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 D
Explanation
Choice A Reason:
A red-top tube is used for serum determinations in chemistry and should be allowed to clot completely, typically for 30 minutes, before centrifugation. Shipping after only 15 minutes may result in incomplete clotting and potentially inaccurate test results.
Choice B Reason:
Serum should not be separated from a lavender-top tube, as this type of tube contains EDTA and is used for whole blood tests, not serum. This indicates a misunderstanding of the tube's purpose and could lead to compromised test results.
Choice C Reason:
A tiger-top tube, also known as a serum separator tube, is used for various chemistry tests. However, bilirubin is light-sensitive, and specimens for bilirubin testing should be protected from light, not shipped in a clear bag. This could lead to degradation of the bilirubin and inaccurate results.
Choice D Reason:
A green-top tube contains heparin and is used for plasma determinations. Ammonia testing requires the plasma to be placed on ice immediately after collection to inhibit the continued production of ammonia from red blood cells. Therefore, shipping in an icy water mixture is the correct procedure to ensure accurate ammonia levels.
In conclusion, the proper preparation and transport of blood specimens are crucial for the accuracy of laboratory tests. The green-top tube for ammonia testing, shipped in an icy water mixture, is the only option that follows the correct protocol for specimen handling and transport.
Correct Answer is D
Explanation
Choice A Reason:
Withdrawing the needle completely would be an incorrect action because it would end the procedure prematurely and require a new venipuncture, causing unnecessary discomfort to the patient. It should only be done if the venipuncture has been completed or if there is a need to stop due to a complication.
Choice B Reason:
Rotating the bevel of the needle could potentially reposition the needle for better blood flow if it has become occluded or is not properly aligned with the vein. However, this action should be done with caution to avoid causing injury to the vein or discomfort to the patient.
Choice C Reason:
Increasing tourniquet pressure is not advisable once blood flow has been established, as it could cause damage to the vein or hemolysis of the blood sample. The tourniquet should be released once the blood starts flowing into the first tube to avoid these issues.
Choice D Reason:
Activating a new evacuated tube is the correct action to take when blood flow stops upon attaching a second tube. This could indicate a problem with the vacuum in the tube rather than with the needle or the venipuncture site. Trying a new tube can resolve the issue without needing to adjust the needle or the patient's position.
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