PROCEDURE HEELSTICK PUNCTURE

1. Wear gloves before any patient contact.

2. IDENTIFY THE PATIENT

3. Choose the heel for the puncture site that is not cold,
cyanotic, bruised, cut, swollen, or has a rash.

4. Warm the heel for three minutes prior to puncture.

5. Select the appropriate containers

6. Clean the puncture site with alcohol.

7. Puncture the skin in one sharp, continuous movement, at a

45 -60 ° angle.
Left Side : Feather Lancet

8. Wipe away the first drop of blood.

Right Side; Regular Disposable Lancet

9. Blood flow is encouraged by positioning the puncture site in

a downward angle and apply a gently pressure to the foot.
2. Sterile Gauze Squares

10. Collect the desired amount for testing.

3. Alcohol Swab

11. Cover the microtubes with the caps provided and mix 4. Disposable Gloves

additive tubes by inversions 8-10x.

5. Safety Glasses and Mask

12. Apply pressure to the site.

6. Biohazard Bag and Sharps Container

13. Dispose the contaminated lancet.

14. Label all the containers.

15. If the sample is insufficient, repeat at a different site.

7. Collection Containers :

PROCEDURE FINGERSTICK PUNCTURE:

Left Side: Microhematocrit
Tube

1. Wear gloves before any patient contact.

Right Side : Microcollection
2. IDENTIFY THE PATIENT
Container

3. Select a finger

4. Avoid the thumb and index finger and the fifth finger

5. Fourth finger is preferred, then the third finger last.

6. If all fingers are cold, warm it for 3 minutes.

Newborn/neonatal Screening (NBS)

7. Select appropriate containers.

- Is the state mandated testing of newborn for the presence of
8. Clean the puncture site with 70% isopropyl alcohol
certain genetic, metabolic, hormonal, and functional disorder
9. Hold the patient’s finger firmly with one hand and place the that can cause severe mental handicaps or other serious
lancet on the finger perpendicular or across the fingerprint.
abnormalities in not detected and treated early.

10. Puncture the skin in on sharp, continuous movement.

- Requirements for disorders to be included in NBS screening
11. Wipe away the first drop of blood.
panels include benefits to early diagnosis, availability of
12. Apply gentle pressure on the finger.
accurate tests to confirm diagnosis, and better health as a
13. Collect the desired amount for testing
result of early detection and treatment.

14. Apply pressure to the site

15. Dispose contaminated lancet

16. Label all collection containers.

17. If insufficient sample was obtained, repeat the puncture at a

different site.

Preferred Specimen

- Capillary Blood - mixture of arterial, Venus and capillary

blood that is mixed with interstitial fluid and intracellular fluid
from surrounded tissues.

Capillary Puncture

- It is done as an alternative to venipuncture.

- Preferred method for infants.

- Dermal puncture/skin puncture

- Finger stick puncture

- Heelstick puncture (Children less than one year of age)

EQUIPMENT AND MATERIALS:

1. Disposable Sterile Lancet

Congenital Hypothyroidism

a.Permanently Retractable - Is recommended when a baby is three days old. Infants who
Plate
are discharged from the hospital earlier should be tested
b. Heel Puncture Lancet
immediately before they leave, although there is a risk of a
c. Needle Point Lancet
false-positive result because of a brief rise in TSH levels
d.Disposable Sterile Lancet
before a baby is three days old.

- If the free T4 is low and the TSH is elevated, a diagnosis of a

Congenital Hypothyroidism is confirmed.

- There are two newborn screen test performed in blood to

detect Hypothyroidism : Thyroid stimulating hormone and
thyroxine. When the thyroid glance is defected, known as
 Primary CH, TSH values are elevated and T4 values usually
are low, although T4 values may be within range in mild CH.

Phenylketonuria (PKU)

- is a genetic disorder characterized by a defect in the enzyme

that breaks down amine acid phenylalanine, converting it into
the amino acid tyrosine.

- Without intervention, phenylalanine, which is almost food,

accumulates in the blood and is only slowly metabolized by
an alternate athwart that results in increased phenylketones
in the urine.

- PKU testing typically requires the collection of two

specimens, one shortly after an infant is born and another
after the infant is 10 to 15 days old.

Galactosemia (GALT)

- Is an inherited disorder characterized by lack of the enzyme

needed to convert the milk sugar lactose into glucose
needed by the body for energy.

G6PD Deficiency

- is an inherited condition. It is when the body doesn't have

enough of an enzyme called G6PD (glucose-6-phosphate-
dehydrogenase. This enzyme helps red blood cells work Thick Blood Smear

correctly.
- often requested to detect the presence of malaria

- A lack of this enzyme can cause hemolytic anemia. This is

when the red blood cells break down faster than they are
made.

Blood Spot Collection :

Newborn screening tests, except hearing tests, are typically

performed on a few days of blood obtained by heel puncture.

Preparing a Blood Smear from a Capillary Puncture:

1. Perform a capillary puncture

2. Wipe away the first blood

3. Touch a slide the next blood drop

4. Hold the blood drop slide between the thumb and

forefinger of the non dominant hand, rest the second slide
in the front of the drop at an angle of approximately 30
degrees.

5. Pull the spreader slide back to the edge. Stop it as soon

as it is or a a bullet-shaped film.

6. Push the spreader slide away from the drop in one

smooth motion

7. Place the drop of blood for the second smear. Use the
slide with the two slides.

8. Place cause over the wound and ask the otherwise, the
phlebotomist must apply pressure

9. Level frosted blood slides by writing the patient

information in pencil on the frosted area

10. Allow the blood films to air-dry and place them in a

secondary container for transport

11. Thank the patient, remove gloves, and sanitize hands

12. Transport specimen to the laboratory

Prepare a Thick Blood Smear

1. A very large drop of blood is placed in the center of a glass

slide and spread with the corner of another slide, or cover
slip, until it is the size of a diam.

2. Allowed to dry for a minimum of two hours before staining

with fresh diluted.