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Scientific Basis of Midwifery > Neonatal Blood Sampling > Flashcards

Flashcards in Neonatal Blood Sampling Deck (17)
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1

What are capillary samples suitable/ not suitable for?

Suitable for most haematological and biochemical tests but not for:
- Blood gases
- Blood cultures
- Haemoglobin and PCV (packed cell vol.) in first 2 days of life

2

What are capillary samples most commonly used for?

- Blood glucose estimation by reagent sticks and machine
- Serum bilirubin measured by a bilirubinometer
- Blood spots for the neonatal screening card

3

What equipment is needed?

- Non-sterile gloves
- Sterile lancet with delivery system
- Cotton wool ball or gauze
- Screening card or sample tube or bottle
- Tape or spot plaster

4

Give steps 1-5 of the procedure

1. Explain procedure to parent(s) and obtain informed consent
2. Ensure card is filled in accurately or any samples are labelled correctly
3. Recommend measures to comfort baby/ reduce pain
4. Protect yourself and the furniture from blood
5. Ensure the baby's foot is clean and warm

5

Give steps 6-10 of the procedure

6. If foot is visibly dirty, clean with water and ensure this completely dries
7. If necessary, pre-warm the foot
8. DO NOT USE HOT WATER
9. Allow the limb to hang to increase blood flow
10. Identify the correct area for puncture

6

Give steps 11-15 of the procedure

11. Hold heel firmly with ankle flexed (heel should be red, not white)
12. Use automated lancet (not more than 2.5mm depth) in correct area
13. Wait up to 15 secs to allow blood flow
14. Gently massage heel if necessary
15. Blood should form large drops and one should fall into each circle of screening card, filling it front and back

7

Give steps 16-20 of the procedure

16. If bleeding stops, perform a 2nd prick from a different part of the foot
17. Allow circles to dry before placing in envelope
18. Best to wipe away 1st drop to avoid contamination when testing blood sugar levels
19. One large drop is required for blood glucose estimation
20. Capillary tubes should automatically fill by capillary action - important that end of tube remains in contact with blood or air bubble will form = inaccurate results

8

What effect may excessive squeezing of the foot have?

May cause haemolysis and inaccurate results, especially in blood glucose and serum bilirubin estimations; it also causes pain and tissue damage

9

What should be done after the procedure?

- Immediate safe disposal of sharps
- After sample collection, apply pressure to puncture site with sterile gauze/ cotton wool
- If bleeding persists a small spot plaster can be applied - advise parents to remove it later
- Record procedure accurately

10

Name 4 possible complications of neonatal blood sampling

1. Cellulitis
2. Osteomyelitis
3. Scarring
4. Pain

11

Describe cellulitis

Infection of the soft tissue due to faulty aseptic technique

12

Describe osteomyelitis

Infection of the calcaneus bone due to sample being taken in the middle of the heel or too deep a puncture; this can necessitate amputation of heel or foot

13

Describe scarring

If multiple samples are requires, another technique should be used to prevent scarring

14

Describe how pain may be reduced

- Good technique
- Take sample while infant is feeding/ sucking or in a deep sleep
- Swaddling and skin to skin contact
- Topical pain relief cannot be used

15

Give some reasons that inaccurate results may be obtained

- Contamination by alcohol, soap etc
- Haemolysis
- Too little/ too much
- Leaving sample too long before analysis
- Blood glucose results can be inaccurate with good technique to in case of doubt, ask a doctor to send a venous sample

16

Give 8 ways to demonstrate safe practice

1. Informed consent
2. Universal precautions
3. Sterile one-use correct equipment
4. Clean baby's heel
5. Correct site and depth of puncture
6. Correct collection of blood drops (prevent need for repeat)
7. Safe disposal of sharps
8. Accurate record keeping

17

What is the only condition that neonatal blood sampling detects that can't be treated?

Sickle Cell