Phlebotomy

- tourniquet 3-4in (8-10cm) above vein

- alcohol swab 30s-1min

- routine needle: insert at 30 degree angle or less

- pressure 3-5min after needle removal

- cold agglutinin, cryofibrinogen, cryoglobulin, semen -> keep at 37C

- Keep cold: blood gases,

- protect from light: blilirubin, vitamins, urine prophobilinogen and urine porphyrins

- leave covering on for 15min

Urinalysis

- Routine: midstream

- RT for 2h, or fridge max 4 hours before testing

- Urine culture & sensitivity: midstream clean-catch collection in sterile container

Types of Urine Specimens:

• - Random
• - First morning/8-hour
  • Collected immediately upon waking after 8 hours of sleep
• Fasting
  • Second specimen voided after fasting
    • glucose monitoring
• Timed
  • 2-hour postprandial urine: 2 hours after meal
    • e.g. glucose tolerance testing
  • 24-hour urine
    • e.g. creatinine clearance, urobilinogen
    • void upon waking, then collect all urine following for 24h
    • void at end of 24h
  • Double-voided: empty bladder, wait specified time, and then collect urine
    • urine glucose and ketone testing

Blood sample storage

• Room temp: up to 8 hours
• Fridge: up to 48 hours
• Freeze: >48 hours (do not freeze and thaw more than once). Thaw at RT.

Capillary Puncture

• <6 months old: heel ONLY
• 6-12 months: fingerstick IF infant weighs more than 10kg (22lbs) AND puncture depth is less than 1.5mm
• Capillary blood is mostly arterial, and has elevated glucose (and maybe K+ if tissue fluid is present) along with lowered protein and electrolytes
  • However, interpret using venous RIs
  • Newborns: increased HBG and HCT
  • Kids have sugar high (high K+ and glucose)
• Unacceptable tests
  • ESR
  • Coagulation (PT/INR, APTT)
  • Blood cultures
  • Tests requiring large volumes of serum or plasma
• Order of Draw is based on specimens most affected by clotting as tissue thromboplastin is released immediately during capillary puncture
  • Blood gas
  • EDTA
  • Other additives
  • Serum specimens
• Lancets: purple low, pink medium, blue high
• Infant lancets: white (preemie), blue (micro-preemie), blue+pink stripe (newborn), pink (toddler)
• Microhematocrit tubes: 50-75uL, colour-coded by additive (blue band are non-additive)
• Medial or Lateral Plantar Heel - Make Little People Happy
• Do not apply bandage to children <2 years old