Fingerstick Proficiency Training

Overview

Fingerstick waiver form Background presentation Universal Precautions Demo Participants do 5 sticks

- 2 on an object (oranges, tennis balls, etc.)- 3 on fingers

No actual tests will be run

Requirements

Passed counselor training

Complete fingerstick proficiency training

Observed doing two finger sticks with no errors

California State Law

State law allows certified HIV test counselors to conduct finger sticks for the purpose of collecting blood samples for HIV and hepatitis C testing

This law does not allow you to do venipuncture

Universal Precautions

The universal practice of avoiding contact with patients' body fluids (blood), by means of the wearing of nonporous articles such as

medical gloves

Gloves • Wear them when handling blood or blood products,

and….

• TODAY – when you perform fingersticks and collect

blood samples!!!!

• How often do you change them?

• How do you remove them?

Sharps Handling & Disposal

Medical instruments that are used to puncture the skin (syringes, lancets, needles)

Dispose of sharps immediately in a hard red plastic bio bin!

Do NOT dispose of sharps in a red bio hazard bag

Biohazard Bags Handling & Disposal

Bandages, used cotton and gauze, and gloves with body fluids on them are bio hazardous waste

Wear gloves when handling biohazard bags

Check where your organization wants you to dispose of filled biohazard bags

For Today’s Training Place loops and

lancets in the sharps container

Place gloves and all other trash in the brown paper bag

Universal Precautions

All of the Universal Precautions that we talked about during the testing proficiency part of the training apply here, including:

Use of gloves Handling and disposal of loops and lancets Use of biohazard bags

Materials

Competency Assessment Test form (CAT) Absorbent workspace cover (chux) “Spill kit” for clean-up in the event of a spill Gloves Alcohol wipes Gauze pads Bandages Lancets Collection loops Sharps container and bio hazard bag

The Workspace

Well lit

Sturdy chair

Sturdy testing surface

Away from traffic, opening doors, and other hazards and distractions

Technician Attributes

Good organizational skills Projects competence Manages unexpected situations Follows Universal Precautions Good interpersonal skills Good eyesight A steady hand

Lancets

Retractable needles or blades

Trigger release or contact activated

Low, medium, and high flow

Trigger release

Contact activated

Choosing a Finger

Best Choices

Do NOT stick Possibility of bone injury

Fingerprints Notice the direction of fingerprints Stick should be perpendicular to fingerprints

Where to Stick

Non-dominant hand Inside the circles Black lines show lancet

position

Do NOT stick On the sides On the tip In the center

Cleaning the Finger

One firm swipe with alcohol wipe- Do not rub the alcohol wipe over the same area over and

over again

Let alcohol air dry – don’t blow or fan- If alcohol is wet, the stick might sting- The sample should not be contaminated with alcohol

Feeling the Stick

Lancet type can affect pain level

Location of stick can determine pain level

Stick lasts for a fraction of a second

Roots of Anxiety

It’s normal

It happens before the stick

It’s not pleasant

Working with Anxious Clients

Reassure the client

Check in with them:– How are they feeling?– Any questions?– Address the anxiety honestly

Positioning the Client

Feet firmly on the floor, or laying down (never standing)

Sitting back in the seat, supported by the seat-back

Positioning the Client Arms are not crossed Sharps container within easy reach

Positioning the Client Who is comfortable here?

Framing the Process

Informs the client what will be happening

“I’m going to collect a drop of blood by doing a fingerstick.”

“Which is your dominant hand?”

Ask, “Do you have any history of fainting or passing out when getting blood drawn?”

TheProcess

Performing the StickContact-Activated Lancets

Remove protective cap (twist to break the seal or pull off)

Position firmly against puncture site

Press firmly against puncture site until you hear a “click”

Discard into a sharps container

Performing the StickTrigger-Activated Lancets

Remove protective cap (twist to break the seal or pull cap off)

Position firmly against puncture site

Press trigger

Discard into sharps container

What’s Wrong Here?See if you can name 2 things wrong

Collecting the Blood Sample Hold finger until sample has been taken

Wipe away first drop with sterile gauze pad

“Milk” the finger to get a second drop of blood

Touch loop to drop of blood

Dispense sample into testing device

Collecting the Blood Sample

Touching the loop to the drop of blood

Dispensing Sampleonto Absorbent Material

Touch open end of loop to center of absorbent material in sample well

If sample remains inside loop, gently twist loop against absorbent material allowing the sample to flow out.

Dispensing Sample into Buffer Solution Vial

Dispense sample into vial

Do not touch sides of vial

Stir loop into buffer solution

Dispose of loop

Model Fingerstick

Participant reads checklist

Trainer follows, pointing out combined steps where necessary

Participants watch

Debrief

Allow alcohol to air dry

The stick and the disposal are like one step

Importance of wiping away first drop (tissue juice)

Discuss specimen collection and dispensing into test device

Answer questions

Practice on Object

Follow checklist

Treat object like a person

Debrief

What was the experience like?

What was easy?

What was difficult?

Did you feel the lancet release and hear a click?

So...

First Participant Fingerstick

Follow the checklist

Stick and dispose

Do not hold filled loop above your head

When you finish, switch roles and do again

Debrief

How did that go?

What were the easy parts?

What were the more challenging parts?

Waddaya think?

Participant Final Fingersticks

Continue to practice fingersticks with new partners.

Use the checklist every time.

Do at least three fingersticks.

Two fingersticks will be observed.

Debrief

How did that go?

Did anything feel easier this time?

What were the more challenging parts?

Better?

End of the Training

Congratulations! You have just completed:

HIV Counselor Training Rapid Test Proficiency Training Fingerstick Training