1. Blood Spot samples Jane Gick Paediatric Metabolic Nurse Specialist Evelina Childrens Hospital Guys & St. Thomas NHS Foundation trust

2. Preparation Write out card with all the necessary details. Write out card with all the necessary details. Have lancet pen ready and loaded Have lancet pen ready and loaded A clean cotton wool ball for wiping site after sample collected A clean cotton wool ball for wiping site after sample collected Plaster if required Plaster if required

3. Using soft clix pen If using a soft clix device, set the gauge. If using a soft clix device, set the gauge. Depth gauge is according to skin type, three to four is usually fine. Depth gauge is according to skin type, three to four is usually fine.

4. cleansing Wash your hands, dry them thoroughly. Wash your hands, dry them thoroughly. Wet hands can contaminate a sample as well as prevent a nice blood bubble formation. Wet hands can contaminate a sample as well as prevent a nice blood bubble formation.

5. Heel prick test Apply booties or warm socks an hour or so prior to collecting sample. Apply booties or warm socks an hour or so prior to collecting sample. Make sure heel is clean Make sure heel is clean Either side of the heel and big toe can be used. Either side of the heel and big toe can be used.

6. Sample site Choose a different finger/toe from last sample. Choose a different finger/toe from last sample. Make sure hands are nice and warm. Make sure hands are nice and warm. Hold device firmly on skin. Hold device firmly on skin. Press button. Press button. Count to three 1,2,3 Count to three 1,2,3 Squeeze. Squeeze.

7. Sample size Use a squeeze and relax, squeeze and relax tension allowing for a good size sample. Use a squeeze and relax, squeeze and relax tension allowing for a good size sample.

8. Apply sample to card Allow for nice bubble formation Allow for nice bubble formation If bubble is not going to drip, bring card to bubble trying not to let finger/heel touch the card. Blood will seep through the card. If bubble is not going to drip, bring card to bubble trying not to let finger/heel touch the card. Blood will seep through the card.

9. How many spots? Most laboratories are happy for two blood spots but they must be big enough. Most laboratories are happy for two blood spots but they must be big enough. If the first spot looks too small collect three blood spots or even four, this will ensure some of the sample sent will be sufficient. If the first spot looks too small collect three blood spots or even four, this will ensure some of the sample sent will be sufficient.

10. coverage Each spot should cover most of the circle diameter. Each spot should cover most of the circle diameter.

11. Whats on the other side? Turn the card over to check enough blood has soaked through. Turn the card over to check enough blood has soaked through.

12. Poor samples Samples that are too small will give an inaccurate phenylalanine level. Samples that are too small will give an inaccurate phenylalanine level.

13. examples Another example of poor samples. Another example of poor samples.

14. spotting Spotting will give a result that may not reflect a true phenylalanine level. Spotting will give a result that may not reflect a true phenylalanine level.

15. What happens next A suitable spot is punched from the card for analysis A suitable spot is punched from the card for analysis

16. Size required for accurate testing This picture demonstrates the size of sample required to get a good phenylalanine result. This picture demonstrates the size of sample required to get a good phenylalanine result.

17. Checking in Samples posted in are received at the laboratory and are logged in to the computer. Samples posted in are received at the laboratory and are logged in to the computer.

18. Punching out spot A special machine punches out the spots A special machine punches out the spots

19. Mixing and shaking Samples are then put onto plates and mixed. Samples are then put onto plates and mixed.

20. Analysing All samples running for analysis. All samples running for analysis.

21. results Sample results are then checked by the laboratory staff. Sample results are then checked by the laboratory staff.

22. Lab team Our hard working biochemistry team. Our hard working biochemistry team.

23. Our screening laboratory

24. Reported results Our dietitians have both a phoned and faxed report of all the days phenylalanine samples received Our dietitians have both a phoned and faxed report of all the days phenylalanine samples received

25. Phoning parents With all the results available, the dietitian phones the families, discusses both the childs well being dietary changes if needed and often a bit of a social chit-chat. With all the results available, the dietitian phones the families, discusses both the childs well being dietary changes if needed and often a bit of a social chit-chat.