WPCZ `gki)Q&3c+moSHA͹!UH{2y5,P2Ee(>w3 z54fUrfc\=j#~^梱$Dv;?Qy ]ɣ>=ֺ^~N )ZEa\}ci=[Ym0KΆh랬 `FW7Ozs6Z{fyۭ?y DVh{ iFL8rN@u:_ݖs JТ'+OE:;NOL!R @*F7[:NHc{tF̆8HvؠH% kW%&U. %BzH D+ 0s 0C& AMioG@ zPUJPEP"PU2QU4:Q CnQfQaQ BtQQnQ 0XyTNTT 0tUUN^V^ VwV4V#VY mY 1uY 0Lc'Z'ZeZU@Z<6X9`(CourierX' Capillary Puncture (Fingerstick) CheckoffForm  0 .   'dxd Level 1 Level 2 Level 3 Level 4 Level 5(K2$ !         ($     A<< cWPCDD9513D,, AG}O;)":)!.(!??#(???'?~>? ??~? ? ??>?  ????? ?  ??? ?  ????  ? ???  ? ??  ???  ???  ?? ? ????  ??? ?   ???   ?????   ?????   ???   ???   ???   ?????   ??????    ???    ????    ????    ?? ?   ?? ?   ??   ? ???    ???    ??    ???    ????    ????    ????    ??    ?? ?   ????    ????   ? ????   ?????   ????   ????   ????   ????   ?????   ???   ?? ? ?  ??? ? ?  ???    ???    ???   ? ??    ??    ??    ???   ???   ??? ?   ?????? ?  ? ?? ????  ?   ???     ???     ????   ??~??  ? ?<?   ?<?   ?????   ????   ???p   ??0   ?? ?   ? ??? ?   ? ??? ??   ?{ ? ?  ? ??  ?? ?  >     (  ?  :?  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' X dEX ?     +/< @55k CapillaryPuncture(_Fingerstick_)Checkoff  C X, X<%Xj X XX, Phlebotomystudentswillbeobservedbyanauthorizedexperiencedclinicalinstructor.Eachitem - onthechecklistmustbeperformedforeachfingerstick.Afterobservation,theclinicalinstructor q  willsignnameanddate.Put NAforitemsnotperformedatyoursite.Aphlebotomystudentis ]   consideredcapableofperformingafingerstickaftercompletingfive(five)successful,observed I   _fingersticks_. 5  NameofPhlebotomyStudent:#X, X X%Xj\##< XX, =#(#(#(#    5 <* ddd Xdd Xdd X(#(#,w@0,00 ,@0 ,@0 ,@0 ,@0 ,@@ +  :+_ _  p: TASK Draw#: '  Room#: 5& 5#1 ;,!' " ;#2 ;,!' " ;#3 ;,!' " ;#4 ?,!' " ?#5 SD,' " p   pS !(#33!""3"  "3* 2#  1  ڈ.3  0 @   "3* W ݌  9,!!U 9Ifthepatientishospitalized,knockgentlyonpatientdoor.Checkforany ! isolationnoticesandfollowinstructionsaccordinglyifpresent. ) ) )! ) )! ) )! ) -! - J;#! p   8pJ""3"  "3 2#  2  ڈ.3  0 @   "3 ݌  9,!U 9Identifyselfandpurposeofvisit. )  ) )! ) )" ) )# ) -$ - J;#% p 8  pJ""3"  "32#  3  ڈ.3  0 @   "3݌  9,!M&U 9Askpatienthis/hername.VerifynameandpatientnumberbycheckingID M' bandorotherform(s)ofID.(Thisisthemostimportantstepinthe ( collectionprocedure.) )}) ) )M* ) )M+ ) )M, ) -M- - E6#M. p   pE""3"  "32#  4  ڈ.3  0 @   "3݌  0#! /U 0Ifoutpatientcallnameandverifyidentityaccordingtoclinicprotocol. ) 0 ) ) 1 ) ) 2 ) ) 3 ) - 4 - E6 5 p  pE""3"  "32#  5  ڈ.3  0 @   "3"݌  9,!=6U 9Reviewrequestform(s).Gatherappropriatesuppliesfortest(s)ordered. )=7 ) )=8 ) )=9 ) )=: ) -=; - J;#=< p   pJ""3"  "3=2#  6  ڈ.3  0 @   "3=j݌  9,!q=U 9Checkfordietrestrictions.(Ifthetestrequiresafastingspecimen,besure q> patientisfasting.) 2#5? 2 2#q@ 2 2#qA 2 2#qB 2 6#qC 6 J;#qD p   pJ""3"  "32#  7  ڈ.3  0 @   "3݌  9,!iEU 9Washhands. 2#iF 2 2#iG 2 2#iH 2 2#iI 2 6#iJ 6 J;#iK p   8pJ""3"  "32#  8  ڈ.3  0 @   "3E݌  9,!ELU 9Putongloves.   _   2#EM 2 2#EN 2 2#EO 2 2#EP 2 6#EQ 6 J;#ER p 8  pJ""3"  "3v2#  9  ڈ.3  0 @   "3v݌  9,!ySU 9Positionequipmentinappropriateplaceclosetopatient.Verifythat yT necessary_microtainers_Ԁorothersuppliesarepresent. 2#=U 2 2#yV 2 2#yW 2 2#yX 2 6#yY 6 J;#yZ p   8pJ""3 "  "3R 2#  10  ڈ.3  0 @   "3R  ݌  9,! q[U 9Positionthepatient. 2# q\ 2 2# q] 2 2# q^ 2 2# q_ 2 6# q` 6 J;# qa p 8  8pJ""3 "  "3"2#  11  ڈ.3  0 @   "3""݌  9,!!bU 9Selectfinger.Usethe3rdor4thfinger. 2#!c 2 2#!d 2 2#!e 2 2#!f 2 6#!g 6 J;#!h p 8  pJ""3 "  "3$2#  12  ڈ.3  0 @   "3$%݌  9,!1# iU 9Warmthefingerifcold.Massagegently5or6timesfrombasetotiptoaid 1# j bloodflow. 2##!k 2 2#1# l 2 2#1# m 2 2#1# n 2 6#1# o 6 J;#1# p p   8pJ""3 "  "3'2#  13  ڈ.3  0 @   "3''݌  9,!)%"qU 9Cleanthesitewithanalcoholprep.Allowtoairdry. 2#)%"r 2 2#)%"s 2 2#)%"t 2 2#)%"u 2 6#)%"v 6 J;#)%"w p 8  8pJ""3 "  "3)2#  14  ڈ.3  0 @   "3)*݌  9,!]&$xU 9Removeprotectivecoverfromlancet. 2#]&$y 2 2#]&$z 2 2#]&${ 2 2#]&$| 2 6#]&$} 6 J;#]&$~ p 8  XpJ""3"  "3:,2#  15  ڈ.3  0 @   "3:,g,݌  9,!'9%U 9Holdfingerfirmlywithyourthumbaboveandwellawayfromthepuncture '9% site.Thepuncturesiteshouldbehalfwaybetweenthecenteroftheballof U(% thefingeranditsside.Applylancettopuncturesitewithfirmpressureand )& activatethedevice. 2#)' 2 2#'9% 2 2#'9% 2 2#'9% 2 6#'9% 6 J;#'9% p X  8pJ""3"  "3/2#  16  ڈ.3  0 @   "3//݌  9,!+(U 9Wipethefirstdropofbloodawaywithacleangauze. 2#+( 2 2#+( 2 2#+( 2 2#+( 2 6#+( 6 J;#+( p 8  pJ""3"  "312#  17  ڈ.3  0 @   "31,2݌  9,!E,)U 9Collectspecimenbyapplyingmoderatepressureandscoopingbloodfrom E,) cutintothecollectiondevice.Gentlymassagetoobtainproperamountof  -* blood. 2#-u+ 2 2#E,) 2 2#E,) 2 2#E,) 2 6#E,) 6 J;#E,) p   pJ   XXX    ""3"  "3I52#  18  ڈ.3  0 @   "3I5v5݌  9,! pU 9Mixanticoagulatedtubesduringcollectionbyshakinggentlyorflicking  p  occasionally. 2#4 2 2# p 2 2# p 2 2# p 2 6# p 6 J;# p p   pJ""3"  "372#  19  ڈ.3  0 @   "378݌  9,!h U 9Whencollectioniscompleted,applycleangauzeorcottonballtothesiteand h  applypressureuntilthebleedinghasstopped. 2#,  2 2#h  2 2#h  2 2#h 2 6#h 6 J;#h p   pJ""3"  "3:2#  20  ڈ.3  0 @   "3::݌  9,! `U 9Ifusingmicrotainer,removethecollectiondevicefromthemicrotainerand  ` replacethecap.Inverttomixmakingsurethatthebubbletravelsfromtopto  $ bottom23times. 2#  2 2# ` 2 2# ` 2 2# ` 2 6# ` 6 J;# ` p   pJ""3"  "3=2#  21  ڈ.3  0 @   "3==݌  9,! U 9Applyabandagewhenbleedingstops.DONOTBANDAGEA   PUNCTURESITETHATISSTILLBLEEDING. 2#  2 2#  2 2#  2 2#  2 6#   6 J;# ! p   pJ""3"  "3G@2#  22  ڈ.3  0 @   "3G@t@݌  9,!  "U 9Beforeleavingthepatient'sside,correctlylabeltubeswithappropriate   # information.(Thisisthesecondmostimportantstepinthecapillary  $ punctureprocedure.) 2#L % 2 2#  & 2 2#  ' 2 2#  ( 2 6#  ) 6 J;#  * p   8pJ""3"  "3GC2#  23  ڈ.3  0 @   "3GCtC݌  9,! +U 9Discardusedequipmentproperly. 2# , 2 2# - 2 2# . 2 2# / 2 6# 0 6 J;# 1 p 8  8pJ""3"  "3E2#  24  ڈ.3  0 @   "3EE݌  9,! 2U 9Thankpatient. 2# 3 2 2# 4 2 2# 5 2 2# 6 2 6# 7 6 L;# 8 p 8  HpL""3"  "3G2#  25  ڈ.3  0 @   "3GG݌  =,!89U =Removeglovesandwashhands. 4#8: 4 4#8; 4 4#8< 4 4#8= 4 6#8> 63)'8? p H   3   `    Signature (#Date XB 1stdrawsupervisedby:(#(#(# TE 2nddrawsupervisedby:(#(#(# H 3rddrawsupervisedby:(#(#(# <K 4thdrawsupervisedby:(#(#(# 8N 5thdrawsupervisedby:(#(#(# !Q