Reviewer in Phleb 102
potassium, calcium, total protein and
Dermal Puncture
Identification
1. Dermal puncture is also known as
2. Pertains to the rupture of RBC
membrane that can affect a series of
tests.
3. Capillary puncture is accomplished by
a quick firm stab using a lancet or
pricker at a depth of __ - __ mm (as per
CLSI guidelines).
4. Depth of capillary bed from skin:
Infants
5. Depth of capillary bed from skin:
adults.
6. Frequently referred to as the
microhematocrit tubes
7. Tubes are available as plain or coated
with ammonium heparin, and they are
color coded: Blue and red
8. Small collection tubes often referred
to as “bullets”
9. This increases blood flow seven times
10. Clay-like substances used in sealing
microhematocrit tubes.
11. Acceptable areas for heel puncture
are ____ and ____ areas of the plantar
(bottom) surface of the heel. It is in
these areas that the distance between
the skin and the calcaneus (heel bone)
is greatest.
12. Finger puncture site are performed
on adults and children over __ year of
age. Fingers of infants younger than __
year old may not contain enough tissue
to prevent contact with the bone.
13. Use of ________ is NOT
recommended for dermal punctures
because sample contamination may
elevate some of the test results,
including bilirubin, phosphorus, uric acid,
glucose.
14. How may punctures is
recommended to be attempted during
capillary puncture?
15. One of the most frequently
performed tests on newborns measures
______ levels.
16. Is a public health program that
involves testing of the newborn babies
for genetic, metabolic, hormonal, and
functional disorders that can cause
physical disabilities, mental retardation,
or even death, if not detected or treated
early.
17. ___________ is an office under the
National Institutes of Health (NIH),
University of the Philippines Manila
created under RA 9288.
Multiple Choice
1. Dermal Puncture may also be
performed in adults in the following
cases: EXCEPT
a. Burned or scarred patients
b. Patients receiving chemotherapy (veins
must be reserved for therapy)
c. Patients with thrombotic tendencies
d. Geriatric or patients with very fragile
veins
e. Patients with inaccessible veins such as:
Obese patients and Apprehended patients
f. POCT tests
g. Healthy adult
2. Satisfactory samples cannot be
obtained from: Except:
a. severely dehydrated patients
b. patients with poor peripheral circulation or
have swollen fingers.
c. NONE
3. What is the blood sample collected
from dermal puncture?
a. capillary blood should not exceed _____ mm in a device
b. dermal blood used to perform heelsticks (infants).
4. Capillary blood is composed of a a. 3.0 mm
mixture of venous and arterial blood b. 4.0 mm
(______portion is higher) plus c. 2.00 mm
intracellular and interstitial fluids. 11. Depth of capillary bed from skin: All
a. venous of these are correct, except:
b. arterial a. infants:  0.35 to 1.6 mm
5. Warming the site prior to collection b. adults  3 mm
increases blood flow in the capillaries by c. NONE
sevenfold. 12. Incision ______ pertains to number of
a. trifold severed or damaged capillaries upon
b. eightfold puncture
c. sevenfold a. width
6. When capillary blood is used for b. depth
sample analysis: The concentration of 13. The recommended incision is width
_______ is HIGHER as compared to limit is up to ____ mm.
venous blood. a. 3.5
a. glucose b. 2.5
b. lipid 14. Small tubes used to collect
c. calcium approximately 50 to 75 µL of blood for
7. When capillary blood is used for the primary purpose of performing a
sample analysis: The concentrations of microhematocrit test.
Potassium, Total Protein and Calcium a. Capillary tube
are LOWER as compared to venous b. Microcollection tube
blood. 15. Blue microhematocrit tubes
a. false a. no anticoagulant
b. true b. coated with heparin
8. A dermal puncture device that is 16. Red microhematocrit tubes
Sterile, disposable, sharp instruments a. no anticoagulant
used for capillary blood collection. b. coated with heparin
a. pricker 17. Made up of plastic; (present no
b. lancet danger from broken glass). Provide
9. OSHA recommends that all dermal larger collection volumes (up to
puncture devices must ________. approximately 600 uL of blood. They are
a. have the ability to retract and lock after color coded; with minimum and
use to prevent reuse and accidental maximum fill levels.
puncture. a. Capillary tube
b. be expensive b. Microcollection tube
c. has the ability to store lancets 18. CLSI recommends using ___%
10. To prevent contact with bone, the alcohol
depth of the puncture is critical. CLSI a. 80
recommends that the incision depth b. 70
19. This is used to wipe away the first 26. Have less tissue mass; may possibly
drop of blood: to eliminate alcohol cause bone injury if punctured.
residue and to eliminate excess tissue a. thumb
fluid b. index finger
a. cotton c. tips and side
b. bandage d. fifth finger
20. This is used to hold site after 27. should not be used because it is
collection heavily callused;
a. cotton a. thumb
b. bandage b. index finger
21. Warming devices can be a towel or a c. tips and side
diaper dampened with warm water (must d. fifth finger
not exceed ____oC for it might scald the 28. also not recommended because of
patient). increased nerve endings;
a. 50 a. thumb
b. 45 b. index finger
c. 43 c. tips and side
22. Previously recommended skin d. fifth finger
puncture site for arterial blood (this site 29. should not be used because of
is not anymore recommended at present) decreased amounts of tissue.
a. belly button a. thumb
c. earlobe b. index finger
c. tongue c. tips and side
23. These are the common sites of d. fifth finger
puncture, EXCEPT: 30. Warming ______ the blood vessels
a. Lateral plantar heel surface (babies) and increases arterial blood flow.
b. Palmar surface of the fingers a. constricts
c. Plantar surface of the big toe b. dilates
d. Earlobe (less painful) 31. Warm the area by moistening of the
24. The ____ is used for dermal towel with warm water (42oC) or
punctures on infants younger than 1 activating a commercial heel warmer and
year because it contains more blood covering the site for ____ minutes
than the fingers and has not yet become effectively warms the site.
callused from walking. a. 3 to 5
a. hand b. 2 to 4
b. heel c. 1 minute
c. finger 32. Warming the site should not exceed
25. The fleshy area are located near the to ____ minutes
center of the third and fourth fingers of a. 5
the palmar side of the ________ hand are b. 10
site of choice for finger puncture. c. 15
a. dominant 33. Eliminate the normal flora that may
b. nondominant possibly cause infection once they gain
entrance to the body.
a. cleaning the site
b. warming the site
c. performing the puncture
34. Failure to allow the alcohol to dry,
may cause the ff, EXCEPT
a. Causes a stinging sensation for the
patient
b. Contaminates the sample
c. Hemolyzes RBCs
d. Prevents the formation of a rounded
blood drop because blood will mix with the
alcohol and run down the finger.
e. clean the blood
35. During sample collection, apply
pressure ____ inch away from the
puncture site to facilitate better blood
flow.
a. 1/3
b. 1/4.
c. ½
36. The capillary sample must be
collected within ___ minutes to prevent
clotting.
a. 2
b. 5
c. 1
37. To prevent introduction of air
bubbles, capillary tubes and
micropipettes are held _______ to fill by
capillary action during the entire
collection.
a. vertically
b. horizontally
38. When tubes are filled, they are sealed
with ______ or designated plastic caps.
a. sealant clay
b. cap
39. The tubes must be mixed for ____
times by gentle inversion as
recommended by the manufacturer. They
may have to be gently tapped throughout
the procedure to mix the blood with the
anticoagulant
a. 8 to 10
b. 5 to 10
40. An overfilled tube may clot, whereas
an underfilled tube can cause
morphological changes in cells.
A. Both statements are true
B. Both statements are false
41. Increased serum bilirubin, which is
caused by HDN or it may simply occur
because the liver of the newborns
(particularly premature infants) is often
not developed enough to process
bilirubin produced from the normal
breakdown of red blood cells.
a. Hypobilirunemia
b. hyperbilirubinemia
42. a very light-sensitive chemical and is
rapidly destroyed when exposed to light.
Specimens must be protected from
exposure to light through: Amber-
colored microcollection tubes or if not
available; one can cover the tube using
carbon paper.
a. calcium
b. bilirubin
43. Newborn screening is embodied in
_______ or also known as Newborn
Screening Act of 2004.
a. RA 9238
b. RA 9338
c. RA 9288
44. During newborn screening, Blood is
typically collected by a med tech, a
nurse or the physician in-charge via heel
puncture _____ hours after birth of the
baby.
a. 24-72
b. 24-48
45. Causes severe salt loss, dehydration
and high levels of male sex hormones in
both male and female.
a. Congenital Hypothyroidism (CH)
b. Congenital Adrenal Hyperplasia (CAH)
c. Galactosemia (GAL)
46. Lack or absence of thyroid hormone
which is essential for physical and
mental development of a child.
a. Congenital Hypothyroidism (CH)
b. Congenital Adrenal Hyperplasia (CAH)
c. Galactosemia (GAL)
47. inability to process galactose
a. Congenital Hypothyroidism (CH)
b. Congenital Adrenal Hyperplasia (CAH)
c. Galactosemia (GAL)
48. lack or absence of the enzyme G-6-
PD needed by RBC’s; most common
a. Phenylketonuria (PKU)
b. Glucose-6-Phosphate Dehydrogenase
Deficiency (G-6-PD def)
49. inability to properly use the amino
acid phenylalanine
a. Phenylketonuria (PKU)
b. Glucose-6-Phosphate Dehydrogenase
Deficiency (G-6-PD def)
Fill in the blanks: Why is dermal
puncture preferred for children below 2
years old?
1. Locating ______ deep/superficial
veins is difficult in these patients, and
available veins may need to be reserved
for intravenous therapy.
2. Use of _____ deep/superficial veins
are dangerous and may cause
complications and injury caused by
restraining the child.
3. Drawing excessive amounts of blood
from premature and small infants can
rapidly cause _____,
4. Certain test require capillary blood,
such as ___________ and
____________.
True or false
1. Dermal puncture is considered the
method of choice for collecting blood
from healthy adults.
2. This is a disadvantage of dermal
puncture: Less amount of blood can be
obtained that is why it is not
recommended for tests requiring large
amounts of blood.
3. Since small blood is taken for
capillary puncture, Additional and
repeated tests can be done.
4. Hemolysis is more common in
venipuncture because of the ff reasons:
 Excessive squeezing of the
puncture site (“milking”)
 Newborns have increased
numbers of red blood cells (RBCs)
and increased RBC fragility
 Residual alcohol at the site
 Vigorous mixing of microcollection
tubes after collection
5. The amount of blood collected via
dermal puncture is more dependent on
the incision width rather than on the
incision depth.
6. Longer incisions should be avoided
so as to prevent unnecessary damage
to the heel or finger of the patient.
7. One can also use a commercial heel
warmer (a packet containing sodium
thiosulfate and glycerin which when
mixed together by gentle squeezing will
generate heat)
8. Punctures could be performed in
other areas of the foot and particularly
not in the arch, where they may cause
damage to nerves, tendons, and
cartilage as long as the phlebotomist is
careful.
9. A swollen, or previously punctured
site is unacceptable because the
increase tissue fluid may contaminate
the blood samples.
10. Warming increases blood flow; It
makes blood collection easier and faster
and it reduces the tendency to squeeze
the site.
11. Removing the microhematocrit tube
from the drop of blood does not affect
the sample.
12. The presence of bubbles limits the
amount of blood that can be collected
per tube and interfere with blood gas
determinations.
Identify whether this is an advantage
or a disadvantage of capillary
puncture
1. Blood hemolyzes easily
2. Easily accessible to the operator
3. Easy to manipulate
4. Less intimidating
5. Prone to microclots and sample
contamination
Arrange the order of draw:
1. Other additive specimens (green or
blue).
2. EDTA(lavender-topped tube)
3. Serum specimens (red/yellow-topped
tube)
Enumeration:
1. What concentration is higher in
capillary blood than vein?
2. What concentrations are lower in
capillary blood than vein?
3. What test results can povidone-iodine
affect when it is used for dermal
puncture? (7)
4. What two lab procedures requires the
use of povidone iodine?

Answers: 1. Skin 2. Hemolysis

Identification puncture/capillary 3. 2-3
puncture 4. 0.35 mm to 1.6 mm
5. 3 mm 21. C 2. T
6. Capillary tube 22. B 3. F
7. Capillary tube 23. D 4. F
8. Microcollection tube 24. B 5. T
9. Warming devices 25. B 6. T
10. Sealant 26. C 7. T
11. Medial/lateral 27. A 8. F
12. 1 28. B 9. T
13. Povidone-iodine 29. D 10. T
14. 4 30. B 11. F
15. Bilirubin 31. A 12. T
16. Newborn screening 32. B Identify (ADV or
17. Newborn Screening 33. A DISADV)
Reference Center 34. E 1. Disadv
(NSRC) 35. C 2. Adv
Multiple choice 36. A 3. Adv
1. G 37. B 4. Adv
2. C 38. A 5. Disadv
3. A 39. B
4. B 40. A Arrange the order of
5. C 41. B draw:
6. A 42. B 1. 2nd
7. B 43. C 2. 1st
8. B 44. B 3. 3rd
9A 45. B Enumeration
10. C 46. A 1. Glucose
11. C 47. C 2. Potassium, total
12. A Fill in the blanks protein and calcium
13. A 1. Superficial 3. Bilirubin, phosphorus,
14. A 2. Deep uric acid, potassium,
15. A 3. Anemia calcium, total
16. B 4. Newborn screening protein/glucose
17. B test and capillary blood 4. Blood culture
18. B test collection and blood
19. A True/False donation
20. B 1. F