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Background The uric acid (UA) level in patients with gout is a key factor in disease management and is typically measured in the laboratory using plasma samples obtained after venous puncture. This study aimed to assess the reliability of immediate UA measurement with capillary blood samples obtained by fingertip puncture with the HumaSensplus point-of-care meter. Methods UA levels were measured using both the HumaSensplus meter in the clinic and the routine plasma UA method in the biochemistry laboratory of 238 consenting diabetic patients. HumaSensplus capillary and routine plasma UA measurements were compared by linear regression, Bland-Altman plots, intraclass correlation coefficient (ICC), and Lin’s concordance coefficient. Values outside the dynamic range of the meter, low (LO) or high (HI), were analyzed separately. The best capillary UA thresholds for detecting hyperuricemia were determined by receiver operating characteristic (ROC) curves. The impact of potential confounding factors (demographic and biological parameters/treatments) was assessed. Capillary and routine plasma UA levels were compared to reference plasma UA measurements by liquid chromatography-mass spectrometry (LC-MS) for a subgroup of 67 patients. Results In total, 205 patients had capillary and routine plasma UA measurements available. ICC was 0.90 (95% confidence interval (CI) 0.87–0.92), Lin’s coefficient was 0.91 (0.88–0.93), and the Bland-Altman plot showed good agreement over all tested values. Overall, 17 patients showed values outside the dynamic range. LO values were concordant with plasma values, but HI values were considered uninterpretable. Capillary UA thresholds of 299 and 340 μmol/l gave the best results for detecting hyperuricemia (corresponding to routine plasma UA thresholds of 300 and 360 μmol/l, respectively). No significant confounding factor was found among those tested, except for hematocrit; however, this had a negligible influence on the assay reliability. When capillary and routine plasma results were discordant, comparison with LC-MS measurements showed that plasma measurements had better concordance: capillary UA, ICC 0.84 (95% CI 0.75–0.90), Lin’s coefficient 0.84 (0.77–0.91); plasma UA, ICC 0.96 (0.94–0.98), Lin’s coefficient 0.96 (0.94–0.98). Conclusions UA measurements with the HumaSensplus meter were reasonably comparable with those of the laboratory assay. The meter is easy to use and may be useful in the clinic and in epidemiologic studies.

Background: In recent years, several systems have been implemented to achieve quick and non-invasive measurements of B-type natriuretic peptide (BNP). Among them, Alere TM Heart Check (AHC) BNP test represents the most recent advancement. It is a rapid point-of-care (POC) immunoassay, projected for measuring BNP directly from a capillary whole blood sample. This study aimed at comparing the analytical and clinical performances of this new POC to our reference method (Abbott Architect System). Methods: One hundred eleven patients with stable chronic heart failure (CHF) referring to one cardiac rehabilitation center were enrolled from December 2013 to May 2015. These patients were subjected to a simultaneous capillary (AHC) and plasma (Abbott) BNP measurements. Clinical and analytical performances of AHC were assessed and compared to the reference method. Results: Capillary BNP showed a good correlation with the reference method (r = 0.94, P < 0.0001), although the values diverged when BNP was higher than 1,500 pg/mL. Indeed, the AHC had a relatively poor precision and the coefficient of variability was 10.1% and 18% for low and high controls, respectively. However, both methods showed similar diagnostic performances in discriminating the patients with heart failure in New York Heart Association (NYHA) class I from those belonging to NYHA classes II-III, with values of area under the curve (AUC) of 0.983 and 0.984, respectively, and equivalent sensitivity, specificity, and positive and negative likelihood ratios. Conclusion: The AHC BNP test is a good POC able to provide reliable information about the hemodynamic status of CHF patients, especially of those belonging to NYHA classes I-III. Cardiol Res. 2016;7(2):51-58 doi: http://dx.doi.org/10.14740/cr468e

На сьогоднішній день у сучасному суспільстві проведення лабораторної діагностики біохімічного аналізу крові є необхідною складовою для визначення стану організму та встановлення достовірного діагнозу. Існуючі методи та засоби дослідження параметрів крові можна поділити на інвазивні та неінвазивні, але найбільш точними є методи які вимагають забір зразка. В наслідок дослідження артеріальної і венозної крові відбувається травматизація судин, що супроводжується больовим відчуттям та існує високий ризик зараження. В роботах (Мингачева А.А., Мишанич Т.В.) показано, що капілярна кров може використовують для моніторингу стану здоров’я людини та має великий потенціал для діагностики стану організму. Недоліки інвазивного методу забору капілярної крові полягають у виникненні похибок отриманих на етапах процедури забору біологічного зразка описані в роботах (Скворцова Р.Г., Лудупова Е.Ю. та ін.): ідентифікація пацієнта, перфорація шкіри, взяття крові, транспортування до лабораторії, аналіз, обробка та передача даних. Основний відсоток похибок виникає переважно в результаті впливу на процес забору зразка людського фактору (випадкового або ціліспрямованого). Актуальність роботи полягає у розробці модулю перфорації для автоматизованої системи забору капілярної крові, що дозволить забезпечити захист від похибок на преданалітичному етапі, а також виключити вплив на зразок людського фактору. Виходячи з цього підвищується точність та достовірність отриманих результатів, а отже розробка даного приладу є актуальною задачею. For today in modern society conducting of laboratory diagnostics of biochemical blood analysis is a necessary component for determining the state of the organism and establishing a reliable diagnosis. Existing methods and tools for studying blood parameters can be divided into invasive and non-invasive, but the most accurate are the methods that require sampling. As a result of the study of arterial and venous blood, vascular trauma occurs, accompanied by a painful sensation and there is a high risk of infection. In the works (Mingacheva AA, Mishanich T.V.) it is shown that capillary blood can be used for monitoring the health of a person and has great potential for diagnostics of an organism's condition. The disadvantages of the invasive method of capillary blood capture are the occurrence of errors in the procedures for obtaining biological samples obtained during the stages described in the works (Skvortsova RG, Ludupova E.Yu, etc.): identification of the patient, skin perforation, blood collection, transportation to the laboratory, analysis, processing and data transmission. The main percentage of errors arises mainly as a result of the impact on the process of sampling a human factor (random or targeted). The urgency of the work is to develop a perforation module for the automated system of capillary blood collection, which will provide protection from errors at the preanalytical stage, as well as exclude the impact on the human factor. Proceeding from this, the accuracy and reliability of the obtained results increases, and therefore the development of this device is an urgent task.

Point-of-care B-type natriuretic peptide (BNP) testing with adequate analytical performance has the potential to improve patient flow and provide primary care givers with easy-to-use advanced diagnostic tools in the management of heart failure. We present the analytical evaluation of the Minicare BNP immunoassay under development on the Minicare I-20 platform for point-of-care testing. Analytical performance was evaluated using EDTA venous whole blood, EDTA plasma and capillary whole blood. Method comparison with a lab-testing system was performed using samples from 187 patients. Normal values were determined based on 160 healthy adults, aging from 19 to 70 years. Limit of blank (LoB), limit of detection (LoD) were determined to be 3.3 ng/L, 5.8 ng/L. Limit of quantitation (LoQ) in whole blood at 20% and 10% coefficient of variation (CV) was found

ObjectivesCapillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref).DesignA prospective observational study.SettingA university teaching hospital emergency department in Hong Kong.ParticipantsPatients triaged as ‘urgent’ (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited.Primary and secondary outcome measuresThe primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers.ResultsThe results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was −0.22 with 95% limits of agreement (LOA) of −2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of −1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being −0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA −0.01 to 1.66 mmol/L.ConclusionOur study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing.Trial registration numberNCT02694887.

Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." Design: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods: The panel consisted of five sections: hemodynamics infection adjunctive therapies metabolic and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. Results: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Conclusions: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality. © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Tuberculosis (TB) is a high-burden infectious disease, especially in low and middle-income countries. The efforts to eliminate this disease are challenged by the emergence of multidrug resistance and TB-HIV coinfection. The cumulative knowledge on pharmacokinetics/pharmacodynamics of antituberculosis agents has recently encouraged therapeutic drug monitoring (TDM) in patient care. However, logistical problems related to conventional sampling limit the application of TDM in research-oriented institutions. Dried blood spot (DBS) compared with conventional venous blood sampling has the advantages of easier sampling, storage and transportation, thus enabling the application of TDM even in remote areas. In addition, DBS with its lower biohazardous risk can be safely performed in a high HIV prevalence area, which also tends to have a high TB burden. Another benefit of DBS sampling is that it requires a smaller blood volume than conventional sampling and is highly recommended for application in pediatric TB. A limitation of DBS is that additional considerations are required for analysis, method development and validation. The accuracy of the DBS method is influenced by a number of factors that need to be thoroughly examined in method development and validation. Further, the agreement between DBS and plasma/serum concentrations is not always understood and further investigations are required

Актуальність проведення порівняльного аналізу гематологічних показників у зразках венозної та капілярної крові донорів, отриманих з використанням К[2]ЕДТА і К[3]ЕДТА, обґрунтована необхідністю враховувати можливі відмінності при стандартизації переданалітичного етапу лабораторних досліджень, розрахунках референтних діапазонів, валідації аналітичних методик, виборі біологічного матеріалу для аналізу, співставленні результатів лабораторних досліджень, виконаних з використанням венозної і капілярної крові. Порівняльному аналізу підлягали показники кількості лейкоцитів, еритроцитів, тромбоцитів, вмісту гемоглобіну та величини гематокриту у зразках венозної і капілярної крові одних і тих же донорів, взятих з К[2]ЕДТА або К[3]ЕДТА і досліджених за допомогою автоматичного гематологічного аналізатора в режимі аналізу цільної крові. У зразках капілярної крові, відібраної з К[2]ЕДТА або К[3]ЕДТА, в порівнянні зі зразками венозної крові, встановлено: більшу кількість лейкоцитів, менший вміст гемоглобіну, менша величина гематокриту, менші кількості еритроцитів і тромбоцитів. Виявлені відмінності, крім особливостей складу капілярної крові, обумовлені більшою чутливістю процедури відбору капілярної крові до факторів, які впливають на величину похибки переданалітичного етапу і залежать від виду, марки та агрегатного стану антикоагулянту, яким наповнені пробірки. За сукупністю проаналізованих даних К[2]ЕДТА є антикоагулянтом вибору при проведенні процедури відбору та підготовки зразків капілярної крові для гематологічних досліджень. Актуальность проведения сравнительного анализа гематологических показателей в образцах венозной и капиллярной крови доноров, полученных с использованием К[2]ЭДТА и К[3]ЭДТА, обоснована необходимостью учитывать возможные различия при стандартизации преаналитического этапа лабораторных исследований, расчетах референтных диапазонов, валидации аналитических методик, выборе биологического материала для анализа, сопоставлении результатов лабораторных исследований, выполненных с использованием венозной и капиллярной крови. Сравнительному анализу подлежали показатели количества лейкоцитов, эритроцитов, тромбоцитов, содержания гемоглобина и величины гематокрита в образцах венозной и капиллярной крови, взятых с К[2]ЭДТА или К[3]ЭДТА и исследованных с помощью автоматического гематологического анализатора в режиме анализа цельной крови. В образцах капиллярной крови, взятой с К[2]ЭДТА или К[3]ЭДТА, в сравнении с образцами венозной крови, установлено: большее количество лейкоцитов, меньшее содержание гемоглобина, меньшая величина гематокрита, меньшее количества эритроцитов и тромбоцитов. Обнаруженные различия, кроме особенностей состава капиллярной крови, обусловлены большей чувствительностью процедуры отбора капиллярной крови к факторам, которые влияют на величину погрешности преаналитического этапа и зависят от вида, марки и агрегатного состояния антикоагулянта, которым наполнены пробирки. По совокупности проанализированных данных К[2]ЭДТА является антикоагулянтом выбора при проведении процедуры отбора и подготовки образцов капиллярной крови для гематологических исследований. Relevance of carrying out a comparative analysis of hematological parameters in venous and capillary blood samples which were obtained using K[2]EDTA and K[3]EDTA is based on the need to take into account possible differences in the standardisation of preanalytical phase of laboratory research, validation of analytical methods, the choice of biological material for analysis, comparing the results of the laboratory studies performed using venous and capillary blood. Comparative analysis included analysis of the number of white blood cells, red blood cells, platelets, hemoglobin and hematocrit value in samples of venous and capillary blood taken using K[2]EDTA or K[3]EDTA, and was investigated by an automatic hematology analyzer in whole blood analysis mode. Capillary blood samples taken using K[2]EDTA or K[3]EDTA in comparison with venous blood samples established increasing number of leukocytes, lower level of hemoglobin, smaller value of hematocrit, smaller number of erythrocytes and platelets. These differences, with an exception to the composition of capillary blood, are due to: greater sensitivity of procedure of sampling capillary blood to the factors that affect the value of pre-analytical phase error and depend on the type, brand and state of aggregation of anticoagulant, which are used in test tubes. In the data analyzed it appears that K[2]EDTA is an anticoagulant of choice during the selection and preparation of capillary blood samples for hematology research procedures.

Background: The StatSensor® Xpress-i™, a point-of-care system for blood creatinine measurement, offers patients the possibility of self-monitoring creatinine. In this study, the analytical performance of the StatSensor® for both detecting current renal function and monitoring renal (dys)function in kidney transplant patients was examined. Methods: Accuracy of the StatSensor® with capillary and venous whole blood was evaluated and compared to an isotopic dilution mass spectrometry (IDMS)-traceable enzymatic creatinine test in venous serum (n=138). Twenty Li-heparin samples were compared to the IDMS reference method performed by a Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratory (RfB, Bonn, Germany). To evaluate StatSensor®'s suitability to monitor kidney function, both venous and capillary samples were obtained in 20 hospitalized transplantation patients. Venous samples were analyzed with an IDMS-traceable enzymatic test, capillary samples were measured using the StatSensor®. For all 2-day intervals, percentage change in creatinine was compared between both methods. Results: The StatSensor® did not meet total allowable error criterion of 6.9%. Average overall CVa for the StatSensor® was 10.4% and 5.2% for capillary and venous whole blood results, respectively. Overall CVa for the central laboratory serum creatinine method was

Background: The StatSensor® Xpress-i™, a point-of-care system for blood creatinine measurement, offers patients the possibility of self-monitoring creatinine. In this study, the analytical performance of the StatSensor® for both detecting current renal function and monitoring renal (dys)function in kidney transplant patients was examined. Methods: Accuracy of the StatSensor® with capillary and venous whole blood was evaluated and compared to an isotopic dilution mass spectrometry (IDMS)-traceable enzymatic creatinine test in venous serum (n=138). Twenty Li-heparin samples were compared to the IDMS reference method performed by a Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratory (RfB, Bonn, Germany). To evaluate StatSensor®'s suitability to monitor kidney function, both venous and capillary samples were obtained in 20 hospitalized transplantation patients. Venous samples were analyzed with an IDMS-traceable enzymatic test, capillary samples were measured using the StatSensor®. For all 2-day intervals, percentage change in creatinine was compared between both methods. Results: The StatSensor® did not meet total allowable error criterion of 6.9%. Average overall CVa for the StatSensor® was 10.4% and 5.2% for capillary and venous whole blood results, respectively. Overall CVa for the central laboratory serum creatinine method was

Capillary blood sampling is a medical procedure aimed at assisting in patient diagnosis, management and treatment, and is increasingly used worldwide, in part because of the increasing availability of point-of-care testing. It is also frequently used to obtain small blood volumes for laboratory testing because it minimizes pain. The capillary blood sampling procedure can influence the quality of the sample as well as the accuracy of test results, highlighting the need for immediate, widespread standardization. A recent nationwide survey of policies and practices related to capillary blood sampling in medical laboratories in Croatia has shown that capillary sampling procedures are not standardized and that only a small proportion of Croatian laboratories comply with guidelines from the Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO). The aim of this document is to provide recommendations for capillary blood sampling. This document has been produced by the Working Group for Capillary Blood Sampling within the Croatian Society of Medical Biochemistry and Laboratory Medicine. Our recommendations are based on existing available standards and recommendations (WHO Best Practices in Phlebotomy, CLSI GP42-A6 and CLSI C46-A2), which have been modified based on local logistical, cultural, legal and regulatory requirements. We hope that these recommendations will be a useful contribution to the standardization of capillary blood sampling in Croatia.

Background The new Earlobe Arterialized Blood Collector (EABC®) is a minimally invasive prototype system able to perform capillary blood collection from the earlobe (EL) with minimal training and risk. This system could improve medical emergency management in extreme environments. Consequently, a prospective validation study was designed to evaluate operational performance of the EABC® in a cohort of critically ill patients. Methods Arterialized capillary blood was sampled from the EL of 55 invasively ventilated patients using the EABC® following a validated procedure. Operational characteristics such as the number of cuts and cartridges required, sampling failure/success ratio, bleeding complications, storage requirements and other auxiliary aspects were recorded. Result turnaround laboratory times (TAT) were compared with published references. Results Blood collection was as easily performed on one earlobe as the other. Twenty-six minutes (mean 25.8; SD = 3.8) were required to obtain results, 15 min for patient preparation (mean 15.3; SD = 2.6) + 11 min for sampling and analysis (mean 11.4; SD = 2.1), which is similar to published hospital reference laboratory TAT. The average number of cartridges required was 1.3 (1–3; mode = 1) with the mean number of cut attempts being 1.2 (1–4; mode = 1). Problems/difficulties occurred in 59% of cases but were mainly attributed to patient’s demographic characteristics, with only 10% attributable to the collector (superficial cut, blood leak, collector misalignment and obstructed vision). Haemostasis was quickly achieved with minimum complications. Storage of the complete sampling kit required a 300 × 300 × 300 mm box. Two 9-V batteries were used during the 2-year study period. Conclusions The new EABC® system concept is safe, fast and easy to use. Observed problems/difficulties are easily amendable with certain design modifications. Definitive versions of the prototype have the potential for significant benefits for isolated and extreme environments in medicine.

OBJECTIVE: Associations between the genetic variation within or downstream of the surfactant protein-D-encoding gene (SFTPD), which encodes the collectin surfactant protein-D (SP-D) and may lead to respiratory distress syndrome or bronchopulmonary dysplasia, recently were reported. Our aim was to investigate whether SFTPD variations affect serum SP-D levels in infants and pulmonary outcome in premature infants.STUDY DESIGN: Serum SP-D levels were measured in 211 mature and 202 premature infants, and 7 SFTPD single-nucleotide polymorphisms (SNPs) were genotyped. SNP analysis and haplotype analysis were used to associate genetic variation to SP-D, respiratory distress (RD), oxygen requirement, and respiratory support.RESULTS: The 5'-upstream SFTPD SNP rs1923534 and the 3 structural SNPs rs721917, rs2243639, and rs3088308 were associated with the SP-D level. The same SNPs were associated with RD, a requirement for supplemental oxygen, and a requirement for respiratory support. Haplotype analyses identified 3 haplotypes that included the minor alleles of rs1923534, rs721917, and rs3088308 that exhibited highly significant associations with decreased SP-D levels and decreased ORs for RD, oxygen supplementation, and respiratory support.CONCLUSION: These findings extend and validate previous observations of SFTPD association with the risk of respiratory outcomes and suggest SFTPD as an essential factor affecting pulmonary adaptation in premature infants.

In conditions with reduced glucose levels/inability of glucose utilization, ketone bodies, especially beta-hydroxybutyrate (BHB), become a major energy source in the brain. In animal models, BHB infusion shows acute beneficial effects on the hypoxic brain. The present prospective observational study is the first to assess the relationship between on-admission capillary blood BHB levels and acute stroke severity/short-term functional outcomes. A total of 51 consecutive first-ever stroke patients (46 ischemic stroke) admitted within 24 hours since the symptom onset and ≤44 hours since the last meal were evaluated for stroke severity (National institutes of health stroke scale, NIHSS) and for disability (modified Rankin scale, mRS) 3 months post-stroke. On-admission BHB values ranged between 0 and 1·6 mmol/l, with 43 (84·3%) values ≤0·4 mmol/l (normal). Higher BHB values were independently associated with longer fasting and hyperglycemia, whereas lower values were associated with dyslipidemia and diabetes. No association between on-admission BHB levels and NIHSS scores at presentation or day 5 was observed. The BHB levels considered either as continuous or as binary (>0·4 vs ≤0·4 mmol/l) variables were independently (adjustment for age, NIHSS score at presentation, fasting period, stroke type, hyperglycemia, diabetes, and dyslipidemia) associated with lower odds of mRS 0-2 (non-to-mild disability) 3 months post-stroke: OR = 0·09 (95% CI 0·00-0·97, P = 0·047) and OR = 0·07 (95% CI 0·00-0·78, P = 0·028), respectively. This preliminary study suggests that higher on-admission BHB values are associated with poorer stroke outcomes and emphasizes the need for further investigations.

The proper technique of capillary blood sampling to determine the level of glycemia plays an important role in diagnostics and therapy of diabetes mellitus. There has been a large shift in this disease in recent years, especially in diagnostics and treatment. It is a disease characterized by high blood sugar levels. In practice, it often happens that although it is a procedure nurses carry out almost daily, during capillary blood sampling to determine the level of glycemia, a number of errors occurs. This fact inspired me to write a bachelor thesis on the topic "The issue of capillary blood sampling to determine the level of glycemia?. The empirical part of the thesis deals with both the disease Diabetes Mellitus itself and the capillary blood sampling. In the introductory part history and definition of diabetes are given, the causes of the disease, complications, diagnostics and treatment of Diabetes Mellitus are described. The issue of capillary blood sampling to determine the levels of glycemia is discussed in detail, as well as the recommended procedure of capillary blood sampling and devices designed for the sampling . The practical part of the thesis is focused on selected objectives, research questions and hypotheses. The objective of the research was to identify the factors that may affect the results of the examination, to find out whether nurses follow the recommended procedure for capillary blood sampling and to identify the most common errors nurses make during the sampling. To achieve the objectives both quantitative and qualitative research surveys were carried out. The qualitative research was conducted by observations of six nurses working in inpatient wards in České Budějovice Hospital, plc, supplemented by interviews with the nurses. The three research questions can be answered as follows. The most common factors that may affect the test results is poor sample handling, sample exposure to unsuitable temperature conditions, and forced squeeze of blood from a finger. While collecting capillary blood nurses often make mistakes in communicating with the patient, when they do not give information about the performed punction and do not properly explain the whole procedure to the patient. They wash their hands before blood sampling without using a disinfectant. The interviews gave the answer to the last research question that the most common problem the nurses are aware of during capillary blood sampling is forced squeeze of blood from a finger, poor disinfection of the punction site and a delayed transport to the laboratory. Qualitative research survey was supplemented by quantitative research, which consisted of 66 observations of capillary blood sampling, which were carried out by nurses in České Budějovice Hospital, plc. This research survey was conducted to verify the results obtained from the qualitative research. This hypothesis was formulated: H1: During capillary blood sampling to determine the level of glycemia nurses most often make mistakes in communication with the patient. Based on the quantitative research, it has been found out that the most common mistake made by nurses is a failure to use a disinfectant for hand hygiene before sampling blood (16%). The mistake in communication took the third place (14%). Based on the above results the conclusion can be made that H1: During capillary blood sampling to determine the level of glycemia nurses most often make mistakes in communication with the patient, has not been confirmed. Using the knowledge earned from literature and the conducted research I have proposed a standard of nursing care for nurses called "Capillary blood sampling to determine the level of glycemia." Nurses will have an opportunity to have a manual at hand that will serve them as a quide to correctly perform capillary blood sampling to determine the level of glycemia and they will not be consider the blood sampling to be a routine procedure.

The analysis of gases and metabolites in arterial and venous blood reflects the condition of homeostasis of the organism and which instantaneous energy demand required, indicating how biological systems behave in front of some physical stress, including the variation of intensity and volume of physical activity performed. Reactions of these compounds maintenance of constant blood pH by neutralization and / or elimination of organic acids derived from the metabolism momentary. It was an objective method, minimally invasive, to evaluate the acid-base resulting from the progressive increase of physical exercise from 100μL of blood capillary. The methodology used was the Balke protocol for cycle ergometer adapted to the operational needs of the equipment Gas Analyzer Radiometer ABL 800. The progressive increase of the load was 50 by 50 Watts until voluntary exhaustion with collecting and analyzing samples of capillary blood. Volunteers are 13 active students (5 women and 8 men) and three amateur athletes UFSCar aged between 20 and 30 years 25 ± 2, and body mass index 24 ± 4. The results are presented in the acid base nomogram Siggaard-Andersen, developed by the pH values between 7.43 ± 0.02 and 7.35 ± 0.04, ABE (Excess Base Real) between 4.16 ± 1 44 and -7.75 ± 3.17 mmol / L, pCO2 between 35.48 ± 2.61 and 37.20 ± 4.67 mmHg and [HCO3-] between 24 and 17 ± 0.6 ± 2.2 mmol / L with analysis of statistical tools ANOVA and Student's t test. The concentration of gases and metabolites present in blood capillary, presents the characteristic behavior expected during graded exercise as the exponential increase of lactate concentration and pH of the linear decay. A análise de gases e metabólitos, de sangue arterial e venoso, reflete a condição de homeostase instantânea do organismo e qual a demanda energética exigida, indicando como os sistemas biológicos se comportam frente a algum stress físico, entre eles a variação da intensidade e volume da atividade física executada. Reações destes analitos garantem a manutenção do pH sanguíneo através da constante neutralização e/ou eliminação dos ácidos orgânicos derivados do metabolismo momentâneo. Foi objetivo um método, minimamente invasivo, para avaliar o equilíbrio ácido base conseqüente do aumento progressivo do exercício físico a partir de 100μL de sangue capilar. A metodologia utilizada contempla o protocolo de Balke para ciclo ergômetro adaptado as necessidades operacionais do equipamento Analisador de Gases ABL 800 Radiometer. O incremento progressivo da carga foi de 50 em 50 Watts até a exaustão voluntária com coleta e análise das amostras de sangue capilar. Os voluntários são 13 universitários ativos (5 mulheres e 8 homens) e 3 atletas amadores da UFSCar com idade entre 20 e 30 anos 25±2, e índice de massa corporal 24±4. Os resultados são apresentados no nomograma ácido base de Siggaard- Andersen, desenvolvidos através dos valores de pH entre 7,43±0,02 e 7,35±0,04, ABE (Excesso de Base Real) entre 4,16±1,44 e -7,75±3,17 mmol/L, pCO2 entre 35,48±2,61 e 37,20±4,67 mmHg e [HCO3 -] entre 24±0,6 e 17±2,2 mmol/L com análise das ferramentas estatísticas ANOVA e Teste T de Student. A concentração dos gases e metabólitos, presentes no sangue capilar, apresenta comportamento característico ao esperado durante o exercício físico progressivo como o crescimento exponencial da concentração de lactato e o decaimento linear do pH.

Introduction Haemoglobin saturation is an obligatory oxygen parameter in the assessment of neonatal oxygenation. Although, pulse oximetry is currently one of the major methods in the determination of haemoglobin saturation, capillary blood saturation is still present in the diagnostic process. As well known, haemoglobin saturation value of capillary blood is insufficiently accurate, but not as much as the difference in relation to the values determined by pulse oximetry. Until now published studies have reported that capillary samples are obtained according to a protocol by the principle of free blood outflow, which is practically almost unachievable in the neonate. Objective Determination of the reference values of oxygen saturation (ScO2) and partial pressure (pcO2) of capillary blood by squeezing of the foot. The determination of difference between ScO2 and pulse oximetry (SpO2). Methods In 134 term newborns, we determined SpO2 . Subsequently, we measured the values of ScO2 and pcO2 from the same extremity. While withdrawing a capillary sample, we exerted multiple squeezing of the foot. The mean value of ScO2, pcO2, SpO2 and the difference between ScO2 and SpO2 were determined. Results Mean ScO2 value was 80.5?}8.5%, pcO2 was 48.2?}11.4 mm Hg and SpO2 was 98?}1.9%. The difference between ScO2 and SpO2 values was 17.5?}8.6% (t=23.568; p=0.000). Conclusion There is a statistically highly significant difference between the values of ScO2 and SpO2. Having the knowledge of this difference can increase the accuracy of clinical evaluation and further diagnostics. Comparison in up-to-now conducted studies suggests that the squeezing of the foot for obtaining a capillary sample in relation to free blood outflow does not bear any significant influence on the resultant values of haemoglobin saturation. .