A phlebotomist should recognize that the Clinical and Laboratory Standards Institute (CLSI) recommends that a heel stick depth should not penetrate deeper than which of the following depths for an infant patient?
2.0 mm
2.5 mm
3.0 mm
3.5 mm
The Correct Answer is A
Choice A Reason:
The recommended heel stick depth of 2.0 mm is based on the need to minimize the risk of injury to the infant. Penetrating deeper than this can increase the likelihood of hitting bone, which in infants can be as close as 2.0 mm under the skin of the plantar surface of the heel. This depth is sufficient to obtain a blood sample without risking injury to deeper tissues or bone.
Choice B Reason:
A depth of 2.5 mm may be too deep for some infants, especially preterm or very small infants, where the calcaneus (heel bone) is closer to the surface. While this depth might still be safe for some infants, it does not provide the same margin of safety as the 2.0 mm recommendation and could potentially lead to bone puncture or other injuries.
Choice C Reason:
A depth of 3.0 mm significantly increases the risk of bone puncture, especially in infants with less subcutaneous fat or in those who are preterm. This depth could easily breach the protective layer of skin and subcutaneous tissue, leading to a higher risk of osteomyelitis, an infection of the bone, which can be a serious complication in infants.
Choice D Reason:
A depth of 3.5 mm is considered too deep for a heel stick procedure and is likely to cause injury to the infant. This depth would almost certainly penetrate the bone in most infants, leading to severe pain, potential for infection, and other complications. It is well beyond the safe range recommended by CLSI and should be avoided.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Positioning the needle at a 45° angle to the skin is not the recommended approach for venipuncture using a butterfly needle on dorsal hand veins. The correct angle for insertion is usually less than 45°, often around 15-30°, to ensure a shallow entry and reduce the risk of going through the vein.
Choice B Reason:
Holding the needle by the wings of the butterfly is the correct technique. This allows for better control and stability during insertion. The wings are designed to be held between the thumb and forefinger, providing an easy grip for the phlebotomist to maneuver the needle with precision.
Choice C Reason:
Instructing the patient to hold the collection tubes is not standard practice and could lead to pre-analytical errors. The phlebotomist should maintain control of the tubes to ensure proper blood flow and fill volume, as well as to prevent contamination or accidents.
Choice D Reason:
Applying the tourniquet at the antecubital area is not specific to the use of a butterfly needle for venipuncture on dorsal hand veins. While a tourniquet is used to engorge the veins and make them more prominent, its placement may vary depending on the selected puncture site and is not the action in question here.
Correct Answer is C
Explanation
Choice A reason:
The nondominant dorsal hand is not typically recommended for dermal specimen collection in toddlers due to the thinness of the skin and the proximity of bones and tendons, which increases the risk of injury.
Choice B reason:
The dominant lateral plantar heel is also not an ideal site for dermal specimen collection in toddlers. The heel is a common site for blood collection in neonates, but as children grow, the skin on the heel thickens, and the risk of hitting bone increases.
Choice C reason:
The nondominant third finger is the recommended site for dermal specimen collection in toddlers over one year of age. The palmar surface of the distal phalanx of the middle or ring finger provides a sufficient area for puncture while minimizing the risk of injury to underlying structures.
Choice D reason:
The dominant antecubital space is not a typical site for dermal specimen collection, especially in toddlers. This area is generally used for venipuncture due to the presence of larger veins suitable for this type of blood collection
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