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?

1. A

   Cleaning with alcohol is not necessary

2. B

   Wipe off first drop because alcohol can give false elevated reading

3. C

   Check blood glucose 2 times

4. D

   Dry the cleaned area with a wet cotton sponge

Appeared in: NORCET -4 , 2023

Explanation

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• The correct action is to wipe off the first drop of blood after the puncture.
• The first drop is contaminated with both tissue fluid and the alcohol used for cleaning.
• Alcohol, if not completely dry or if mixed with the sample, can cause a falsely elevated glucose reading.
• Tissue fluid can dilute the blood sample, also leading to an inaccurate result.
• Using the second drop of blood ensures a pure capillary blood sample for an accurate measurement.

Why Other Options Were Wrong

• Option A: Cleaning the site is a mandatory step in any skin puncture procedure to prevent infection by removing pathogens from the skin surface.
• Option C: Checking the blood glucose twice is not a standard part of the routine procedure. A single, properly collected sample is considered sufficient and accurate.
• Option D: The area must be allowed to air dry completely. Using a wet sponge would re-contaminate the site and introduce moisture, which can interfere with the accuracy of the test.

Related Visual

• Visual 1: Diagram - An illustration of a newborn's foot showing the appropriate sites for a heel prick on the lateral (outer) aspects of the heel, and highlighting the areas to avoid (the central part over the calcaneus).
• Visual 2: Flowchart - A step-by-step flowchart of the capillary blood glucose testing procedure, from hand hygiene and site selection to sample collection and documentation, with a specific box for 'Wipe away the first drop of blood'.

Clinical Relevance

• Nursing practice connection: Knowing The concept tested is the correct procedural step in capillary blood glucose monitoring, specifically after cleaning the site with alcohol 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 the early detection and management of hypoglycemia or hyperglycemia, conditions that can lead to significant neurological injury if not treated promptly.
• Failure to follow the correct procedure, such as not wiping away the first drop of blood, can lead to erroneous results, potentially causing a delay in necessary treatment or leading to incorrect interventions.
• What if? - If the newborn's heel is cold and pale, the nurse should first warm the site with a warm compress for 3-5 minutes. This promotes vasodilation and ensures adequate blood flow for a successful sample collection, preventing the need for repeated painful punctures.

How to Approach the Question

• First, identify the core procedure being described: a heel prick for blood glucose in a newborn.
• Recall the standard, evidence-based steps for this procedure. Key steps include site selection, warming, cleaning, allowing to dry, puncturing, wiping the first drop, and collecting the sample.
• Evaluate each option against this standard protocol.
• Option A (no cleaning) violates infection control principles.
• Option C (checking twice) is not a routine step.
• Option D (drying with a wet sponge) is counterintuitive and incorrect.

Concept Tested & Keywords

• Concept Tested: The concept tested is the correct procedural step in capillary blood glucose monitoring, specifically after cleaning the site with alcohol.
• Stem keywords: capillary blood, heel prick, new born, blood glucose estimation, alcohol
• Lead-in keywords: CORRECT
• Negative lead-in flag: false

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Q8aRuUpnZPyiFpbDSNY-JK

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