why is dermal puncture the preferred blood collection technique on infants and v small children?
- child smaller size = difficult to locate vein + children dont enjoy blood draw and usually odnt remain still
who else can dermal puncture be good for?
Children
Infants
Elderly patients
Oncology patients
Severely burned patients
Obese patients
Inaccessible veins
Extremely fragile veins
Home testing by patient
Point-of-care testing
Procedure requiring capillary
specimen only
Patients with thrombotic
(clotting) tendencies
what tests can not be done with dermal puncutre
coagulation tests, blood culture and ESR (last 2 need lots of blood)
what is the specimen botained during dermal capillary puncture?
mixture of venous blood, arterial blood, and interstitial fluid (fluid between
cells and tissues). When capillary blood is drawn it must be noted for the testing
personnel. Capillary blood is higher in glucose and lower in potassium, total
protein, and calcium making the normal values (reference ranges) different
how to select site for dermal puncture?
- warm, pink, scar, cut, rash, bruise free skin
- distal region of middle finger and ring finger in children and adults and medial or alteral regions of plantar surface of heels
- could do on toes or earlobes
- dont use thumb or pointer bc thick skin and pinkie because bones r closer to surface
- near grain of finger line
- never end or tip
- not on foot of infant just walking
choosing heel spot for dermal puncture?
- not arch, back of heel or plantar (sole of foot) area
- away from calcaneus (could cause osteomyelitis)
equipment for dermal puncture
● Requisition slip
● Gloves
● Alcohol prep pad
● Gauze
● Adhesive bandage or tape
● Sharps container
● Computer label
● Permanent marker or pen
● Safety dermal (capillary) puncture device or lancet
● Microspecimen containers
- same as venipuncture but diff puncture device and collection container
regions to do dermal puncture
Heel; medial and lateral plantar surfaces
Central fleshy area of third and fourth fingers Across fingerp`rint lines
areas not to do dermal puncture
Callused finger (usually index finger), thumb, or pinkie
Back of heel, bottom of foot, arch of foot
Along fingerprint lines
Areas with visible damage or edema
Sites previously used for dermal (capillary) puncture
what is diff about the actual dept hof the puncture and the lancet
the actual depth of puncture is slighlt more than the lancet length because the pressure punctures the skin
- devices r usually set at 2.2 mm for children over 8 and adults
depth of puncture depth for premature and full term neonates
premature - 0.85 mm
full term - less than 2 mm
depth of puncutre for child 6 months to 8 years
1.5 mm
depth of punctre for child over 8 and adults
2.4 mm
how to preform dermal puncture
- warm up skin
- stretch skin tightly
- cut is made across fingerprint line (across/ perpendicular to fingerprint) (if parallel blood flow is lower and lbood tends to flow down fingerprint)
- clean finger with alc prep pad
- dont use spring loaded device for glucose monitoring (only produces 2-3 drops and microcollection containers need more)
how to immobilize pediatric pt for dermal puncture?
- Cross the parent’s legs over the child’s legs
- Secure the arm that will not be punctured by extending the parent’s arm
across the child’s chest and tucking it under the parent’s own arm. - Grasp the elbow of the child’s dermal (capillary) puncture arm and hold it
securely. - Use the parent’s other arm to grasp the child’s wrist, holding it palm down.
how to collect dermal specimen
- wipe firm drop of blood away because it contains contaminated blood specimen (interstitial fluid and damaged tissue cells)
- touch collection tuvbe of microcollection to drop of blood and capillary action/ gravity
- dont “milk” blood bc that can cause hemolyze or clots (gentle squeezes instead)
- tap container on hard surface after each blood drop enters container to cause blood to flow down side or wall
what is the order to draw for dermal puncture
● EDTA (lavender or pink)
● Heparin (green or light green)
● Sodium fluoride (gray)
● Nonadditive (red) or serum separator (gold)
complicatiosn of dermal puncture
- dont puncutre previous site bc scar or infection
- dont puncutre bone (osteochondritis or ostemyelits)
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 1 kg
2.5 and 5
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 2 kg
5 and 10
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 3` kg
6 and 12
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 4 kg
8 and 16
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 5 kg
10 and 20
Maximum Allowable Volume
(mL) in One Blood Draw (2.5% of
Total Blood Volume)
Total Maximum Allowable Volume
(mL) Drawn Over 30 Days for 6 kg
12 and 24
-
venipuncture51
-
Dermal capillary puncture32
-
Blood Collection Equipment93
-
Patient and Specimen Requirements61
-
Blood Specimen Handling50
-
quality essentials37
-
special phlebotomy procedures62
-
Safety and Preparedness59
-
infection control71
-
waived testing32
-
Collection of Non-blood specimens28
-
medical terminology and abbreviations137
-
Body Systems and Related Laboratory Tests199
-
Cardiovascular system73
-
Practicing Professional Behavior47
-
Phlebotomy : A compentency-based approach83
-
Insurance >:(15
