Specimen Collection Guide for Metabolic Screening

1
Specimen Collection Guidefor Metabolic Screening

• Florida Newborn Screening Program

2
Objectives
The specimen collector will be able to

• Complete demographic information correctly.
• Select appropriate site for heel puncture.
• Properly collect the specimen.
• Correctly dry and send specimen cards.
• State common reasons for unsatisfactory
  specimens.

3
Completing Demographic Info

• Accuracy and completeness !
• Fill out all areas of card.
• Print as clearly as possible.
• Parents should not be filling out the specimen
  card.
• Avoid abbreviations of doctors, hospitals, and
  collection sites.

4
Floridas Filter Spot Card

• This is the revised specimen card that became
  available at the end of December.

5
Infants Information

• Babys last name and first name if known
• Date of birth, military time of birth, (if baby
  is born at midnight 0000, use 0001 to avoid
  confusion), deceased
• Gender, weight at time of collection, gestational
  age, NICU?, birth order (for multiple birth,
  please use only letters a, b, c), ethnicity (can
  choose more than one)
• First feed, TPN/hyperal, breast, bottle or NPO
• Collected by (init.), transfused date and time

6
Mothers Information

• Mothers last name first name.
• Address
• City, state, zip code.
• Mothers or contacts phone (when mom has no
  phone, attempt to get a number of someone who can
  reach the mom). Medicaid , Social Security are
  extremely important!
• Adoption
• Address of where report is to be sent, lab ID
• Name of Collection Facility

7
Collection Facility Information

• Enter your facility's name, city, state, zip
  under both areas unless your collection site is
  different from where reports are sent.

8
Hearing Screening Information

• Date of screening, results, test method used.
• Hearing risk status.
• If hearing screen not completed when specimen is
  collected, darken a reason why
• The results of the hearing screen can be
  submitted later, using a separate form, or later
  screening card.
• Please remember to submit hearing results at
  collection or at a later time!

When hearing results are not reported, we must
contact parents for the information, this
sometimes causes undue stress on parents, who
then worry that their baby may have a problem.
9
Physicians Insurance Information

• Name bubble whether attending or
  post-discharge physician.
• Telephone number.
• Private Insurance Information (other than
  Medicaid).

10
Pre-Collection Foot Care

• Place newborns foot in a dependent position to
  increase venous pressure (lower than the level of
  the heart).
• Warm the heel with an appropriate heel warming
  device.

11
Informed Consent
Explain to the baby what you are about to do and
why !

• Just Kidding ! But you do need to explain to
  the parents !

12
Selecting a Heel Puncture Site

• Wash hands.
• Wear powder-free gloves.
• ID patient.
• Select puncture site in shaded area only (to
  avoid nerve damage and larger blood vessels).
• Wipe heel with alcohol swab (or other hospital
  approved antiseptic).
• Allow heel to air dry.

13
Collecting the Specimen I

• Puncture heel with sterile 2.5 mm disposable
  lancet.
• Wipe off first drop of blood.
• Wait for a large drop of blood to form, touch a
  circle of the filter paper to the blood (do not
  touch the filter paper with your hands or the
  babys foot).
• Fill ALL the circles with ONE LARGE drop of blood
  each.

14
Collecting the Specimen II

• Apply blood to one side of the specimen
  collection card only.
• A single drop only per circle, NO repetitive
  spotting.
• VERY GENTLE intermittent pressure may be applied
  to area surrounding puncture site.
• Remember not to touch the area within the circle
  before or after specimen collection.

15
Post-Collection Foot Care

• Elevate the foot.
• Apply gentle pressure using sterile gauze.
• Puncture site care should be consistent with your
  institutions policies and procedures.

16
Card Drying After Collection I

• Allow to AIR DRY at least 4 hours.
• Position horizontally, not vertically.
• Dont stack specimens together.
• Dont stand on end, or hang to dry.

17
Card Drying After Collection II

• Non-absorbent, open surface (or drying rack).
• Dont heat dry specimens, or use a fan to shorten
  drying time.
• Dont refrigerate the specimen.
• Dont package specimens for mailing until
  completely dry.
• If humid, allow extra drying time.

18
Medical Record Keeping

• Document and track the collection, transmittal,
  and results of the specimen. Use your copy of the
  demographics card. Place in the babys medical
  record.
• DONT HOLD SPECIMENS FOR BULK MAILING! Delay of
  more than 24 hours can cause deterioration in the
  quality of the specimen.

19
Packaging Specimen After Drying

• After the specimen circles are completely dry
• Fold the end flap (biohazard shield) over the
  blood spots.
• Do Not apply tape to this area.
• Insert the card into the mailing envelope.
• Send to the State Lab within 24 hours of
  collection.

Biohazard shield folded over circles of blood
20
Shipping the Specimen Card

• Never put specimens in the big metal mail boxes
  located outside on the street.
• Specimens must be transported by First Class mail
  or Rapid Carrier.

NO!
YES!
USPS
Fed EX
21
Special Considerations I

• Do not collect more than one specimen card if the
  first card is full and contains a good quantity.
• Do not tape specimens together If a second
  specimen card is collected at the same time on
  the same baby, fill out all of the demographic
  information. Staple in 2 places at the top of
  the card, specifically above the word STATE and
  above the zip code 32202. Be sure the
  biohazard shield is not caught between the 2
  cards BEFORE STAPLING.

Staple
Staple
22
Special Considerations II

• Please be sure to check the specimen card for the
  expiration date. Discard outdated specimen cards.

Expiration Date
This is the kit number. It is another way the
lab identifies specimens, and it is printed on
the mailer next to the specimen number.
23
Hearing Screening Not Completed

• Do not delay submitting the specimen card to the
  state laboratory if the hearing screening
  component is not completed !
• The hearing portion can be submitted later. But
  please be sure to indicate reason for omitting
  the hearing screening results.

24
Unsatisfactory Specimens

• Should any specimen collected by a hospital or
  other submitting entity be REJECTED by the State
  Lab as UNSATISFACTORY
• The hospital or submitting entity MUST make
  reasonable attempts to obtain and submit a
  SATISFACTORY specimen.
• A reasonable attempt to locate a newborn for
  repeat testing MUST be made and the steps taken
  must be documented!

25
Common Reasons for Unsats

• Touching the filter paper with hands or babys
  foot.
• Overlapping the blood spots on the filter paper.
• Blood clots on specimen circles.
• Not enough blood on circles.
• Improper drying techniques.
• Delays in sending the specimen to the State Lab.
• Incorrect or not enough information written in
  the demographic section.

26
Guidelines for Collection

• 48 hours of age.
• 24 hours on protein feedings.
• If the infant is being discharged prior to 48
  hours of age and/or not been on a protein diet
  for 24 hours
• a specimen must be obtained before discharge,
  irrespective of age or feeding status.
• The parent must be given written instructions
  that a repeat specimen must be collected within 5
  days.

27
A Specimen MUST be obtained prior to discharge!
Whether the baby is 2 minutes, 2 days old, or 2
weeks old !
Collect a Specimen on All babies!
Exceptions Normal, healthy newborns, not
requiring NICU care. Parent must sign a waiver
refusing the testing. Waiver should be kept in
the babys medical record. Send in the specimen
card with demographic information without a blood
sample to the State Lab as you normally would.
Although the parent can opt-out of the
metabolic screening for healthy, non-NICU
newborns, this option should not be encouraged.
28
State Lab Jacksonville

• Once the specimen is received in the State
  Lab
• It is logged in, scanned, and holes are punched
  in the circles.
• Demographics are entered into the database.
• Punched circles are placed on different testing
  equipment.
• Tests are often repeated to ensure accuracy of
  results.

29
Follow-Up Office Tallahassee

• RN follow-up coordinators receive the lab results
  that are borderline or abnormal.
• Babies must be located and repeat screenings may
  be required for borderline results. Abnormal
  results require referral to a special center for
  further testing.
• For genetic and endocrine disorders, three
  Florida Universities provide services for
  confirmatory testing and follow-up care.
• For hemoglobinopathies, there are eleven referral
  specialists across the state that provide
  confirmatory testing and follow-up services.

A typical follow-up coordinator!
30
Disorder Information

• Please see our website for information about each
  of the 34 specific disorders screened for in
  Florida. (Cystic Fibrosis will be added in the
  Summer of 2006)
• www.doh.state.fl.us/cms/nbscreen.html
• You will also find our newsletter Baby-Steps,
  which is packed with useful information
• www.doh.state.fl.us/cms/nbscreen-public.htmlb
  abysteps

31
Have More Questions ?
32
Contacts

• Nurse Follow-Up Coordinators (Metabolic
  Screening)
• North Florida Counties Letwyla White, RN, BSN
  
• [phone]
• E-Mail Address letwyla_white_at_doh.state.fl
  .us
• West Coast Counties Donna Barber, RN, BSN
  
• [phone]
• E-Mail Address donna_barber_at_doh.state.fl.us
• East Coast Counties Shari Andrew, RN, BSN
  
• [phone]
• E-Mail Address shari_andrew_at_doh.state.fl.
  us
• South Florida Counties Mary Canova, RN, BSN
  
• [phone]
• E-Mail Address mary_canova_at_doh.state.fl.u
  s
• Hearing Screen Coordinators

33
Additional Contacts

• General Contact Information
• Florida Newborn Screening Program (850)
  245-4201
• Secure Fax [phone]
•  
• Lois Taylor, RN, BSN Unit Director
  [phone]
• Angela Marcus QA, Advisory Council (850)
  245-4672
• Lucy Smith Trait Letters/Administrative
  [phone]
• 
  x3272
• Kristin Jenkins Release of Test Results to
  Pediatricians
• [phone]
• Christopher Porter Senior Management Analyst II
  
• [phone] x2261
• Hospitals MUST call the State Lab for Results at