This document provides guidance on venepuncture and capillary blood sampling procedures for paediatric and adult patients. It discusses:
- Preparation for venepuncture including immobilizing the patient and choosing equipment like needle size.
- The venepuncture procedure of inserting the needle into the vein.
- Capillary sampling as an alternative for small blood volumes, including indications, choice of finger or heel puncture site based on patient age and weight.
- Ensuring proper patient identification before blood collection.
Grundfos' experiences from implementing Yammer in the organisation as a part of larger project around cultural change in the organisation. The presentation focuses on lessons learned in the process as well as a few good examples.
Presented at Microsoft Next in Aarhus and Copenhagen in October 2013 by Martin Risgaard Rasmussen
Building dynamic distributed data stores with OSGi - Tim Wardmfrancis
OSGi Community Event 2013 (http://www.osgi.org/CommunityEvent2013/Schedule)
ABSTRACT
Managing large distributed runtimes can be very hard, particularly when it comes to configuration. Tools like Puppet and Chef try to solve this by automating configuration rollout, but it can be very hard to cope when parts of the runtime need to be moved, or the underlying platform changes.
OSGi is a powerful modularity framework for Java, but it also provides support for dynamic life-cycles and loosely coupled service interactions. This makes OSGi an ideal tool for configuring and managing distributed environments, especially when responding to change.
In this talk you will see how an OSGi framework can be used to manage external processes, and how by using OSGi Remote Services it is possible to automatically configure these processes into a resilient, distributed NoSQL store that adapts to its environment.
SPEAKER BIO
Tim Ward is a Principal Engineer at Paremus Ltd, a co-author of Enterprise OSGi in Action, and has been actively working with OSGi for over five years. Tim has been a regular participant in the OSGi Core Platform and Enterprise Expert Groups, and led development of several specifications. Tim is also an active Open Source committer and a PMC member in the Apache Aries project, which provides a container for enterprise OSGi applications.
Collecting blood samples and other biological specimens is crucial to the understanding, prevention, and treatment of disease. However, from the patient’s perspective, it can also be painful, unnerving, frightening, and inconvenient.
Transcatheter closure of atrial septal defect in symptomatic childrenRamachandra Barik
Atrial septal defect (ASD) constitutes 8%–10% of the
congenital heart defects in children. The secundum
ASD accounts for nearly 75% of all ASDs. Since
the introduction of transcatheter device closure for
secundum ASDs in 1976 by King et al., there has been
a paradigm shift in their management. Over the years,
the procedure has evolved significantly to become a
treatment of choice in many institutions. The Amplatzer
septal occluder (ASO) is the most widely used device
owing to its user-friendliness and high success rate.
Various studies have reported transcatheter closure
to be as effective, and with lower complication rate, as
compared to surgical closure.[4,5] However, most of these
studies have included bigger children, adolescents, and
adults. Although a few studies have demonstrated
the feasibility and reasonable safety of transcatheter
ASD device closure in very young children,[7-10] none of
them have addressed important issues like how large
a defect is too large for device closure, how to select
the size of the device, does the length of the interatrial
septum (IAS) matter in the device selection, and is
there a need for using modified techniques to achieve
successful deployment of the device in this subset of
patients which is characterized by relatively large defects
in small hearts.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Ms REPORT
1. Volume: 2: Issue-1: Jan-Mar -2011
ISSN 0976-4550
Review Article
BASIC PROCEDURE OF VENEPUNCTURE IN PAEDIATRIC AND ADULT
PATIENTS: A REVIEW
Manjunatha Goud B.K1, Sarsina Devi O3, Bhavna Nayal2*, Niveditha Suvarna2, Ayaz K Mallick1,
Sweta Shivashanker 4.
1
Department of Biochemistry, MMMC, Manipal University, Manipal, Karnataka, India
Department of Pathology, MMMC, Manipal University, Manipal, Karnataka, India
3
Department of Nursing, New City Nursing College, Udupi, Karnataka, India
4
Department of Biochemistry, KMC, Manipal University, Manipal, Karnataka, India
2
ABSTRACT: Venepuncture is the preferred method of blood sampling for term neonates and causes less
pain than heel-pricks. The choice of site and procedure (venous site, finger-prick or heel-prick – also
referred to as “capillary sampling” or “skin puncture”) depends on the volume of blood needed for the
procedure and the type of laboratory test to be done. Venepuncture is the method of choice for blood
sampling in term neonates; however, it requires an experienced and trained phlebotomist. If a trained
phlebotomist is not available, the physician may need to draw the blood sample. The blood from a
capillares is similar to an arterial blood in oxygen content, and is suitable for only a limited number of
tests because of its higher likelihood of contamination with skin flora and smaller total volume.
Key words: Venepuncture, neonates, finger-prick
INTRODUCTION
Venepuncture
Venepuncture is the preferred method of blood sampling for term neonates and causes less pain than heelpricks (1).
Materials required:
• Use a winged steel needle, preferably 23 or 24 gauge, with an extension tube (a butterfly):
• Avoid gauges of 25 or more because it may be associated with an increased risk of haemolysis.
• Use a butterfly with either a syringe or an evacuated tube with an adaptor; a butterfly can provide
easier access and movement, but movement of the attached syringe may make it difficult to draw
blood.
• Use a syringe with a barrel volume of 1–5 ml, depending on collection needs; the vacuum
produced by drawing using a larger syringe will often collapse the vein.
• When using an evacuated tube, choose one that collects a small volume (1 ml or 5 ml) and has a
low vacuum; this helps to avoid collapse of the vein and may decrease haemolysis.
• Where ever possible, use safety equipment with needle covers or features that minimize blood
exposure. Auto-disable (AD) syringes are designed for injection, and are not appropriate for
phlebotomy.
International Journal of Applied Biology and Pharmaceutical Technology
Page:385
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2. Bhavna et al
ISSN 0976-4550
Preparation
Ask whether the parent would like to help by holding the child. If the parent wishes to help, provide full
instructions on how and where to hold the child; if the parent prefers not to help, ask for assistance from
another phlebotomist.
Immobilize the child as described below.
Designate one phlebotomist as the technician, and another phlebotomist or a parent to immobilize
the child.
Ask both adults to stand on opposite sides of an examination table.
Ask the immobilizer to:
Stretch an arm across the table and place the child on its back, with its head on top of the
outstretched arm
Hold the child close, as if the person were cradling the child
Grasp the child’s elbow in the outstretched hand
Use the other arm to reach across the child and grasp its wrist in a palm-up position (reaching
across the child anchors the child’s shoulder, and thus prevents twisting or rocking movements;
also, a firm grasp on the wrist effectively provides the phlebotomist with a “tourniquet”)
If necessary, take the following steps to improve the ease of venepuncture:
Ask the parent to rhythmically tighten and release the child’s wrist, to ensure that there is an
adequate flow of blood.
Keep the child warm, which may increase the rate of blood flow by as much as sevenfold (2), by
removing as few of the child’s clothes as possible and, in the case of an infant, by:
Swaddling in a blanket
Having the parent or care giver hold the infant, leaving only the extremity of the site of
venepuncture exposed.
Warm the area of puncture with warm cloths to help dilate the blood vessels.
Use a transilluminator or pocket pen light to display the dorsal hand veins and the veins of the
antecubital fossa.
Drawing blood
• Follow the procedures given:
•
•
•
Aseptic precautions
Advance preparation
Patient identification and positioning
Skin antisepsis (but DO NOT use chlorhexidine on children under 2 months of age).
Once the infant or child is immobilized, puncture the skin 3–5 mm distal to (i.e. away from) the
vein (3); this allows good access without pushing the vein away.
If the needle enters alongside the vein rather than into it, withdraw the needle slightly without
removing it completely, and angle it into the vessel.
Draw blood slowly and steadily.
Capillary sampling
Choice of procedure and site
The choice of site and procedure (venous site, finger-prick or heel-prick – also referred to as “capillary
sampling” or “skin puncture”) depends on the volume of blood needed for the procedure and the type of
laboratory test to be done. Venepuncture is the method of choice for blood sampling in term neonates (4,
5); however, it requires an experienced and trained phlebotomist. If a trained phlebotomist is not
available, the physician may need to draw the blood sample.
International Journal of Applied Biology and Pharmaceutical Technology
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The blood from a capillares is similar to an arterial blood in oxygen content, and is suitable for only a
limited number of tests because of its higher likelihood of contamination with skin flora and smaller total
volume.
Finger and heel-prick
Whether to select a finger-prick or a heel-prick will depend on the age and weight of the child. Patient
immobilization is crucial to the safety of the paediatric and neonatal patient undergoing phlebotomy, and
to the success of the procedure. A helper is essential for properly immobilizing the patient for
venepuncture or finger-prick.
Patient identification
•
•
•
•
For paediatric and neonatal patients, use the methods described below to ensure that patients are
correctly identified before withdrawing blood.
Use a wrist or foot band only if it is attached to the patient. DO NOT use the bed number or a
wrist band that is attached to the bed or cot.
If a parent or legal guardian is present, ask that person for the child’s first and last name.
Check that the name, date of birth, hospital or file numbers are written on the laboratory form and
match them to the identity of the patient.
Indications for skin puncture:
Skin puncture is a practical alternative to venepuncture if the desired test can be done on a small amount
of blood.
Following are the indications
• Adults and children who doesn’t have accessible veins
• Available veins are fragile (eg: old age) and must be saved for other procedures like
chemotherapy
• Sever burns
• Extreme obesity
• Patient has thrombotic or clot forming tendencies
• Obtaining blood for glucose estimation by glucometer
• Skin puncture is the preferred way to obtain blood from infants and very young children
• Capillary blood is the preferred specimen for newborn screening
Capillary puncture should not be performed under the following conditions
•
•
•
•
•
•
•
•
Through the posterior curvature of the heel, because it can injury the bone
Heel of a child who has just began walking
Patient who has callous development
Fingers of neonates, because it can cause nerve damage
Previous puncture sites
Inflamed, swollen or edematous tissues
Cyanotic or poorly perfused tissues
Localized areas of infection
Choice of site
Adult patients
The finger is usually the preferred site for capillary testing in an adult patient. The sides of the heel are
only used in paediatric and neonatal patients. Ear lobes are sometimes used in mass screening or research
studies.
International Journal of Applied Biology and Pharmaceutical Technology
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Paediatric and neonatal patients
Selection of a site for capillary sampling in a paediatric patient is usually based on the age and weight of
the patient. If the child is walking, the child’s feet may have calluses that hinder adequate blood flow.
Table shows the conditions influencing the choice of heel or finger-prick.
Conditions influencing the choice of heel or finger-prick
Condition
Heel-prick
Finger-prick
Age
Weight
Placement of lancet
Birth to about 6 months
From 3–10 kg, approximately
On the medial or lateral plantar
surface
Recommended finger
Not applicable
Over 6 months
Greater than 10 kg
On the side of the ball of the finger
perpendicular to the lines of the
fingerprint
Second and third finger (i.e. middle
and ring finger); avoid the thumb
and index finger because of
calluses and avoid the little finger
because the
tissue is thin
Selecting the length of lancet
Adult patients
A lancet slightly shorter than the estimated depth needed should be used because the pressure compresses
the skin thus, the puncture depth will be slightly deeper than the lancet length. In one study of 52 subjects,
pain increased with penetration depth, and thicker lancets were slightly more painful than thin ones (6).
However, blood volume increased with the lancet penetration and depth.
Lengths vary by manufacturer (from 0.85 mm for neonates up to 2.2 mm). In a finger-prick, the depth
should not go beyond 2.4 mm, so a 2.2 mm lancet is the longest length typically used.
Paediatric and neonatal patients
In heel-pricks, the depth should not go beyond 2.4 mm. For premature neonates, a 0.85 mm lancet is
available.
• The distance for a 7 pound (3 kg) baby from outer skin surface to bone is:
• Medial and lateral heel – 3.32 mm
• Posterior heel – 2.33 mm (this site should be avoided, to reduce the risk of hitting bone)
• Toe – 2.19 mm.
• The recommended depth for a finger-prick is:
• For a child over 6 months and below 8 years – 1.5 mm;
• For a child over 8 years – 2.4 mm.
• Too much compression should be avoided, because this may cause a deeper puncture than is
needed to get good flow.
International Journal of Applied Biology and Pharmaceutical Technology
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Order of draw
With skin punctures, the haematology specimen is collected first, followed by the chemistry and blood
bank specimens. This order of drawing is essential to minimize the effects of platelet clumping. The order
used for skin punctures is the reverse of that used for venepuncture collection. If more than two
specimens are needed, venepuncture may provide more accurate laboratory results.
Procedure for capillary sampling
Adult patients
Prepare the skin
•
•
•
•
•
Apply alcohol to the entry site and allow to air dry
Puncture the skin with one quick, continuous and deliberate stroke, to achieve a good flow of
blood and to prevent the need to repeat the puncture
Wipe away the first drop of blood because it may be contaminated with tissue fluid or debris
(sloughing skin).
Avoid squeezing the finger or heel too tightly because this dilutes the specimen with tissue fluid
(plasma) and increases the probability of haemolysis (7).
When the blood collection procedure is complete, apply firm pressure to the site to stop the
bleeding.
Paediatric and neonatal patients
Immobilize the child
First immobilize the child by asking the parent to:
Sit on the phlebotomy chair with the child on the parent’s lap
Immobilize the child’s lower extremities by positioning their legs around the child’s in a crossleg pattern
Extend an arm across the child’s chest, and secure the child’s free arm by firmly tucking it under
their own
Grasp the child’s elbow (i.e. the skin puncture arm) and hold it securely
Use his or her other arm to firmly grasp the child’s wrist, holding it palm down.
Prepare the skin
• Prepare the skin as described above for adult patients.
•DO NOT use povidone iodine for a capillary skin puncture in paediatric and neonatal patients; instead,
use alcohol, as stated in the instructions for adults.
Puncture the skin
I. Puncture the skin as described above for adult patients.
II. If necessary, take the following steps to improve the ease of obtaining blood by finger-prick in
paediatric and neonatal patients
III. Ask the parent to rhythmically tighten and release the child’s wrist, to ensure that there is
sufficient flow of blood;
IV. Keep the child warm by removing as few clothes as possible, swaddling an infant in a blanket,
and having a mother or caregiver hold an infant, leaving only the extremity of the site of capillary
sampling exposed.
V. Avoid excessive massaging or squeezing of fingers because this will cause haemolysis and
impede blood flow (7).
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Give follow-up care
There are two separate steps to patient follow-up care – data entry (i.e. completion of requisitions) and
provision of comfort and reassurance.
Data entry or completion of requisitions
• Record relevant information about the blood collection on the requisition and specimen label; such
information may include:
a. Date of collection
b. Patient name
c. Patient identity number
d. Unit location (nursery or hospital room number)
e. Test or tests requested
f. Amount of blood collected (number of tubes)
g. Method of collection (venepuncture or skin puncture)
h. Phlebotomist’s initials
Comfort and reassurance
Show the child that you care either verbally or physically. A simple gesture is all it takes to leave the
child on a positive note; for example, give verbal praise, a handshake, a fun sticker or a simple pat on the
back.
A small amount of sucrose (0.012–0.12 g) is safe and effective as an analgesic for newborns undergoing
venepuncture or capillary heel-pricks (8).
Unsuccessful attempts in paediatric patients
Adhere strictly to a limit on the number of times a paediatric patient may be stuck. If no satisfactory
sample has been collected after two attempts, seek a second opinion to decide whether to make a further
attempt, or cancel the tests.
Complications
Complications that can arise in capillary sampling include:
• Collapse of veins if the tibial artery is lacerated from puncturing the medial aspect of the heel
• Osteomyelitis of the heel bone (calcaneus) (9)
• Nerve damage if the fingers of neonates are punctured (10)
• Haematoma and loss of access to the venous branch used
• Scarring
• Localized or generalized necrosis (a long-term effect)
• Skin breakdown from repeated use of adhesive strips (particularly in very young or very elderly
patients) – this can be avoided if sufficient pressure is applied and the puncture site is observed
after the procedure.
NOTE:
• DO NOT use a surgical blade to perform a skin puncture.
• DO NOT puncture the skin more than once with the same lancet, or use a single puncture site
more than once, because this can lead to bacterial contamination and infection.
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7. Bhavna et al
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REFERENCES
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