Blood Spot samples

Jane GickJane Gick

Paediatric Metabolic Nurse SpecialistPaediatric Metabolic Nurse Specialist

Evelina Children’s HospitalEvelina Children’s Hospital

Guy’s & St. Thomas’ NHS Foundation trustGuy’s & St. Thomas’ NHS Foundation trust

Preparation

Write out card with all Write out card with all the necessary details.the necessary details.

Have lancet pen ready Have lancet pen ready and loadedand loaded

A clean cotton wool A clean cotton wool ball for wiping site ball for wiping site after sample collectedafter sample collected

Plaster if requiredPlaster if required

Using soft clix pen

If using a soft clix If using a soft clix device, set the gauge.device, set the gauge.

Depth gauge is Depth gauge is according to skin type, according to skin type, three to four is usually three to four is usually fine.fine.

cleansing

Wash your hands, dry Wash your hands, dry them thoroughly.them thoroughly.

Wet hands can Wet hands can contaminate a sample contaminate a sample as well as prevent a as well as prevent a nice blood bubble nice blood bubble formation.formation.

Heel prick test

Apply booties or warm Apply booties or warm socks an hour or so prior socks an hour or so prior to collecting sample.to collecting sample.

Make sure heel is cleanMake sure heel is clean

Either side of the heel and Either side of the heel and big toe can be used.big toe can be used.

Sample site

Choose a different Choose a different finger/toe from last finger/toe from last sample.sample.

Make sure hands are nice Make sure hands are nice and warm.and warm.

Hold device firmly on Hold device firmly on skin. skin.

Press button.Press button. Count to three 1,2,3Count to three 1,2,3 Squeeze.Squeeze.

Sample size

Use a squeeze and Use a squeeze and relax, squeeze and relax, squeeze and relax tension allowing relax tension allowing for a good size sample.for a good size sample.

Apply sample to card

Allow for nice bubble Allow for nice bubble formationformation

If bubble is not going If bubble is not going to drip, bring card to to drip, bring card to bubble trying not to let bubble trying not to let finger/heel touch the finger/heel touch the card. Blood will seep card. Blood will seep through the card.through the card.

How many spots?

Most laboratories are Most laboratories are happy for two blood spots happy for two blood spots but they must be big but they must be big enough.enough.

If the first spot looks too If the first spot looks too small collect three blood small collect three blood spots or even four, this spots or even four, this will ensure some of the will ensure some of the sample sent will be sample sent will be sufficient. sufficient.

coverage

Each spot should Each spot should cover most of the cover most of the circle diameter.circle diameter.

What’s on the other side?

Turn the card over to Turn the card over to check enough blood check enough blood has soaked through.has soaked through.

Poor samples

Samples that are too Samples that are too small will give an small will give an inaccurate inaccurate phenylalanine level.phenylalanine level.

examples

Another example of Another example of poor samples.poor samples.

spotting

Spotting will give a Spotting will give a result that may not result that may not reflect a true reflect a true phenylalanine level.phenylalanine level.

What happens next

A suitable spot is A suitable spot is punched from the card punched from the card for analysisfor analysis

Size required for accurate testing

This picture This picture demonstrates the size demonstrates the size of sample required to of sample required to get a good get a good phenylalanine result. phenylalanine result.

Checking in

Samples posted in are Samples posted in are received at the received at the laboratory and are laboratory and are logged in to the logged in to the computer.computer.

Punching out spot

A special machine A special machine punches out the spotspunches out the spots

Mixing and shaking

Samples are then put Samples are then put onto plates and mixed.onto plates and mixed.

Analysing

All samples running All samples running for analysis.for analysis.

results

Sample results are Sample results are then checked by the then checked by the laboratory staff.laboratory staff.

Lab team

Our hard working Our hard working biochemistry team.biochemistry team.

Our screening laboratory

Reported results

Our dietitians have Our dietitians have both a phoned and both a phoned and faxed report of all the faxed report of all the day’s phenylalanine day’s phenylalanine samples receivedsamples received

Phoning parents

With all the results With all the results available, the dietitian available, the dietitian phones the families, phones the families, discusses both the discusses both the child’s well being child’s well being dietary changes if dietary changes if needed and often a bit needed and often a bit of a social chit-chat.of a social chit-chat.