lead testing

[H Schinske]

I just did a home water test and it came up positive for lead (on the bright
side, false positives do occur, and it was negative for everything else the kit
tested, like bacteria and pesticides). I'm taking the kids in for blood draws
next week. Anyone been through this? (And yes, my husband and I should be
tested too, I know.) What kinds of things do they do if the blood levels are
high? Neurological tests?

--Helen

[Karen G]

Helen,

I would strongly recommend that you locate an independent testing lab in
your area to run a certified water test. Depending on your water source
and pipes, the city will want to know that you came up positive. Look
on Laboratory in your phone book. It shouldn't run you more than about
15 to 20 dollars.

Karen

PS I used to work for this kind of a lab as a chemist.

[H Schinske]

wrote:

>I would strongly recommend that you locate an independent testing lab in
>your area to run a certified water test. Depending on your water source
>and pipes, the city will want to know that you came up positive. Look
>on Laboratory in your phone book. It shouldn't run you more than about
>15 to 20 dollars.

Thanks, Karen. I've been checking into it and found some useful resources on
the city's web site. The doctor said today that he felt it was unlikely there
would be a problem, that most of the serious exposure comes from things like
kids eating lead paint, but we went ahead with the blood tests. The girls took
it totally in stride, but Peter freaked :-(. We ended up holding him down.
Fortunately they got a good stick and it didn't take long, and he doesn't have
a bruise or anything.

He cheered up pretty quickly, though. I am hoping it won't be a lasting trauma.
It's pretty rare that kids need blood drawn, though, with any luck he won't
have to worry about it until he's old enough to donate blood.

--Helen

[C. S.]

This information is specific to Tennessee law, but also explains
testing procedures and treatment protocols for elevated lead levels. My
child was recently tested, using the finger stick method. Everything
turned out fine; no lead at all in her system! Yay! Hope this helps.
Carol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Included Page: Childhood Lead Poisoning Prevention Program - For Health
Care Professionals

Screening for Elevated Lead Levels
Finger Stick Method For Blood Lead Screening
Heel Stick Method For Blood Lead Screening
What To Do About Elevated Blood Lead Levels
Schedule for Follow-Up Blood Lead Testing
Medical Management Summary of Lead Poisoning in Accordance with
Confirmed Blood Lead Levels
Pediatric Physician Consultant
SCREENING FOR ELEVATED LEAD LEVELS
The current health standard requires a capillary (finger or heel stick)
blood test for lead screening at 12 months and at 24 months. All
children aged 36-72 months who have not previously received a blood test
for lead screening should be tested. A lead risk assessment
questionnaire should be completed at each well child checkup on all
children 6 months to 72 months of age. This questionnaire will help the
health care professional determine your child's risk for lead exposure
and if anything has changed in the child's home environment that would
put the child at a higher risk for lead exposure.
The first three questions must be asked and the remaining nine questions
may be asked at the provider's discretion. If the parent/guardian
answers "yes" or "don't know" to any of the questions, the child is
considered to be at high risk and should be screened with a blood lead
test.
(see the assessment below).
Does your child live in or regularly visit a house built before 1950?
(This could include a day care center, home of a baby sitter, or a
relative.)
Does your child live in or regularly visit a house built before 1978
with recent, ongoing, or planned renovations or remodeling (within the
past six (6) months)?
Does your child have a sibling or a playmate that has or did have lead
poisoning?
Does your child frequently come in contact with an adult who works with
lead? (Examples: construction, welding, pottery, etc.)
Does your home contain any plastic or vinyl mini blinds?
Have you ever been told that your child has low iron?
Have you seen your child eating paint chips, crayons, soil or dirt?
Does your child live near or visit with someone who lives near a lead
smelter, battery recycling plant or other industry that could release
lead?
Do you give your child any home or folk remedies that may contain lead?
(such as moonshine, Azarcon, Greta, Paylooah)
Does your child live within 80 feet (or one block) of a heavily traveled
road or a heavily traveled street?
Does your home's plumbing have lead pipes or copper pipes with lead
solder joints?
Does your family use pottery ware or leaded crystal for cooking, eating,
or drinking?
FINGER STICK METHOD FOR BLOOD LEAD SCREENING
(Not recommended for children less than 1 year of age.)
FOLLOW CDC RECOMMENDED UNIVERSAL PRECAUTIONS
FOR OBTAINING BLOOD
It is important that the blood circulates freely in the finger sampled.
DO NOT USE fingers with tight rings. The patient's fingers should be
straight, but not tense, to avoid the stasis effect which occurs when
the fingers are bent. The middle finger is recommended for use to obtain
the best blood flow.
For children less than one year of age, use the heel for a puncture
site.
See HEEL STICK METHOD FOR BLOOD LEAD SCREENING
Purpose: Detect lead exposure.
For accurate test results, environmental lead contamination must be
avoided. Use clean white paper towel as a work surface as recycled or
colored towels can contain trace levels of lead.
Equipment:
disposable gloves
alcohol swab
dry sterile gauze pads
sterile lancet
microtubes (250 microliters)
appropriate laboratory request form
Procedure:
Explain to the parent the reason for the test and how important it is to
the child's learning ability to have the test done.
Wash your hands and put on clean gloves
Thoroughly clean the child's hands with soap and warm water; rinse well,
then dry the hands. Remember to use clean white paper towels as recycled
or colored towels can contain trace levels of lead. (Once washed, the
finger to be punctured must not be allowed to come into contact with any
surface.)
Grasp the finger that has been selected (usually the middle finger) for
puncture between your thumb and index finger with the palm of the
child's hand facing up.
If not done during washing, massage the fleshy portion of the finger
gently.
Clean the ball or pad of the finger to be punctured with the alcohol
swab. Dry the fingertip using the sterile gauze.
Grasp the finger and quickly puncture it with a sterile lancet in a
position slightly lateral of the center of the fingertip. The cut should
be perpendicular to ridges of the skin. Ask the child to hang her/his
arm down or assist her/him to do so to permit the steady flow of
unclotted blood into the tube.
Dispose of the lancet in an appropriate biohazard waste container, e.g.,
sharp container.
Wipe off the first droplet of blood with the sterile gauze or cotton
ball. (The first drop of blood contains tissue fluids that will produce
inaccurate results.)
Hold the puncture site downward and gently apply pressure to the
surrounding tissue to enhance blood flow. Strong repetitive pressure
(milking) should be avoided as it may cause hemolysis or contamination
of the specimen with tissue fluid.
Continuing to grasp the finger, touch the tip of the collection
container to the beaded drop of blood. Collect the second and third
drops of blood in the microtube and mix with the EDTA in the tube to
prevent clotting. Continue collecting blood and periodically mixing the
blood with the EDTA throughout the collection until 250 microliters are
collected.
Once the required amount of blood is collected, cap the tube and rock it
8-10 times to further mix the blood with the EDTA.
Apply a bandaid when appropriate (it is not advisable to apply a bandaid
over skin puncture sites in children less than two years old. Adhesive
bandages in infants can irritate the skin. An older infant may remove
the bandage, put it in the mouth, and possibly aspirate it.)
Send sample to the lab for analysis.
HEEL STICK METHOD FOR BLOOD LEAD SCREENING
(Preferred method for children less than one year of age.)
FOLLOW CDC RECOMMENDED UNIVERSAL PRECAUTIONS
FOR OBTAINING BLOOD
For accurate test results, environmental lead contamination must be
avoided. Use clean white paper towel as a work surface as recycled or
colored towels can contain trace levels of lead.
Equipment: * SAME AS FOR FINGER STICK METHOD.
Procedure:
Explain to the parent the reason for the test and how important it is to
the child's learning ability to have the test done.
Wash your hands and put on clean gloves.
Thoroughly clean the child's heel with soap and warm water; rinse well,
then dry the heel. Remember to use clean white paper towels as recycled
or colored towels can contain trace levels of lead. (Once washed, the
heel must not be allowed to come into contact with any surface.)
Select the puncture site on the heel. The preferred puncture site is
indicated by the shaded areas on the following diagram. The least
hazardous sites for heel puncture are at the sites indicated below.
Thoroughly wash the puncture site with soap and water.
Clean the area of the heel to be punctured with the alcohol swab and let
air dry. Vigorous rubbing during this step stimulates blood flow in the
area.
Puncture the skin with one continuous motion using a sterile lancet with
a 2.5 mm tip. Longer tips may cause excessive tissue damage.
Wipe away and discard the first drop of blood since it is contaminated
by the disinfectant or tissue fluid.
Allow the second drop to form by the spontaneous free flow of blood.
Grasp the heel, touch the tip of the collection container to the beaded
drop of blood. Collect the second and third drops of blood in the
microtube and mix with the EDTA in the tube to prevent clotting.
Continue collecting blood and periodically mixing the blood with the
EDTA throughout the collection until 250 microliters are collected.
Once the required amount of blood is collected, cap the tube and rock it
8-10 times to further mix the blood with the EDTA.
Once the blood collection is completed, and while the patient's foot is
held above the heart level, press a sterile gauze to the puncture site
until the bleeding has stopped.
Send specimen to the lab for analysis.
WHAT TO DO ABOUT ELEVATED BLOOD LEAD LEVELS
All elevated blood lead levels must be confirmed by venous blood
sampling. The time between the initial capillary screening and venous
confirmation must be based on the criteria listed below. A venous
confirmation is required if comprehensive case management and
environmental follow-up services are to be rendered.
RECOMMENDED SCHEDULE FOR A CONFIRMATORY VENOUS SAMPLE
Screening Test Result (µg/dL)
Perform a confirmation venous test within:
10-193 months20-441 week - 1 month*45-5948 hours60-6924 hours>
70Immediately, as an emergency lab test
*The higher the BLL on the screening test, the more urgent the need for
confirmatory testing.
SCHEDULE FOR FOLLOW-UP BLOOD LEAD TESTINGa
Medical management includes follow-up blood lead testing. The following
table presents the suggested frequency of follow-up tests and should be
used as guidance. Case managers and PCPs should consider individual
patient characteristics and caregiver capabilities and adjust the
frequency of follow-up tests accordingly.
Confirmed Venous Blood
Lead Level (µg/dL)Early Follow-Up (first 2-4
tests after identification)Late Follow-Up (after
BLL begins to decline)10-143 monthsb6-9 months15-191-3 monthsb3-6
months20-241-3 monthsb1 month25-442 weeks-1 month1 month> 45As soon as
possibleChelation, subsequent
follow-up
a*Seasonal variation of BLLs exists and may be more apparent in colder
climate areas.* Greater exposure in the summer months may necessitate
more frequent follow-ups.
bSome case managers or PCPs may choose to repeat blood lead tests on all
new patients within a month to ensure that their BLL is not rising more
quickly than anticipated.
MEDICAL MANAGEMENT SUMMARY OF LEAD POISONING IN ACCORDANCE WITH
CONFIRMED BLOOD LEAD LEVELS
*
**Contact CLPPP when an environmental investigation is indicated. (615)
741-0355
PEDIATRIC PHYSICIAN CONSULTANT
The State of Tennessee Department of Health, Childhood Lead Poisoning
Prevention Program has contracted with Dr. Andy Spooner, MD as a
resource person. He is experienced in the management and treatment of
lead poisoning in children and welcomes questions from health care
professionals. *
Dr. Andy Spooner, MD, FAAP
John Dustin Buckman Professor, and Director
UT Memphis Division of General Pediatrics
50 N. Dunlap Ave., 4th floor, Central Building
Memphis, TN 38103
Office: (901) 572-3292; Fax: (901) 572-5198
Email:
Tennessee.gov Home**|**Search Tennessee.gov**|**A to Z
Directory**|**Policies**|**Survey**|**Help**|**Sit e
Map**|**Contact

[Rosalie B.]

x-no-archive:yes
(H Schinske) wrote:

wrote:
>
>>I would strongly recommend that you locate an independent testing lab in
>>your area to run a certified water test. Depending on your water source
>>and pipes, the city will want to know that you came up positive. Look
>>on Laboratory in your phone book. It shouldn't run you more than about
>>15 to 20 dollars.
>
>Thanks, Karen. I've been checking into it and found some useful resources on
>the city's web site. The doctor said today that he felt it was unlikely there
>would be a problem, that most of the serious exposure comes from things like
>kids eating lead paint, but we went ahead with the blood tests. The girls took

It's true that serious exposure comes from eating lead contaminated
materials, but not true that it is the only way there could be a
serious problem.

>it totally in stride, but Peter freaked :-(. We ended up holding him down.
>Fortunately they got a good stick and it didn't take long, and he doesn't have
>a bruise or anything.
>
>He cheered up pretty quickly, though. I am hoping it won't be a lasting trauma.
>It's pretty rare that kids need blood drawn, though, with any luck he won't
>have to worry about it until he's old enough to donate blood.

My dd#1 had blood taken often because of a medical condition. I don't
think she has been traumatized by it. It might have been a good idea
to do him first.

In any case, IMHO it is better not to obsess about 'lasting trauma'
when something is necessary to do. If a kid has to have blood drawn,
it has to be done, and he shouldn't get the idea that his mom is
ambivalent about it so that he might get out of it by pitching a fit.

grandma Rosalie

[H Schinske]

wrote:

>It's true that serious exposure comes from eating lead contaminated
>materials, but not true that it is the only way there could be a
>serious problem.

Sure. And the doctor didn't say it was, only that it was not *likely* that
there was a serious problem. Which frankly is true. He wasn't trying to talk me
out of testing the kids.

>If a kid has to have blood drawn,
>it has to be done, and he shouldn't get the idea that his mom is
>ambivalent about it so that he might get out of it by pitching a fit.

Yup. In fact I was relieved in a way to see that it was possible to get it done
without his cooperation, should it ever be required for some other serious
reason, and I was certainly pleased to see that the lab techs could get a good
stick in much less than optimal conditions. It just wasn't a whole lot of fun.

--Helen

[Robyn Kozierok]

In article >,
H Schinske > wrote:
wrote:
>
>>If a kid has to have blood drawn,
>>it has to be done, and he shouldn't get the idea that his mom is
>>ambivalent about it so that he might get out of it by pitching a fit.
>
>Yup. In fact I was relieved in a way to see that it was possible to get it done
>without his cooperation, should it ever be required for some other serious
>reason, and I was certainly pleased to see that the lab techs could get a good
>stick in much less than optimal conditions. It just wasn't a whole lot of fun.
>

Sorry for the unpleasant experience. My worst blood draw experience
was with Matthew, who had blood drawn as an infant, which took a long
time to get and several pokes, with me holding him down. :(

When Evan has had to have blood drawn as an infant or toddler, I
requested that EMLA be applied in advance, and it made a huge
difference. Evan watched with interest as the needle was inserted and
his blood was drawn. The only bad experience he had was one time when
they used a different version of the cream (ELA) which is supposed to
work better and faster and deeper, but didn't seem to work for him at
all. (The poor girl doing that draw was doing her first ever blood
draw on an infant. She did a fantastic job, but I guessed it was her
first time by the way another technician was talking to her about/through
it, and asked her after she finished.) For a healthy kid, he's had blood
drawn on far too many occasions already (including once for a lead test)!
Luckily for us, with EMLA it is usually not a bad experience at all!

--Robyn (mommy to Ryan 9/93 and Matthew 6/96 and Evan 3/01)

[Daye]

On Wed, 23 Jul 2003 19:15:12 EDT, (Robyn
Kozierok) wrote:

>When Evan has had to have blood drawn as an infant or toddler, I
>requested that EMLA be applied in advance, and it made a huge
>difference.

My daughter has "hysterical" episodes and she has had them on and off
since she was about 6 months, but she is growing out of them. We used
EMLA for her vaccinations. She still got very upset, but it was a lot
easier on all of us -- me, DD, DH and the doctor. The fact that she
felt no pain was a blessing.

--
==Daye==
Momma to Jayan
#2 EDD 11 Jan 2004
E-mail: brendana AT labyrinth DOT net DOT au