WPCn ,[͇=SxpGv9JV8K(L+-i>hj"*2,wٻ=[dĔ06Nc]\2"R׎$isIW4B7I pq؁sNl5'8\[tz 9*[;;uP=lKZɶá5a7w..1ρ6*30|ஃJ{ ꩉgK'd x`SݶͩEoHQ p_eԇfhzU&˾9OJ>-C)oj!uHduv;\\B~I|{|3pXmt+\csA c vO6 c {Yl5C '!/&[B(IfJ&Î0ȭMIAU. %z D+<g 0s- 0C AM oG0 @ QUJRE^R"`RU2RU4R CRfSaS BfS5SnES 0XUNKVMVwNW4RW 0tfWUNW^ (X#4XZ mZ 0U[U@k[ 1u[ 72 \ 0R\ 0A] 0^ 0^ 0_ 0I` 0` 0a 0>b 0b 0c 0cd 0e 0e 0Xf 0f 0g 0h 0h 0Zi 0"j 0j 0pk 0l 0l 08m 0mU >Hn<6X9`(CourierX' Capillary Puncture (Heelstick) CheckoffForm  0 .   'dxd Level 1 Level 2 Level 3 Level 4 Level 5(K2$ !         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(@ Z 6Times New Roman Regularp5 Journal Note Writer 0U*+ (_2623  ..(O Z(Times New Roman 3#37=CIQYag1.a.i.(1)(a)(i)1)a)#i)({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#*D+D (_25   ," <DL,23  ..," <DL,   *5+5 (_24  ) <DL)23  ..) <DL)  *2+2 (_23 ` &<<DL&23  ..&<<DL& ` */+/ (_22  #DL#23  ..#DL#  *,+, (_21   DL 23  .. DL  *)+) (_20 h DDL23  ..DDL h *&+& (_19  L23  ..L  *#+# (_18   L23  .. L  *>> (_17  2( 4 <DL223  Ԁ2( 4 <DL2  *DD (_16   ," <DL,23  Ԁ," <DL,   *55 (_15  ) <DL)23  Ԁ) <DL)  *22 (_14 ` &<<DL&23  Ԁ&<<DL& ` *// (_13  #DL#23  Ԁ#DL#  *,, (_12   DL 23  Ԁ DL  *)) (_11 h DDL23  ԀDDL h *&& (_10  L23  ԀL  (## &_9   L23  Ԁ L  (>> &_8  2( 4 <DL223  2( 4 <DL2  (DD &_7   ," <DL,23  ," <DL,   (55 &_6  ) <DL)23  ) <DL)  (22 &_5 ` &<<DL&23  &<<DL& ` (// &_4  #DL#23  #DL#  (,, &_3   DL 23   DL  ()) &_2 h DDL23  DDL h (&& &_1  L23  L  &## $_   L23   L  \  `&Times New Roman !         _XX QA=z (` D@ H@EXMMXM $$$$"XX  "RR$PhlebotomyTechnicianProgram   $$$$? ' X dEX ?    N   N@l CapillaryPuncture(_Heelstick_)Checkoff  C X7SX"XXXX7SPhlebotomystudentswillbeobservedbyanauthorizedexperiencedclinicalinstructor.Eachitem - onthechecklistmustbeperformedforeachheelstick.Afterobservation,theclinicalinstructorwill q  signnameanddate.Aphlebotomystudentisconsideredcapableofperformingaheelstickafter ]   completingfive(5)successful,observed_heelsticks_. I   NameofPhlebotomyStudent:#X7SXX"XE##XX7S&#(#(#(# !  * * ddd Xdd Xdd X(#(#,@0,00 ,@0 ,@0 ,@0 ,@0 ,@@ +  5&s s  pp5 TASK Draw#: >/$;  >#1 ;,!; " ;#2 ;,!; " ;#3 ;,!; " ;#4 ?,!; " ?#5 N?'; " pp  pN1. 9,!U 9Reviewrequestform(s).Gatherappropriatesuppliesfortest(s)ordered. 2# 2 2# 2 2# 2 2# 2 6# 6 J;# p   pJ2. 9,!U 9Checkforanyisolationnoticesandfollowinstructionsaccordinglyif  present. 2# 2 2# 2 2#  2 2#! 2 6#" 6 j[## p    @3.p@j3. XK@ $U  @3. @ XІVerifynameandpatientnumberbycheckingIDbandorotherform(s)ofID.  % (Thisisthemostimportantstepinthecollectionprocedure.) 2#y& 2 2# ' 2 2# ( 2 2# ) 2 6# * 6 J;# + p   8pJ4. 9,!,U 9Identifyselfandpurposeofvisittoparent/sofinfant. 2#- 2 2#. 2 2#/ 2 2#0 2 6#1 6 J;#2 p 8  pJ5. 9,!93U 9Checkfordietrestrictions.(Ifthetestrequiresafastingspecimen,besure 94 patientisfasting.) 2#5 2 2#96 2 2#97 2 2#98 2 6#99 6 J;#9: p   pJ6. 9,!1;U 9Washhandsbyacceptednurseryscrubtechnique.(Scrubuptoforearmfor3 1< minutes.) 2#= 2 2#1> 2 2#1? 2 2#1@ 2 6#1A 6 J;#1B p   8pJ7. 9,!)CU 9Positionthepatient. 2#)D 2 2#)E 2 2#)F 2 2#)G 2 6#)H 6 J;#)I p 8  pJ8. 9,!]JU 9Positionequipmentinappropriateplaceclosetopatient.Verifythat ]K necessary_microtainers_Ԁorothersuppliesarepresent. 2#!L 2 2#]M 2 2#]N 2 2#]O 2 6#]P 6 J;#]Q p   8pJ9. 9,!URU 9Putongloves. 2#US 2 2#UT 2 2#UU 2 2#UV 2 6#UW 6 J;#UX p 8  8pJ10. 9,!1YU 9Selectheel. 2#1Z 2 2#1[ 2 2#1\ 2 2#1] 2 6#1^ 6 J;#1_ p 8  pJ11. 9,! e`U 9Warmtheheelifcold.Massagefootgently5or6timestoaidbloodflow. 2# ea 2 2# eb 2 2# ec 2 2# ed 2 6# ee 6 J;# ef p   8pJ12. 9,!!gU 9Cleanthesitewithanalcoholprep.Allowtoairdry. 2#!h 2 2#!i 2 2#!j 2 2#!k 2 6#!l 6 J;#!m p 8  8pJ13. 9,!%# nU 9Removeprotectivecoverfromlancet. 2#%# o 2 2#%# p 2 2#%# q 2 2#%# r 2 6#%# s 6 J;#%# t p 8  $pJ14. 9,!Y$"uU 9@  * @? @Holdheelgentlybutfirmlywithyourthumbaboveandwellawayfromthe Y$"v #@ @?h!#@? @puncturesite.Thepuncturesiteshouldbeonthesideofthebaby'sheel.#@ @?"#@? @ԀLancets  %"w aresemi#@ @?"#@? @automatedandretract.Positionthelancetfirmlyon#@ @?"#@? @theskin,DONOT %a#x causeindentationasthismayresultinapunctureofan#@ @?s##@? @unacceptabledepth.#/@?I!##* /$#ԀDo i&$y notusealancetwhichexceedsadepthof2.0mmoninfants,particularly -'$z neonates. 2#'%{ 2 2#Y$"| 2 2#Y$"} 2 2#Y$"~ 2 6#Y$" 6 J;#Y$" p $  8pJ15. 9,!%)&U 9Wipethefirstdropofbloodawaywithacleangauze. 2#%)& 2 2#%)& 2 2#%)& 2 2#%)& 2 6#%)& 6 J;#%)& p 8  pJ16. 9,!Y*(U 9Collectspecimenbyapplyingmoderatepressureandallowingbloodtoflow Y*( fromcutintotheflotopcollectordevice.Gentlymassagetoobtainproper +( amountofblood. 2#+) 2 2#Y*( 2 2#Y*( 2 2#Y*( 2 6#Y*( 6 J;#Y*( p   pJ17. 9,!-*U 9Mixanticoagulatedtubesduringcollectionbyshakinggentlyorflicking -* occasionally. 2#-+ 2 2#-* 2 2#-* 2 2#-* 2 6#-* 6 J;#-* p   pJ   XXX    18. 9,! pU 9Whencollectioniscompleted,applycleangauzeorcottonballtothesiteand  p  applypressureuntilthebleedinghasstopped. 2#4 2 2# p 2 2# p 2 2# p 2 6# p 6 J;# p p   pJ19. 9,!h U 9Ifusingmicrotainer,removethecollectiondevicefromthemicrotainerand h  replacethecap.Inverttomixmakingsurethatthebubbletravelsfromtopto ,  bottom23times. 2#  2 2#h  2 2#h 2 2#h 2 6#h 6 J;#h p   pJ20. 9,! $U 9Applybandagingmaterialasappropriateforthesite.DONOTBANDAGE  $ APUNCTURESITETHATISSTILLBLEEDING.Donotuseabandaid. 2#  2 2# $ 2 2# $ 2 2# $ 2 6# $ 6 J;# $ p   pJ21. 9,! U 9Atbedside,correctlylabeltubeswithappropriateinformation.(Thisisthe   secondmostimportantstepintheheelstickprocedure.) 2#  2 2#  2 2#  2 2#  2 6#   6 J;# ! p   8pJ22. 9,!  "U 9Discardusedequipmentproperly. 2#  # 2 2#  $ 2 2#  % 2 2#  & 2 6#  ' 6 J;#  ( p 8  8pJ23. 9,!H )U 9Thankpatientorfamilymember. 2#H * 2 2#H + 2 2#H , 2 2#H - 2 6#H . 6 L;#H / p 8  HpL24. =,!,| 0U =Removeglovesandwashhands. 4#,| 1 4 4#,| 2 4 4#,| 3 4 4#,| 4 4 6#,| 5 63)',| 6 p H   3   `    Signature (#Date L9 1stdrawsupervisedby:(#(#(# < 2nddrawsupervisedby:(#(#(# 4? 3rddrawsupervisedby:(#(#(# 0B 4thdrawsupervisedby:(#(#(# |E 5thdrawsupervisedby:(#(#(# H