Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name: ___________________________________________ Grade: _________

Year & Section: ____________________________________ Date: __________
Group No: ________________________________________

PROCEDURE CHECKLIST
NEWBORN SCREENING
Instruction: Below is the grading scale which will be used in rating your performance.

5 EXCELLENT 95 - 100
4 VERY SATISFACTORY 88 - 94
3 SATISFACTORY 82 – 87
2 FAIR 76 – 81
1 NEEDS PRACTICE 70 – 75

A. EQUIPMENT:
 Sterile Lancet with tip approximately 2.0 mm
 Sterile Alcohol Prep
 Sterile gauze Pads
 Soft Cloth
 Blood Collection Form
 Gloves

B. PRECAUTIONS
 Blood should be collected from Heel prick on one side of filter paper.
 Blood should be dried at room temperature.
 Blood should not be collected in layers on paper.
 Venous blood & syringe should be avoided.
 Discard first drop of blood.
 Cord blood should be avoided as it is contaminated with maternal blood

C. TO AVOID UNSATISFACTORY SPECIMENS (“UNSAT”)

 Ensure there are five good blood spots on the card.
 Double check for accurate and complete demographic information.
 Send the specimen in as soon as possible.
 Prevent specimen contamination.
 Check expiration dates on collection kits.

PROCEDURES 5 4 3 2 1
1. Inform the parents/guardian of the ENBS by discussing the process and
purpose of the procedure.
2. Be sure that the baby had breastfeed
3. Prepare the following;
a. ENBS filter card
b. Lancet
c. Gloves
d. cotton balls with alcohol
e. sterile gauze
4. Be sure that ENBS filter card is accurately filled up.
5. Check the ENBS card for the expiration date.
6. Prepare the site and collect the blood spot specimen.
a. Wash hands vigorously
b. Confirm the identity of the infant
c. warm site with commercial heel warmer or warm, moist cloth not
exceeding three minutes.
d. warm site with commercial heel warmer or warm, moist cloth not
exceeding three minutes.

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

e. Allow heel to dry completely

f. To obtain sufficient blood flow, puncture the infant’s heel at the most
medial or lateral portion of the plantar surface of the heel with a
sterile lancet or heel incision device.
g. Gently wipe away first blood drop with sterile gauze pad. Allow
another LARGE blood drop to form.
h. Lightly touch filter paper to LARGE blood drop. Allow blood to soak
through and completely fill circle with SINGLE application of blood
(To enhance blood flow, apply GENTLE intermittent pressure to
area surrounding puncture site) Apply blood to one side of the filter
paper only and ensure the blood soaks through the paper to the other
side before moving on to the next filter paper circle. Do not
contaminate the filter paper by touching the specimen or the printed
circles with your fingers
i. Fill remaining circles in the same manner. If blood flows are
diminished, repeat heel stick. After the specimen is collected, elevate
the infant’s foot and, using the sterile gauze, briefly apply gentle
pressure to the puncture site until the bleeding stops. Do not apply
adhesive bandages.
j. Blood spots must air-dry horizontally on a non-absorbent open
surface for at least three to four hours at ambient temperature and
away from directly sunlight and moving sources of air. Blood spots
on the filter paper should not be heated, stacked, or allowed to touch
other surfaces during the drying process.
 To assist in the drying process, use the protective cover by
simply elevating the filter paper to gently rest on the edge of
the protective cover.
 After drying, the protective cover should be placed over the
blood spots to prevent contamination.
 To avoid cross-contamination, do not allow filter paper blood
spots to come into contact with each other
7. Completed ENBS filter paper kit will be sending to courier pick-up
location, after drying is complete.
8. Ensure all fields on the ENBS filter paper are completed.
a. Verify the mothers address
b. Verify the infant’s planned health care provider.
9. If a parent/guardian refuses to have the ENBS blood spot collected.
a. Ensure the parents fill out and sign a Refusal Form
b. Fax a copy of the refusal Form to the ENBS program.
c. Place a copy of the Refusal Form in the newborn’s chart/medical
record.
10. Mail completed form to testing laboratory within 24 hours of collection.

REMARKS:__________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Date & Time: ______________________

Clinical Instructor: ______________________

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