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ARIZONA DEPARTMENT OFHEALTH SERVICESBUREAU OF NUTRITION &PHYSICAL ACTIVITYLABORATORY PROCEDURE MANUAL17th Edition1Revised March 2021

Table of ContentsChapter 1 – Introduction Purpose Anemia and Hemoglobin Testing Types of Hemoglobin Testing Individual and Local Agency Hematology Training RequirementsChapter 2 - Universal / Standard Precautions Universal Precautions Standard Precautions (Hand Hygiene) Standard Precautions (Personal Protection Equipment) Standard Precautions (Sharps Safety) Standard Precautions (Cleaning and Disinfection) Exposure Control PlanChapter 3 - Capillary Sampling Equipment Lancets Microcuvetteso HemoCue 201 Microcuvetteso HemoCue 301 Microcuvetteso McKesson Consult Microcuvettes Hemoglobin Analyzerso HemoCue 201 HemoCue 201 Hemoglobin Measurement HemoCue 201 Cuvette Holder Cleaning HemoCue 201 Optical Parts Cleaning HemoCue 201 Supply Ordering HemoCue 201 Troubleshooting HemoCue 201 User Manualo HemoCue 301 HemoCue 301 Measurement HemoCue 301 Cuvette Holder Cleaning HemoCue 301 Optical Parts Cleaning HemoCue 301 Supply Ordering HemoCue 301 Troubleshooting HemoCue 301 User Manualo McKesson Consult McKesson Consult Operation McKesson Consult Cuvette Holder and Device Cleaning McKesson Consult Troubleshooting McKesson Consult User ManualChapter 4 - How to Perform a Capillary Sampling Hemoglobin Test Participant Consent Select Work Area2Revised March 2021

Explain ProcedurePerform Hand Hygiene and Put on GlovesAssemble SuppliesChoose SitePosition ParticipantWarm the Site (If Necessary)Cleanse the SiteHold the SitePunctureFill the MicrocuvettePrepare the Cuvette for TestingMeasuring Hemoglobin ValueSeal and Bandage SiteCleanse SurfaceDisposal of SuppliesRemove Gloves and Perform Hand HygienePerform Another Capillary Sampling Test (If Necessary)Chapter 5 - Masimo Pronto Equipment Masimo Pronto Pulse CO-Oximetero Pronto Display Parameter/Measurement Numeric Display Pulse Indicator Spot Check Progress Indicator SpHb Parameter Label Battery Level Indicator Low SIQ Indicator Sensor Use Indicatoro Pronto Controls Power On/Off SpHb Button Up and Down Buttonso Perfusion Index Perfusion Index (PI)o Battery Compartmento Disabling Pulse Rate and Oxygen Saturation (Optional)o Patient Cableo Rainbow DCI Digit Sensoro Rainbow DCIP Digit Sensoro Slender Digit Gaugeo Cleaning the Masimo Prontoo Cleaning the Rainbow Cableso Ordering, Returning, and Replacing Masimo Equipmento Masimo Pronto Troubleshootingo Masimo Pronto User ManualChapter 6 - How to Perform a Hemoglobin Test using the Masimo Pronto3Revised March 2021

Participant ConsentChoose a LocationExplain ProcedurePerform Hand HygienePosition ParticipantSelecting Child or Adult SensorDisconnect and Connect Sensor (If Necessary)Sensor Site SelectionCleanse the SiteSensor PlacementLight ShieldingObtain a Hemoglobin Value with the Masimo ProntoChapter 7 - Hemoglobin Value Results Different Hemoglobin Values Normal Hemoglobin Values “Low Hemoglobin” Value “Nutritionist” Hemoglobin Value “Very Low Hemoglobin” ValueAppendices Appendix A – CDC Cutoffs for Anemia Appendix B – Very Low Hemoglobin Values Appendix C – HemoCue 201 Troubleshooting Guide Appendix D – HemoCue 301 Troubleshooting Guide Appendix E – McKesson Consult Troubleshooting Guide Appendix F – Masimo Pronto Troubleshooting Guide Appendix G – CLIA Laboratory Certification Procedures4Revised March 2021

Chapter 1. IntroductionPurposeAnemia andHemoglobinTestingTypes ofHemoglobinTestingIndividual andLocal AgencyHematologyTrainingRequirementsThis manual is designed to be used as a reference tool to help WIC staff safely andaccurately perform hemoglobin tests. Use the hyperlinks in the Table of Contentsabove to quickly locate the information needed.The Arizona WIC Program conducts hemoglobin testing on its participants as ascreening tool for anemia, which is a condition resulting from low levels of healthyred blood cells. Its symptoms include poor appetite, tiredness, weakness,developmental delays and learning problems. Iron deficiency anemia is the mostcommon type of anemia, and represents a significant global health concern. Eventhough the hemoglobin testing performed within Arizona WIC clinics is not able to beused to diagnose anemia, let alone the specific type of anemia, the obtainedhemoglobin values can still be used for participant education and communityhealthcare referrals.The Arizona WIC Program utilizes two different types of hemoglobin tests. TheMasimo Pronto is a non-invasive hemoglobin testing device that is required to beused on WIC participants aged 2 years and older. Capillary sampling is the other,more invasive type of hemoglobin testing completed within the Arizona WICprogram, and is only designed to be used on participants under the age of 2, but canbe used on participants over the age of 2 if no hemoglobin value is able to beobtained with the Masimo Pronto. Capillary sampling involves taking a small sampleof a participant’s blood, and measuring the amount of hemoglobin it contains using ahemoglobin analyzer. We’ll discuss both types of hemoglobin tests in future chaptersof this manual.In order for CPAs to complete unsupervised hemoglobin blood tests within ArizonaWIC clinics, it's mandatory that they: Complete the Hemoglobin LMS course, and pass the corresponding post testComplete the Hemoglobin Guidebook, and discuss their answers with theirlocal agency trainerComplete the required Hematology observations as indicated in the NewEmployee Training PlanIn addition to these individual requirements, each local agency must also designateone or more trainers to provide hematology training and observations with staff.Designated trainers must be trained and re-certified at least once every three yearsby attending Anthropometric / Hematology Trainings provided by the Arizona WICState office.Local agencies must also receive and maintain a CLIA Laboratory Certification inorder to complete hemoglobin tests. Visit Appendix G of this manual to review theprocedures for obtaining a CLIA Laboratory Certification.5Revised March 2021

Chapter 2. Universal / Standard PrecautionsUniversalPrecautionsThe umbrella term “Universal Precautions” refers to approaches to minimizeoccupational exposure to bloodborne pathogens. A key component of takingUniversal Precautions is to treat the blood and bodily fluid of others as if it containeda bloodborne pathogen such as Human Immuno-deficiency Virus (HIV), Hepatitis BVirus (HBV), or Hepatitis C Virus (HCV), regardless if the person has a known orsuspected bloodborne pathogen.There are 2 types of universal precautions: “Standard Precautions” and“Transmission-Based Precautions”. Standard Precautions are a basic set ofprecautions that need to be taken whenever coming into potential contact with bloodor other bodily fluids. Transmission-Based Precautions are steps that should be takenin addition to “Standard Precautions” if the person you’re coming into contact withhas a known or suspected condition that can be spread through the air (e.g.chickenpox), through droplets from coughs or sneezes (e.g. influenza) or by cominginto contact with the skin (e.g. herpes simplex virus).There are four main components of Standard Precautions that are required to befollowed in all Arizona WIC clinics: Hand Hygiene, Personal Protective Equipment,Sharps Safety, and Cleaning and Disinfection. We’ll discuss each of these topics in thefollowing sections of this chapter.Transmission-Based Precautions will not be discussed in this document. Speak withyour supervisor if you ever believe that additional Transmission-Based Precautionsare necessary in order to protect your health and safety.StandardPrecautions(Hand Hygiene)The Centers for Disease Control and Prevention (CDC) defines Hand Hygiene as“Cleaning your hands using either handwashing (washing hands with soap andwater), antiseptic hand wash, antiseptic hand rub (i.e. alcohol-based hand sanitizerincluding foam or gel), or surgical hand antisepsis.” In the WIC program, there aretwo methods generally used for hand hygiene: alcohol-based hand sanitizer andwashing hands with soap and water. The table below describes examples of wheneach is recommended.Source: CDC6Revised March 2021

Alcohol-Based Hand Sanitizer vs Soap and WaterWhen to Use Alcohol-BasedHand SanitizerWhen to Wash with Soap andWaterImmediately before touching apatientWhen hands are visibly soiledBefore moving from work on asoiled body site to a clean body siteon the same patientAfter caring for a person withknown or suspected infectiousdiarrheaAfter touching a patient or thepatient’s immediate environmentAfter known or suspected exposureto spores (e.g. B. anthracis, Cdifficile outbreaks)After contact with blood, bodyfluids, or contaminated surfacesImmediately after glove removalSource: CDCHow to Use Alcohol-Based Hand Sanitizer:Apply the amount of product recommended by the manufacturer in yourhands, and continuously rub the product over all parts of your hands untilyour hands feel dry (approximately 20 seconds).How to Wash Hands with Soap and Water:Wet your hands first. Apply the amount of product recommended by themanufacturer in your hands, and vigorously rub it over all parts of yourhands for at least 20 seconds. Rinse your hands with water, and dry themwith disposable towels. Use a disposable towel to turn off the water.Source: )Wearing personal protection equipment (PPE) is essential in order to helpprotect your safety, and the safety of others while working in the lab and mustbe worn whenever it can be reasonably assumed that contact with blood orother potentially infectious materials may occur. Gloves are by far the mostcommon form of PPE used in WIC clinics, so they are the only form of PPEdiscussed in this manual. However, you must wear additional forms of PPE (e.g.gloves, masks, goggles, face shields etc.) if required by your local agency’spolicies. Gloves provide an additional layer of protection, helping to stop thepossible spread of infection from the wearer and others. However, wearinggloves should never replace hand hygiene. At WIC, gloves should be worn in thefollowing situations:7Revised March 2021

When starting to perform a capillary sampling test, perform hand hygieneand cover any breaks in the skin with bandages before applying gloves. Change gloves in between capillary sampling tests, even if performing thetests on members of the same family. Immediately change gloves and perform hand hygiene if gloves ever becomedamaged while performing a capillary sampling test. If gloves become visibly soiled with blood or other body fluids, carefullyremove gloves, and perform hand hygiene after completing the capillarysampling test.To remove gloves, take the following steps:1. Using a gloved hand, pinch the palm area of the other gloved hand and peeloff the first glove.2. Using the gloved hand only, roll-up the removed glove into a ball, and hold itin the palm of the gloved hand.3. Using your ungloved hand, slide a finger under your gloved hand and peel offthe second glove over the first rolled-up glove.4. Discard both gloves in the waste container designated by your local agency.Source: CDCStandardPrecautions(Sharps Safety)Retractable lancets are used during capillary sampling tests. Even though retractablelancets contain safety features (e.g. retractable needles) that help to prevent theuser from accidental needle sticks, it’s still important to take safety precautions.These include: Focusing on the task at handKeeping fingers away from the opening of the lancetImmediately disposing of used lancets and microcuvettes in a “sharps”container.There are a variety of styles, and all are clearly marked with a biohazard symbol (seefigure to the left). The container must be rigid, puncture-resistant, leak-proof, anddisposable with a locking lid.When this container is filled to the acceptable level, it must be properly disposed ofas biohazardous waste.8Revised March 2021

StandardPrecautions(Cleaning andDisinfection)There are different receptacles for trash that is generated in the lab. Lancets and microcuvettes must be disposed of in sharps containers. Throw away trash that is saturated with blood in a red, plastic biohazard bag.All waste that is saturated and dripping with blood must be, sterilized,incinerated or, chemically disinfected prior to mixing and disposing withordinary waste. Find out from your supervisor how to handle biohazardouswaste since it must be decontaminated before it can be disposed of in alandfill. Waste, such as lint-free tissue, alcohol preps, gloves, bandages & wrappers,that contain blood but are not dripping, can be discarded in a regular trashbag if there are no means for biohazard waste disposal.It’s important that all lab work surfaces are cleaned thoroughly at least once a day,but also must be cleaned immediately if they are visibly soiled. Lab work surfacesmust be cleaned using either a 10% bleach solution or a disinfectant approved for usein your local agency. To prepare a 10% bleach solution, mix 1 part household bleach with 9 partstap water. Store at room temperature in an opaque plastic bottle labeled"10% Bleach." The date of preparation and the expiration date should be clearly marked onthe outside. The expiration date is seven calendar days after the date thesolution was prepared.Note: Keep the sharps container, biohazard bag, lab trash, and all cleaning productsout of the reach of children.ExposureControl PlanA written exposure control plan must be kept in an easily accessible location at eachWIC clinic. The plan in your clinic will include a copy of your local agencies’ policiesand procedures for employee safety and a procedure for reporting accidents. Speakwith your supervisor to ensure that you know where to locate the exposure controlplan in your clinic, and familiarize yourself with its contents. If blood touches your skin or hair, wash the area with soap and water immediately.If blood enters your eye(s), flush them with water immediately.If you are accidentally stuck by a used lancet, have blood touch your skin/hair, haveblood enter your eye(s), or if you have any reason to believe that you may have beenexposed to an infectious substance, notify your supervisor immediately to discussseeing a licensed healthcare provider to be tested for infectious diseases such as HIV,HBV, and HCV.9Revised March 2021

Chapter 3. Capillary Sampling EquipmentLancetsLancets are small, single-use devices that are designed to pierce the skin, allowing ablood sample to be collected with a microcuvette. There are various lancetsavailable depending on incision depth and intended puncture location (e.g. finger orheel). Check with local agency trainers / supervisors to ensure that the correctlancets are used based on differing situations. In addition, refer to the chart belowfor lancet requirements for each WIC participant tscertified at 9months oldN/AInfants certifiedfrom 9to 11 months1.5 mm or lessChildren(1 to 5 years)1.5 mm or lessWomen(Pregnant / Postpartum /Breastfeeding)2.4 mm or lessN/A2.0 mm or less*N/AN/A*May only be performed on infants who have not yet begun to learn to walk.MicrocuvettesHemoCue 201 MicrocuvettesMicrocuvettes are manufactured to be used only in the hemoglobin analyzer forwhich they were designed. Therefore, only use the microcuvettes designed for thehemoglobin analyzer(s) used in your local agency clinic.HemoCue 201 Microcuvettes contain a special reagent designed towork inside of the HemoCue 201 which is noticeable due to itsyellow color at the tip of each microcuvette (see picture).Once the vial of HemoCue 201 MIcrocuvettes has been opened, they are able tobe used up to 90 days afterwards. Upon opening a vial for the first time, write thedate the vial was opened, as well as the date that the microcuvettes must be usedby on the side of the vial.HemoCue 201 MicrocuvettesHemoCue 301MicrocuvettesIn addition, always use microcuvettes by the expirationdate written on the side of the each vile, regardless ofwhether the vial has been opened or not.Unlike HemoCue 201 Microuvettes, HemoCue 301Microuvettes do not contain any reagent, so their tips arecompletely clear (see picture).10Revised March 2021

Once the vial of HemoCue 301 Microcuvettes has been opened, they are able to beused up to 24 months afterwards. Upon opening a vial for the first time, write thedate the vial was opened, as well as the date that the microcuvettes must be usedby on the side of the vial.In addition, always use microcuvettes by the expirationdate written on the side of the each vile, regardless ofwhether the vial has been opened or not.HemoCue 301MicrocuvettesMcKesson Consult Microcuvettes do not contain any reagent, sotheir tips are completely clear (see lyzersUse microcuvettes for the McKesson Consult prior the expiration date printed onthe package regardless of whether the package has been opened or not.The purpose of hemoglobin analyzers is to measure the amount of hemoglobincontained in a blood sample. The Arizona WIC Program utilizes 3 different types ofHemoglobin Analyzers: HemoCue 201 , HemoCue 301, and McKesson Consult.The HemoCue 201 hemoglobin analyzer is a portable instrument with a slidingcuvette holder and display screen. It can operate on AC power (AC adapterincluded) or 4 AA batteries.HemoCue 201 HemoCue 201 HemoglobinMeasurementTo obtain a reading, turn the device on by pressing the power button, and rotatethe cuvette holder into the loading position. Place a filled microcuvette in thecuvette holder and rotate the cuvette holder into the measuring position. Themeasurement takes between 40 and 240 seconds to display, and the hemoglobinvalue is expressed as grams per deciliter or g/dl. After reading the sample, thevalue will remain displayed on the screen as long as the cuvette holder is in themeasuring position. Once the cuvette holder is rotated back to the loading positionthe previously recorded value will be erased.11Revised March 2021

HemoCue 201 Cuvette HolderCleaningClean cuvette holder after each day of use by following these steps:1. Turn off the analyzer. Pull the cuvette holder out to theloading position.2. While pressing the catch carefully pull out the cuvetteholder.3. Remove the cuvette holder from the analyzer. It willcome off the stainless steel pin it rotates on.4. Clean the cuvette holder with alcohol (20-70%) or milddetergent.Wait 15 minutes to air dry before replacing the cuvette holder (making sure that it’slocked in place by the catch) and using the HemoCue 201 .HemoCue 201 Optical PartsCleaningThe optronic unit inside the HemoCue 201 (see picture) onlyneeds to be cleaned when an error code appears on the display(e.g. 901 or 902), or if the hemoglobin values obtained arehigher or lower than anticipated.To clean the optronic unit, first follow steps 1-3 as outlinedabove for cleaning the HemoCue 201 cuvette holder.4. Push a HemoCue Cleaner, or a lint free cottonswab, moistened with alcohol (20-70% withoutadditives) or water, inside the device as far aspossible. Move it from side to side 5 to 10 times.Do not attempt to use an alcohol prep pad toclean inside the device.12Revised March 2021

5. Push and pull the HemoCue Cleaner or cottonswab in and out of the device opening (on the leftside where the optronic unit is located).6. Remove the HemoCue Cleaner or cotton swab from the device. If theHemoCue Cleaner or cotton swab is stained, repeat steps 4 and 5.Wait 15 minutes before replacing the cuvette holder and using the HemoCue 201 .HemoCue 201Supply OrderingLocal agencies are responsible for procuring all related supplies for capillarysampling.HemoCue 201 hemoglobin analyzers, and microcuvettes will be purchased by localagencies directly from HemoCue. Please place your order with:Ryan KunaEmail: [email protected]: 412-328-3349HemoCue Microcuvette Ordering InformationPart Number 111716 - Box of 200 (4 vials of 50 each) HemoCue 201 MicrocuvettesFor agencies that need smaller quantities:Part Number 111715 – 100 individually wrapped HemoCue MicrocuvettesHemoCue 201 TroubleshootingWhen the analyzer is turned on, it will perform a self-test to verify the performanceof the optronic unit. If the self-test fails, or if experiencing any other issue,troubleshooting may be required to discover and resolve the problem.For troubleshooting information regarding the HemoCue 201 , review theHemoCue 201 Troubleshooting Guide (Appendix C).If experiencing problems that are not able to resolved by taking the steps outlinedin the troubleshooting guide, speak with your supervisor or call HemoCue TechnicalSupport at 1-800-881-1611.HemoCue 201 User ManualFor additional information regarding the HemoCue 201 , review the HemoCue 201 User Manual, which can be viewed by visiting the following 0/07/Manual Glu 201.pdf13Revised March 2021

HemoCue 301HemoglobinMeasurementThe HemoCue 301 hemoglobin analyzer operates in much the same way as theHemoCue 201 hemoglobin analyzer. However, instead of measurements taking 40to 240 seconds to display, once the filled microcuvette has been placed in thecuvette holder and rotated into the measuring position, the HemoCue 301 willdisplay the measured hemoglobin value within 3 seconds.HemoCue 301 Cuvette HolderCleaningClean cuvette holder after each day of use by following these steps:1. Turn off the analyzer. While the cuvette holder isstill in the loading position, press the catch using apointed object.2. While still pressing the catch, carefully pull out thecuvette holder.3. Clean the cuvette holder with alcohol (20-70%) ormild detergent.4. Wait 15 minutes to air dry before replacing thecuvette holder (making sure that it’s locked inplace by the catch) and using the HemoCue 301.HemoCue 301Optical PartsCleaningThe optronic unit inside the HemoCue 301 (see picture) only needsto be cleaned when an error code appears on the display (e.g. E00,E01, E02, E08, E10-30), or if the hemoglobin values obtained arehigher or lower than anticipated.14Revised March 2021

To clean the optronic unit, first follow steps 1-2 as outlined above for cleaning theHemoCue 301 cuvette holder.3. Push a HemoCue Cleaner, or a lint free cotton swab,moistened with alcohol (20-70% without additives) orwater, inside the device as far as possible. Move it fromside to side 5 to 10 times. Do not attempt to use analcohol prep pad to clean inside the device.4. Push and pull the HemoCue Cleaner or cotton swab inand out of the device opening (of the left side where theoptronic unit is located).5. Remove the HemoCue Cleaner or cotton swab from the device. If theHemoCue Cleaner or cotton swab is stained, repeat steps 3 and 4.6. Wait 15 minutes to air dry before replacing the cuvetteholder (making sure that it’s locked in place by the catch)and using the HemoCue 301.HemoCue 301Supplies andOrderingLocal agencies are responsible for procuring all related supplies for capillarysampling.HemoCue 301 hemoglobin analyzers and microcuvettes will be purchased by localagencies directly from HemoCue. Please place your order with:Sharon BynumEmail: [email protected]: 972-249-5202HemoCue 301 Microcuvette Ordering Information:Part Number 11801 - Box of 200 (4 vials of 50 each) HemoCue 301 Microcuvettes15Revised March 2021

HemoCue 301TroubleshootingWhen the analyzer is turned on, it will perform a self-test to verify the performanceof the optronic unit. If the self-test fails, or if experiencing any other issued,troubleshooting may be required to discover and resolve the problem.For troubleshooting information regarding the HemoCue 301, review the HemoCueHb 301 HemoCue Troubleshooting Guide (Appendix D).If experiencing problems that are not able to resolved by taking the steps outlinedin the troubleshooting guide, speak with your supervisor or call HemoCue TechnicalSupport at 1-800-881-1611.HemoCue 301User ManualFor additional information regarding the HemoCue 301, review the HemoCue 301User Manual, which can be viewed by visiting the following 0/08/HB-301 OperatingManual US.pdfMcKessonConsultMcKessonConsultOperationThe McKesson Consult hemoglobin analyzer is a portable instrument with astationary cuvette holder and display screen. It can operate on AC power, but alsocontains a rechargeable battery that can last up to 40 days if fully charged. Thebattery can be charged via the USB port of a computer, or by connecting the USBcord to the AC adapter, and plugging the AC adapter into a power outlet.To obtain a reading, it is not necessary to turn the unit on (the device is always onand does not have a “on” or “off” button). Place a filled microcuvette in the cuvetteholder and press down gently until a “click” is felt. The hemoglobin measurement(expressed as grams per deciliter or g/dl) will appear on the display within a fewseconds. As soon as the hemoglobin value appears, immediately pull themicrocuvette out of cuvette holder. After reading the sample, the value will remaindisplayed on the screen until the next measurement is taken. To erase the latestresult, press down on the empty cuvette holder until a “click” is felt.16Revised March 2021

McKessonConsultCuvette Holderand DeviceCleaningClean cuvette holder and device after each day of use by following these steps:1. Pull the backside of the cuvette holder towards you andlift up.2. Using a lint-free cotton swab, clean the cuvette holderwith cold water or a mild detergent, followed by adisinfectant. Dry thoroughly.3. Reinsert the dry cuvette holder by pressing down untilyou feel a “click”.4. Clean the device with cold water or a mild detergent,followed by disinfectant. Do not spray the instrumentwhen cleaning, as this will damage the instrument!McKessonConsultTroubleshootingFor McKesson Consult troubleshooting information, review the McKesson ConsultTroubleshooting guide (Appendix E).If experiencing problems that are not able to resolved by taking the steps outlinedin the operating manual, speak with your supervisor or call McKesson technicalsupport at (855) 625-4677.McKessonConsult UserManualFor additional information regarding the McKesson Consult, review the McKessonConsult User Manual, which can be viewed by visiting the following link:https://imgcdn.mckesson.com/CumulusWeb/Click and learn/Mckesson consult user manual A5.pdf17Revised March 2021

Chapter 4. How to Perform a Capillary Sampling HemoglobinTestParticipantConsentPrior to any lab testing (including the completion of a hemoglobin blood test viacapillary sampling), have the Authorized Representative read and sign the “Consent”signature type using the signature pad. The “Consent” signature type may beselected by using the “Signatures” button located at the bottom of the MedicalScreen in HANDS.Select WorkAreaSelect a work area to complete the capillary sampling test.An ideal work area: Is clean Ensures participant and staff safety Has a surface which is smooth, free of cracks, and washable Ensures participant privacy Is away from noise and confusion Has a chair and tableExplainProcedureExplain the procedure to the Authorized Representative in simple terms.Example:"I am going to make a little poke in your child’s finger to get a few drops of blood toput into this little container. Then I am going to put it into this machine to find outhow much hemoglobin it has in it."Reassure them that you will make it as quick and painless as possible, but also behonest with participants if they ever ask if it may hurt. Answer, by letting them knowthat it may hurt a little, but only for a moment.Perform HandHygiene andPut on GlovesAssembleSuppliesPerform Hand Hygiene (either by washing hands or using an alcohol-based handsanitizer) before putting on unused gloves.Assemble all necessary supplies in order to perform the capillary sampling test. ADHS/PHS/BNPALaboratory ManualHemoglobin AnalyzerAlcohol prep padsSterile lancetLint-free tissues/KimWipes or Gauze padsMicrocuvette (remove 1 at a time & reseal container)Bandages (not for children under age 2)Sharps containerBiohazard bag10% bleach solution or EPA-registered disinfectant18Original: January 1983Revised: January 2019

Daily Steps for Performing Hemoglobin Tests ContinuedChoose SiteThe ring and middle fingers are the primary testing sites for all WICparticipants for whom capillary sampling is indicated. Avoid using fingers withrings on them.The heel may only be used for infants 9-11 months of age who have not yetbegan to learn to walk.Position ParticipantWhen performing a fingerstick, position the participant comfortably seatedwith their arm extended, (but lower than their heart), with their palm facingup.When performing a heelstick, position the infant laying comfortably on theirback.Warm the Site(If Necessary)The site should not be cold, blue, swollen or calloused.If cold, warm the site by holding it in your hands, rubbing the site for a minute,or by have the Authorized Representative wash the site vigorously with warmrunning water and soap.Cleanse the Site Cleanse the site thoroughly with an alcohol pad (unless the AuthorizedRepresentative already washed the site with warm water and soap).Wipe the site with a tissue or lint-free wipe. Be sure skin is dry.Do not touch the prepared site after cleaning.Note: Pooled alcohol at the puncture site will dilute and hemolyze the blood,giving a lower reading, if the skin surface is not dried completely.Hold the SiteWhen performing a fingerstick, apply gentle pressure near the participants firstfinger joint.When performing a heelstick, grasp the heel between your thumb andforefinger with your other fingers underneath the infa

LABORATORY PROCEDURE MANUAL 17th Edition . 2 Revised March 2021 Table of Contents Chapter 1 - Introduction Purpose Anemia and Hemoglobin Testing . Purpose This manual is designed to be used as a reference tool to help WIC staff safely and accurately perform hemoglobin tests. Use the hyperlinks in the Table of Contents