Lab Test Procedure : PERFORMING A CAPILLARY PUNCTURE

General Guidelines for a Capillary Puncture: Capillary punctures are ideal for small children when only a small volume of blood is needed. They are also advantageous in certain adult populations, such as: those with severe burns, obese patients, those with thrombotic tendencies, and for point-of-care testing when a small volume of blood is needed. Capillary puncture should not be used on patients who are extremely dehydrated or have poor peripheral circulation. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash should be avoided. A warm compress or heel warmer should be used to warm fingers and heels that are cold, or if a capillary blood gas is being drawn, to increase the circulation of blood to the area.

All approved lancets utilized at Akron Children's are for single use and feature autmatic retraction of the blade.

Heel punctures are performed on infants less than 6 months of age, or on older premature infants who are the approximate size of a full-term 6 month old. For children over 6 months and adults, the finger is punctured. It may be necessary, on occasion, to perform a capillary puncture on the toe of a patient who is severely burned. Follow the same procedure as for performing a finger capillary puncture.

Order of Draw for a Capillary Puncture: Proper collection of tubes when performing a capillary puncture is as follows:

1. Gas tubes (must warm the site before collecting the
specimen)
2. Slides
3. EDTA - purple top tube
4. Heparin – light or dark green top tube
5. Serum – red top or amber tube with red top

Procedure for Capillary Puncture of the Finger:

• The best site for a finger puncture is just off the center of the finger pad of the 3rd (middle) or 4th (ring) finger of the hand. The sides and the tip of the finger should be avoided.
• Select the proper lancet: The BD Microtainer Contact-Activated Lancet 1.5 mm (lavender) is used for glumeters and the BD Microtainer Contact-Activated Lancet 2.0 mm (blue) is used any time you need more than a drop or two of blood.
• Prepare the finger by cleaning it with a Chlorhexadine wipe. Allow it to air dry.
• Grasp the finger, and using a sterile lancet, press firmly against the finger to make a puncture.
• The first drop contains excess tissue fluid and must be wiped away. Collect the drops of blood into the collection device by gently massaging the finger.
• Avoid excessive pressure that may squeeze tissue fluid into the drop of blood or cause bruising.
• When full, cap and then gently invert the collection device 5-10 times to mix the blood.
• Hold a gauze pad over the puncture site for a short time to stop the bleeding.
• Dispose of the contaminated materials and lancet in the appropriate waste containers.
• Place a band-aid on the patient’s finger or have someone continue to hold gauze on the finger. (See “Use of Band-Aids in the Post Phlebotomy policy.)
• Label the specimens before leaving the patient’s bedside.

Procedure for Capillary Puncture of the Heel:

•A heel puncture is performed on the lateral or medial plantar surface of the foot. The area of the arch should be avoided, as should the posterior curvature of the heel; a puncture in these areas could cause injury to the underlying bone.
• All babies in the neonatal unit must be warmed before performing a puncture. Begin by selecting the proper, approved lancet, such as:

 BD Microtainer Quikheel Lancet, 2.5 mm for full-term babies (green)
 BD Microtainer Quickheel Preemie Lancet, 1.75 mm for neonatal babies (purple)
 Unistick2 Neonatal 18G, 1.2mm Lancet for neonatal babies less than 1000g (blue)

• Prepare the heel by cleaning it with a Chlorhexadine wipe. Allow it to air dry.
• Grasp the foot, and using a sterile lancet, press firmly against the heel to make a puncture.
• The first drop contains excess tissue fluid and must be wiped away. Collect the drops of blood into the collection device by gently squeezing the foot. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood or cause bruising.
• When full, cap and then gently invert the collection device 5-10 times to mix the blood.
• Hold a gauze pad over the puncture site for a couple of minutes to stop the bleeding, and then tie gauze around the foot. (See “Use of Band-Aids in this policy.)
• Dispose of the contaminated materials and lancet in the appropriate waste containers. Label the specimens before leaving the patient’s bedside.


References

Ernst, Dennis J. “Pediatric Pointers.” Center for Phlebotomy Education, Inc. 2004-2008, edited for accuracy 1/08.

Ernst, Dennis J. and Catherine Ernst. “Mastering Pediatric Phlebotomy.” Center for Phlebotomy Education, Inc. Adapted from Phlebotomy for Nurses and Nursing Personnel. HealthStar Press, Inc. 2001, updated 1/08.

Kiechle, Frederick L. So You’re Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 11th Edition. Northfield, IL: College of American Pathologists, 2005.

NCCLS. Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard—Sixth Edition. CLSI document H04-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

Proper Handling of an Uncooperative Patient in an Outpatient Setting – Akron Children’s Hospital

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