may be advisable for patients undergoing frequent glucose monitoring or frequent blood tests, obese patients, patients with IV's in place, geriatric patient, patients with burns or scars, patients at risk for venous thrombosis restrained patients, and patients at risk anemia, hemorrhage, infection, organ or tissue damage, arteriospasm, or cardiac

Explain why, in a dermal puncture, the first drop of blood is wiped away with clean gauze.

The first drop blood in a dermal punctures is wiped away with clean gauze to prevent contaminating the sample with tissue fluid.

Describe what micropipets are used for.

Micropipets are typically used for the collection of samples for arterial blood gas determination

Describe the Unopette system and what it is used for.

The Unopette system allows you to collect a very small blood sample, which is diluted to the correct volume for analysis in the Unopette reservoir. The system includes a capillary pipet in a holder, a pipet shield, and a sealed reservoir containing diluent. This system is useful for CBC tests when a large sample is not needed for other tests.

What can be used to stimulate blood flow to the capillaries?

Warm washcloths or heel warmers can be used to stimulate blood flow to the capillaries

List six specific areas of the skin to avoid when performing a capillary stick.

Specific areas of the skin to avoid when performing a capillary stick include areas with scars, cuts, bruises, rashes, or edema, and callused, burned, bluish, and infected areas, as well as previous puncture sites.

At what age are heel sticks preferred to finger sticks?

Heel sticks are preferred to finger sticks in children under the age of 1 year.

List four reasons why alcohol must air-dry before a capillary stick.

Unless alcohol air dries before a capillary stick, stinging, hemolysis, and contamination can occur. Alcohol also can interfere with the formation of rounded drops of blood on the skin surface.

Explain why povidone-iodine should not be used for capillary collection procedures.

Povidone-iodine may elevate test results for bilirubin, uric acid, phosphorus, and potassium, and therefore is not recommended for use with dermal puncture

Which fingers are acceptable to use for dermal puncture.

The third and fourth fingers are acceptable to use for dermal punctures.

Describe the order of collection for a dermal puncture.

The order of collection for a dermal puncture is: (1) blood smears; (2) platelet counts, CBCs, and other hematology tests; (3) other tests

Explain the purpose of the bleeding time test.

The bleeding time test measures the length of time required for bleeding to stop after an incision is made. It helps assess the overall integrity of primary hemostasis, involving the vascular system and platelet function

Why should bandages not be placed on young children following a dermal puncture?

Small children may remove bandages and choke on them; therefore, it is not recommended that bandages be used on children younger than 2 years.

Dermal punctures are performed on:

capillaries

Which of the following has a higher value in capillary blood as opposed to venous blood?

hemoglobin

A red-banded microhematocrit tube contains which anticoagulant?

heparin

The Unopette system can be used for which kind of tests?

hematology

An infant heel-warming device should be applied for approximately:

3 to 5 minutes

The depth of a heel puncture should be more than:

2.0 mm

Which finger is most used for capillary collection?

ring

In performing a dermal puncture, the puncture should be:

perpendicular to the whorls of the fingerprint

The location for heel sticks is the:

medial or lateral borders of the plantar surface.

In a dermal puncture, which test is collected first?

Blood smear

Which test cannot be collected by dermal punctures?

blood cultures

Which medication does not interfere with the bleeding time test?

acetaminophen

At what level does the blood pressure cuff remain during a bleeding time test?

40 mm Hg

A normal bleeding time result is:

2 to 10 minutes

How frequently is the blood wicked during a bleeding time test?

every 30 seconds

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