A nurse is going to drawing capillary blood by heel prick in a new born for blood glucose estimation. The nurse cleans the site with alcohol and then pricks the needle. Which of the following statement is CORRECT?

Appeared in: NORCET -4 , 2023

Explanation

The first drop of blood from a capillary puncture is contaminated with interstitial (tissue) fluid and any remaining antiseptic, such as alcohol.
Including tissue fluid and alcohol in the sample can alter the composition of the blood and lead to a falsely elevated and inaccurate glucose reading.
Standard nursing protocol for all capillary blood tests (heel prick or fingerstick) mandates wiping away the first drop to ensure the sample's integrity.
Using the second drop of blood provides a more pure capillary blood sample, leading to a more accurate and reliable test result.

Option A: Cleaning the puncture site is a mandatory step in aseptic technique. It reduces the number of microorganisms on the skin, significantly lowering the risk of introducing infection into the newborn's bloodstream.
Option C: Checking the blood glucose twice is not a routine part of the standard procedure. A single, properly collected sample is considered sufficient and accurate.
Option D: The cleaned area must be allowed to air dry completely. Using a wet cotton sponge would re-contaminate the site and introduce moisture, which can dilute the blood sample and affect the accuracy of the glucose reading.

Clinical Relevance

Nursing practice connection: Knowing The correct procedure for obtaining a capillary blood sample for glucose testing in a newborn helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Accurate blood glucose monitoring in newborns is critical for detecting and managing hypoglycemia or hyperglycemia, conditions that can have serious neurological consequences if not treated promptly.
Following the correct procedure for capillary blood sampling is a fundamental nursing skill that directly impacts patient safety and the reliability of diagnostic results.
What if? If the nurse squeezes the heel too forcefully ('milks' it) to get a blood drop, this action introduces excess tissue fluid into the sample, which will dilute the blood and cause a falsely low glucose reading, potentially leading to missed diagnosis of hyperglycemia or unnecessary treatment for perceived hypoglycemia.

How to Approach the Question

First, identify the core nursing procedure in the question: obtaining a capillary blood sample via heel prick in a newborn.
Recall the standard, evidence-based steps for this procedure. Think about the sequence: preparation, cleaning, puncture, and collection.
Evaluate each option against this standard protocol.
Option A suggests skipping a critical safety step (cleaning), which is incorrect.
Option B describes a specific action (wiping the first drop) and provides a rationale. Evaluate if this is a known step for ensuring sample accuracy.
Option C suggests a non-standard action (checking twice). Consider if this is routine or only for specific situations.

Concept Tested & Keywords

Concept Tested: The correct procedure for obtaining a capillary blood sample for glucose testing in a newborn.
Stem keywords: capillary blood, heel prick, new born, blood glucose estimation, alcohol
Lead-in keywords: CORRECT
Clinical cues: The procedure is being performed on a newborn, which has specific site considerations (heel).
Clinical cues: The purpose is for blood glucose estimation, where accuracy is critical.

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E6 textbook of Applied Biochemistry and Nutrition & DieteticsHarbans Lal (pp 26-464 of 479) p. 221-223

E6 Nursing Fundamentals Taylor p. 698-700

Practise the full NORCET -4 , 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.