WV CARDIAC Project

Coronary Artery Risk Detection in Appalachian Communities

William A. Neal, M.D.

Procedure Guidelines

Measuring Standing Height of Children:

• Place the height measuring board on a hard, flat surface (preferably against a wall).
• Have the child remove any footwear or headgear that may alter the measurement (including braids, barrettes, etc.).
• Kneel on the left side of the child.
• Confirm that the child is standing erect with the feet together in the center of the base of the height measuring board.
• Instruct the child to look straight ahead so that his/her line of sight is parallel with the floor.
• Make sure the child's shoulders are level and his/her hands are at the sides.
• Place your open left hand on the child's chin.
• With your right hand, lower the sliding headpiece on top of the child's head.
• Read the measurement to the nearest centimeter.

Adapted from "How to Weigh and Measure Children" I.J. Shorr, United Nations, N.Y., 1986.

Measuring Blood Pressures in Children:

• The child should be seated with the right arm resting on the armrest so that the cubital fossa is at the level of the heart
• Allow the child to relax for five minutes (use this time to confirm family history, etc.)
• The blood pressure should not be taken over clothes unless absolutely necessary
• Select correctly sized cuff (bladder width should be ~40% of the upper arm circumference)
• Rotate the child's arm so the thumb points outward and the cubital fossa is facing up
• Place the cuff so that the lower edge is approximately one inch above the cubital fossa and the center of the bladder is covering the brachial artery
• Be sure that the manometer is clearly visible
• Place the diaphragm of the stethoscope over the brachial artery (approximately 2 cm above the cubital fossa)
• Inflate the cuff to 160-170 mmHg
• Open the pressure relief screw and adjust the rate to 2-5 mmHg per second
• The first Korotkoff sound (tapping) should be recorded as the systolic pressure, while the fifth Korotkoff sound (disappearance) should be recorded as the diastolic pressure
• After fully deflating the cuff, repeat the measurement
• Record both blood pressures ascertained and the average of both the systolic and diastolic pressures

Taken from: Adams,G.M. 1994. Exercise Physiology Laboratory Manual.. IA: Wm. C. Brown Communications, Inc.

How to Perform a Fingerstick:
Note: A warm hand and good blood flow from the puncture site are essential in order to collect a good capillary sample.

ALWAYS WEAR LATEX GLOVES WHEN HANDLING BIORAZARDOUS SUBSTANCES!

Cassettes should be unopened and left at room temperature for at least 10 minutes before use. Also confirm that the cassette has not expired. Put a capillary plunger into the end of the capillary tube with the red mark. Choose a spot that is on the side of one of the center fingers of either hand. To help increase blood flow, the fingers and hand should be warm to the touch. To warm the hand, you can: Wash the child's hand in warm water, or... Gently massage the finger from the base to the tip several times Clean the site with an alcohol swab. Dry thoroughly with a gauze pad before pricking the finger. Perform a deep and firm puncture. Squeeze the finger to obtain a large drop of blood. Wipe away this first drop as it may contain tissue fluid. Squeeze the finger gently again while holding it downward (below the heart) until a second large drop of blood forms. Do not milk the finger. Hold the capillary tube by the end with the plunger at a slight descending angle to the drop of blood. Touch it to the drop of blood without touching the skin. The tube will fill by capillary action to the black mark. Do not collect air bubbles. If necessary, wipe the finger with gauze then massage again from base to tip until another large drop of blood forms. If blood stops flowing, wipe finger firmly with gauze to reopen the puncture. Wipe off any excess blood and have the child apply pressure to the puncture site until the bleeding stops. The blood must be dispensed within five minutes of collection.

Preferred Fingerstick Site

Taken from: The Cholestech LDX User Manual: Testing Procedure

Venipuncture procedures:

• Typically, venipuncture is performed using the antecubital fossa. If necessary, it can be performed on a vein in the dorsum of the hand or in the wrist.
• Open the needle packet, and attach the needle(21 G needle) to its holder.
• Label all collection tubes with the patient’s name, and the date and time of collection.
• Wash your hands thoroughly and put on gloves to prevent cross-contamination.
• Have the child sit in a chair and support the arm securely on an armrest or table.
• Assess the child’s veins to determine the best puncture site.
• Tie a tourniquet 2" proximal to the chosen area.
• Clean the venipuncture site with an alcohol sponge. (Wipe in a circular motion, spiraling outward from the site to avoid introducing potentially infectious skin flora into the vessel during the procedure.
• Allow the skin to dry before performing venipuncture.
• Immobilize the vein by pressing just below the venipuncture site with your thumb and drawing the skin taut.
• Position the needle holder with the needle bevel up and the shaft parallel to the path of the vein and at a 30 degree angle to the arm.
• Insert the needle into the arm.
• Grasp the holder securely to stabilize it in the vein, and push down on the collection tube until the needle punctures the rubber stopper. Blood will flow into the tube automatically.
• Remove the tourniquet as soon as the blood flows adequately.
• After you’ve drawn the sample, place a gauze pad over the puncture site, and slowly and gently remove the needle from the vein. Remove the tube from the needle holder before withdrawing the needle from the vein.
• Apply gentle pressure to the puncture site for 2 or 3 minutes or until bleeding stops.
• After bleeding stops, apply an adhesive bandage.

Taken from: Nursing Procedures. PA: Springhouse Corporation.