Which is the most correct method for performing a capillary puncture?

Intended audience: This program is designed as an educational and training tool for laboratory personnel, phlebotomists, and other healthcare personnel who perform dermal punctures for capillary blood collection or point-of-care testing. This course is also appropriate for clinical laboratory science and phlebotomy students.

Author information: Mary Ertl Dettmann, MA, CLS, MT(ASCP) is the education supervisor for Wheaton Franciscan Laboratory in Wauwatosa, Wisconsin. She holds a Master of Arts degree in Health Care Administration from Central Michigan University. She has created several interactive, adult-learning courses in laboratory-related subjects including phlebotomy.

Author Information: Beth Kratzer, CLS, MT(ASCP) is a Clinical Trainer in the Education Department at Wheaton Franciscan Laboratories in Wauwatosa Wisconsin. She earned her Bachelor’s degree from the University of Wisconsin Eau-Claire in 1981 and obtained a Certificate of Professional Training from the University of Wisconsin-Milwaukee in 2004. In addition to many years of technical experience in the hospital environment, Beth has been involved in the creation, implementation, and facilitation of educational and training programs for healthcare associates since 2001.

Reviewer information: Carolyn Webb, MT(ASCP) is the CLS-Lead for the Wheaton Franciscan Central Laboratory in Milwaukee, Wisconsin. She is responsible for reviewing and revising policies and procedures in hematology, urinalysis, and coagulation and is the primary instructor for all new employees in these areas. She previously held the position of Point-of-Care Coordinator. Ms. Webb graduated from Marquette University with a BS in Medical Technology.

Reviewer Information: Alexandru Casapu, MBA, MLS(ASCP)CM, has over 20 years of experience as a medical laboratory scientist, section supervisor, and laboratory manager. He is the former Director of Clinical Laboratory Technology Program at Georgia Piedmont Technical College. He is currently a Program Director at MediaLab, Inc. Alexandru holds BS degrees in Biology and Medical Technology from Clark Atlanta University and an MBA from the University of Georgia.

LTD: Performing a Capillary Puncture  Version 7

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

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 glucometers 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 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

When performing capillary draws what is the correct order of draw?

Which of the following is a preferred capillary puncture site?

In which situation is capillary puncture the best method to obtain a specimen?

Which of the following is the proper technique for performing a venipuncture?