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PERFORMING A CAPILLARY PUNCTURE

Collection Procedure:

Policy Tech: Version: 6

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

automatic 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 approved 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.)

  • The chlorhexidine is a concern for the premature babies in NICU as it can

      be absorbed through the skin. For all NICU babies, once you have

     collected the blood, wipe off the area with a sterile saline wipe, to remove

     the chlorhexidine residue before tying a piece of gauze around the foot.

  • 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 StandardSixth 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