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Friday, August 31, 2018

What capillary puncture is and how it is performed

Capillary puncture is one of the three general methods of blood specimen collection.   Called capillary puncture because blood comes from the capillaries, it is usually the preferred method of collection in infants and in adults when venipuncture is not feasible.



Materials used in capillary puncture



Sterile dry cotton
Sterile wet cotton
Lancet or penlet
Capillary tube of capillette or an appropriate collection vessel

Steps in Capillary Puncture



The practitioner prepares materials and place them within reach.

They then identify the patient properly by asking his/her name.

A suitable site is selected, usually the ring finger of the left hand for adults and the big heel or big toe for infants.

The site of puncture is sterilized from the center going outwards in a circular manner.

With a smooth and deliberate manner, the site is punctured

The first blood is wiped and the specimen is collected making use of the capillary tubes or other appropriate container.

The wound is pressed for 3-5 minutes and a sterile dry cotton and a micropore or plaster are applied.

Additional Tips on Capillary Puncture



Practitioners should smile and introduce themselves before asking the name of the patient.

They should give a brief description of the test to be done.

Children 5 years old and below would most likely would need a restraining blanket or device.

Older children will usually understand if the doctor explains why they need to perform the procedure.

The practitioner needs to make them an active participant by making them understand that they need their cooperation for the success of the blood collection.

The other pads of the fingers and the earlobes are other alternative capillary puncture sites. Determine which is best for your patient by examining the site.

Practitioners should say thank you after the procedure.

Precautions on Capillary Puncture



The practitioner should not state the patient's name but let the patient state it. The patient may not hear correctly and still say yes or no.

He may state it, or have him spell it out, or best if he can write it down; and then patient identification can be done properly.

The practitioner's material should not be near the patient, especially if the patient is a child. Children can pull the material.

The practitioner should not underestimate children. They can become stronger when intimidated and afraid.  They should be restrained properly.

The practitioner should not puncture sites which have hematoma or bruises.

The practitioner should wipe the first drop of blood, as it contains mainly tissue juices and may yield inaccurate results.

If the test is bleeding time (BT) or clotting time (CT) then the practitioner should not wipe the first drop of blood. There is protocol with these two tests.

The practitioner should make sure that all materials are sterile and dry to prevent infecting the patient and contaminating the blood samples.

Sunday, August 26, 2018

What is Type I Diabetes?

Diabetes is a metabolic condition composed of several clinical symptoms. It may also be classified into diabetes mellitus and diabetes insipidus.

The former is caused primarily by the insufficiency of the pancreatic hormone, insulin; while diabetes insipidus is the insufficiency of the posterior pituitary hormone ADH (antidiuretic hormone), or vasopressin.



Type 1 diabetes is of the diabetes mellitus type. The clinical symptoms for diabetes mellitus are the following:

Hyperglycemia: elevation of blood sugar levels, above 126 mg/dL, tested in the blood of an 8-12-hour fasting patient.

Hyperglucosuria: presence of glucose in urine as shown by the urine testing positive (change in the
blue color of the reagent strip) in the chemical phase of the routine laboratory urinalysis.

Polyphagia: this is one of the 3 P's that characterizes diabetes mellitus. It is described as experiencing excessive hunger in spite of having eaten a meal. After meals, the person grows weaker instead of becoming stronger.

This is because when a diabetic person eats, the more his blood sugar increases which exacerbates the condition leading to body weakness. If left untreated this would lead to comma and eventually death.

Polyuria: this is the 2nd P. It is characterized by excessive urination. This occurs because glucose is a diuretic substance which induces urination and enhances excretion of water from the body; so the more elevated your blood glucose levels are, the more you urinate frequently.

Polydypsia: this is the 3rd P. It is excessive thirst. Because of the frequent urination, the person's metabolism has to cope now with the water loss and therefore has the urge to drink more to compensate for the loss.


What is the etiology of type 1 DM, (diabetes mellitus)?



Homeostasis (the body's built in, automatic process of maintaining balance of the different substances in the blood), is responsible in maintaining the blood glucose levels by increasing the secretion of insulin in the beta cells of the pancreas when blood glucose levels are high; and increasing the secretion of glucagon in the alpha cells of the pancreas when the blood glucose levels are low.

This occurs automatically only when the pancreatic gland is functioning properly.

In diabetes mellitus, the pancreas is dysfunctional and is not able to produce sufficient insulin. It may also be because of the surgical removal of the pancreas (pancreatectomy); thereby resulting to the complete absence of the insulin production.

There are other secondary causes too like the dysfunction. of other endocrine glands.

What is Type I DM (diabetes mellitus?



Type 1 diabetes mellitus is also called IDDM (Insulin Dependent Diabetes Mellitus). It is called as such because the treatment requires treatment with insulin to maintain normal blood glucose levels. Under normal conditions, the insulin which is produced by the beta cells of the Islets of Langerhans is sufficient to maintain the glucose levels in the bloodstream.

Type I DM may be thin compared to Type II DM patients, who are usually obese and overweight.

Type I DM also occurs at an early age (usually during adolescence or even earlier), while type II DM occurs at a later age (usually about 40 years and above.)

Type I DM's serum is characterized by the elevation of auto-antibodies which is absent in Type II DM.

There is elevation too of ketone bodies (acetoacetate, acetone, betahydroxybutyrate) in a type I DM patient, which may lead to ketonemia (elevation of ketone bodies in the blood) and the resulting condition, ketosis. In Type II patients this do not often occur.

Ketosis can lead to a change in the blood pH; making it more acidic, resulting to coma and eventually death.

What is the normal range of glucose in a fasting patient?



Glucose is generally tested in a patient who has fasted for 8-12 hours; FBS (Fasting Blood Sugar). The normal value ranges from 70 to 100 mg/dL depending upon the method used for the laboratory test.
The 2-HPPT (Two Hour Post Prandial Test) could also be done and is a more sensitive test for DM than the FBS test.

Sometimes the OGTT (Oral Glucose Tolerance Test) is performed on the blood of pregnant women to determine whether they have GDM (Gestational Diabetes Mellitus).

What is the cure for Type I diabetes mellitus?



There is no cure for diabetes mellitus; but diet, exercise and a healthy lifestyle could help a lot in maintaining the normal blood glucose levels. Insulin or drugs may be prescribed by the physician to help lower the glucose levels if it is too elevated.

It is also vital to remember that DM should not be taken for granted as all functional organs are affected in the body; the eyes, the heart, the kidneys, and the lungs. What more, wounds do not heal easily when one has uncontrolled DM.

This is often the cause of the amputation of the arms or legs of diabetic patients because the wound could not heal and that portion of that body had developed gangrene: even simple pedicure/manicure wounds should be promptly attended to.

Knowing about Type I DM and diabetes mellitus in general would be of great help in staying healthy and maintaining wellness.

Be knowledgeable and stay healthy!

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