Bilirubin

CAPILLARY
BLOOD SAMPLING
For Use with Newborns
and Older Infants
Self Directed Learning Package
Current Reviewers:
Janet Barr, RN, PCVC
Amy Domingues, RN, BScN, Clinical Educator
Nancy Watts, RN, MN, CNS
Revised September 2010
NS4762 (Rev. 2010/09/16)
Originally Developed by:
Colleen Wright, RN
Initial Review by:
Heather Tupling, RN, BScN, Clinical Educator
Contributors to this edition:
Margaret Belliveau, RN, BScN, Perinatal Clinical Educator
Claire McDonald, RN, BScN, NICU Clinical Educator
C A P I L L A R Y B L O O D S A M P L I N G
- 1 -
TABLE OF CONTENTS

Purpose of Program ....................................................................... 2
Learning Objectives ....................................................................... 2
How to Use This Self Directed Learning Package ....................... 3
Anatomy and Physiology Review: ................................................ 4
Skin ................................................................................................ 4
Capillaries ....................................................................................... 5
Circulatory System ......................................................................... 6
Review of Site Selection: ............................................................... 7
Heel Site ......................................................................................... 7
Physiology and Technique: ........................................................... 8
Depth of Skin Puncture ................................................................... 8
Bloodflow ........................................................................................ 8
Indications for Capillary Sampling ................................................ 9
Complications of Capillary Heel Sampling ................................... 9
Equipment List .............................................................................. 10
Guidelines for Use of Tenderfoot ............................................. 11
Instructions for Capillary Blood Sampling: ................................ 12
CBC Collection ............................................................................. 16
Newborn Screening Collection ..................................................... 17
Collection Tubes and Blood Volumes Table .............................. 20
Computer Generated Labels ........................................................ 26
Laboratory Medicine Manual Requisition ................................... 28
References .................................................................................... 29
Appendicies: ................................................................................. 30
Appendix I .................................................................................... 30
Appendix II ................................................................................... 35
- 2 -
PURPOSE OF PROGRAM

To provide health care providers with information, guidelines and basic principles
to competently perform capillary blood sampling on newborns and older infants

LEARNING OBJECTIVES

After reading this Capillary Sampling Self Directed Teaching Package you will be
able to:
Identify the appropriate sites for capillary sampling in newborns and older
infants
Describe the indications for capillary sampling
List any contraindications or complications associated with capillary
sampling
Describe the step-by-step procedure for capillary blood sampling
Identify the correct handling, labelling and transportation of blood specimens
Apply the principles of the capillary sampling technique in the clinical setting
Complete the final test after reviewing the information provided

- 3 -
HOW TO USE THIS SELF DIRECTED LEARNING PACKAGE

Each of the sections in this learning package has been developed around one or
more of the outlined learning objectives.
Follow the steps below:
1. Read the manual at your own speed
2. Review the content in each section as many times as necessary to ensure
that you understand the information
3. View the Heel incision device video available online at
www.itcmed.com/products-6.html/2008
4. Once you have finished the review, you need to complete a capillary
sampling knowledge test. The test and response sheet have been included
as a handout with this package or can be completed online (LHSCPCVC
program website). Upon completion, return the test, response sheet and
this manual to your Clinical Educator. A passing mark of 80% will indicate
your readiness to proceed to coached clinical practice demonstrations. For
those doing the online test, return the grade to the LHSC Perinatal Clinical
Educator or appropriate Paediatric Clinical Educator/Coordinator.
5. Your Clinical Educator will forward you a Clinical Performance
Demonstration Record. to complete once your test has been evaluated. To
facilitate consistency, a number of delegates will be responsible for
observing your clinical performance. These delegates will include clinical
experts from your area
6. Return the completed performance record to your Clinical Educator as soon
as possible

You now have all the information you need to begin. If you should have any
questions contact the Clinical Educator in your area.

- 4 -
ANATOMY AND PHYSIOLOGY REVIEW

SKIN
Functions:
Protection: protects underlying structures from organisms, mechanical
injury and sunlight
Sensation: through millions of microscopic nerve endings in the skin
Excretion: assists in maintaining fluid and electrolyte balance and
temperature control

Structure:
Consists of two main layers; the epidermis and the dermis

The Epidermis:
is the thinner, outer layer consisting of stratified squamous epithelial tissue
epidermal ridges (fingerprints) exist because the epidermis conforms to the
underlying dermal ridges
has four layers in all parts of the body except the hands and feet where
there are five layers as follows:
a) stratum corneum (horny layer) - dead cells are converted to a water
repellent protein called keratin that continually flakes off
b) stratum lucidum - present only in the thick skin of the palms and soles
c) stratum granulosum - granules are visible in the cytoplasm of the cells
(cells die in this layer)
d) stratum spenosium (prickle cell layer) - several layers of irregularly
shaped cells
e) stratum germinaturin (basal layer) - columnar shaped cells that undergo
mitosis to produce new cells at the rate that old cells are lost from the
stratum corneum. New cells push up to the surface to continue the cycle
of regeneration
Figure 1 Cross-section of the skin. Microscopic view of the skin is a longitudinal section.
- 5 -

The Dermis:
inner, thicker, layer
consists of fibrous connective tissue
has parallel ridges

The Subcutaneous Tissue or Superficial Fascia
under the dermis
made of areolar tissue and in many areas, adipose tissue

CAPILLARIES

Numerous capillaries are located close to all cells in the body and are very
tiny (average 1 mm long)
Walls consist of a single layer of endothelial cells (no smooth muscle layer,
elastic fibres or surrounding adventitia). The thin, flattened cells allow rapid
movement of substances between blood and interstitial fluid by diffusion or
active transport. Role of the capillaries is to carry essential materials to and
from all cells in the body
Functionally, capillaries are the most important vessels because the entire
circulatory system pivots around the essential task of keeping the capillaries
supplied with adequate blood to meet the changing needs of the cells

Figure 2 - Cross Section of a Capillary. The walls of capillaries consist of only a single layer of endothelial
cells. These thin, flattened cells permit the rapid movement of substances between blood
and interstitial fluid. Note that capillaries have no smooth muscle layer, elastic fibres, or
surrounding adventitia.
(Anthony, Catherine Parker and Kolthoff, Norma Jane. The Textbook of Anatomy and Physiology,
9th edition. CV Mosby Company, St. Louis, 1975. pg 340).

- 6 -
CIRCULATORY SYSTEM

Arteries
distributors carrying
blood to arterioles

Arterioles
distributors carrying blood to
capillaries
serve as resistance cells to assist
in maintaining normal blood
pressure and circulation

Capillaries
two-way exchange of
substances between
blood and cells

Venules
collectors and
transporters

Veins
collectors and reservoir vessels
which can accommodate varying
amounts of blood to maintain
normal pressure and circulation
blood can be shifted to the heart
and skeletal muscles to meet
increased demands

Heart
pumps blood through
the circuit of vessels
changes to meet
varying demands of
cells (exercise,
emotions, hormones,
blood temp, etc.)

Figure 3 - Blood circulates from the left side (ventricle) of the heart to arteries; to arterioles, to capillaries, to
venules, to veins, to the right side of the heart (atrium to ventricle), to the lungs, and back to the left
side of the heart.
Anthony, Catherine Parker and Kolthoff, Norma Jane. The Textbook of Anatomy and Physiology, 9th
edition. CV Mosby Company, St. Louis, 1975. pg 353).
- 7 -
REVIEW OF SITE SELECTION

In an infant, capillary blood can be obtained by skin puncture from the lateral or
medial plantar surface of heel (see Figure 4)

HEEL SITE
Choose the heel site with the least number of previous heel sticks. If a heel
has been extensively traumatized this should be reported to the
Physician/APN
To landmark the site, draw a line medially from the middle of the great toe to
the plantar surface of the heel or draw a line posteriorly from the fourth and
fifth toes to the heel

Puncture the most medial or lateral portion of the plantar surface of the heel.
These areas are highly vascular therefore risk of injury is decreased
Avoid puncturing the central area of the foot as this has a potential to cause
injury to nerves, tendons and cartilage
Avoid puncturing the posterior curvature of the heel (back of the heel) to
avoid puncturing the calcaneus (heel bone) and calcaneal nerves. The
distance from skin to bone at the heels posterior curve is the narrowest

Figure 4 - Capillary sampling from the heel
Moxley, Susan. Heel Puncture. The Canadian Nurse, January 1989, pg. 25.
Medial plantar nerve
Medial plantar artery
Lateral plantar artery
Lateral plantar nerve
Medial calcaneal nerves
- 8 -
PHYSIOLOGY AND TECHNIQUE

DEPTH OF SKIN PUNCTURE
Studies performed, to determine the best depth for adequate blood
sampling without injury to the area, indicate that a puncture should be less
than 2.4 mm, to decrease the risk of bone damage, especially in premature
infants
The skins primary blood supply is an arterial-venous network at the junction
of the lower dermis and upper subcutaneous tissue (keep in mind the layers
of skin-epidermis, dermis and subcutaneous tissue)

tenderfoot DEVICE
Device that performs a gentle, sweeping arc incision above the level of sensitive
nerve fibres

Incision vs. Puncture

Incision Puncture

BLOODFLOW
Warming of the site can increase the bloodflow to the site by seven times.
This is primarily arterial flow and is therefore called arterialized skin
puncture blood. (National Committee for Clinical Lab Standards, 1991)
Current research has demonstrated that this may not influence capillary
samples. Warming of the heel is optional, particularly for normal newborn
testing, e.g., Newborn screening.
To warm site, wrap the selected foot with a warm cloth and then put
wrapped foot in a small clear plastic bag. Use warm, moist heat no greater
than 42C for 3 minutes; several reapplications may be necessary to
maximize arterial flow. (Ongoing assessment of the site is required to
ensure the site is warmed with no tissue damage) If available an
institutionally approved warming device may be used as per instructions.
http://www.itcmed.com/products
- 9 -
If obtaining a blood gas, prewarm heel x 3-5 minutes
Approximately 0.5 ml of blood can be obtained from one site
Gently milking the flow of blood above the level of the puncture encourages
flow. NOTE: milking the site refers to using your fingers to apply gentle
peristaltic massage of the soft tissue above the site
Excessive squeezing, pinching, scooping of blood causes bruising,
hemolysis, tissue fluid contamination and mixing of venous and
arterial blood. This can lead to erroneous blood results or clot the
specimen.

INDICATIONS FOR CAPILLARY SAMPLING

In the Mother/Baby, Birthing, NICU and Pediatric areas, capillary draw is the
preferred method when obtaining a blood sample from an infant.
Capillary blood sampling is used:
To obtain blood from infants when venous samples are not necessary or
unobtainable
When arterial samples are not necessary or arterial access is not available

NOTE REGARDING PERCUTANEOUS VENOUS BLOOD SAMPLING
Venous sampling is done if:
obtaining blood cultures
the infants heels are in poor condition
the infant bleeds poorly and capillary sampling has been unsuccessful

When obtaining a venous blood culture, any extra blood can be used for any
additional lab work that has been ordered. The computer lab order would have to
reflect that the samples were drawn venously. Remember that blood gas results
are affected by the route they are drawn (capillary, venous or arterial) therefore a
discussion with the interdisciplinary team should be done prior to drawing a blood
gas venously.

- 10 -
COMPLICATIONS OF CAPILLARY HEEL SAMPLING
Lacerations of lower dermal artery
Excessive blood loss
Excessive scarring from incorrect punctures
Osteomyelitis
Cellulitis
Abscess formation
Bruising of the site
Focal necrotizing chondritis (infection of the calcaneus or heel bone from a
puncture wound of the calcaneal cartilage)
Inaccurate values from:
contamination of a specimen with tissue fluid from excessive
squeezing or scraping
decreased circulation to the site
hemolysis of a specimen especially since newborns RBCs are
extremely fragile
contamination of a specimen with an antiseptic cleanser (can alter
glucose levels if not allowed to evaporate from the site)
inadequate warming of site
contamination with air bubbles
clots in specimen

EQUIPMENT LIST
1. If warming, clean warm cloth and plastic bag to arterialize heel
2. 2% chlorhexidine 70% isopropyl alcohol wipe (Alcohol only if
Newborn Screening)
3. Sterile 2X2 gauze sponge
4. Appropriate size heel incision device tenderfoot
, tenderfoot
preemie or
tenderfoot

micropreemie
5. Collection tubes / heparinized pipettes, caps, magnets, fleas
(small metal sticks)
6. Clean non-latex gloves (avoid latex gloves with latex allergies)
7. Computer labels or manual requisitions and addressograph labels, or
Newborn Screening requisition
8. Petrolatum skin protectant, if appropriate
9. Small adhesive bandages

- 11 -
GUIDELINES FOR USE OF TENDERFOOT

Fully automated heel incision device for capillary blood sampling:
tenderfoot

(puncture depth 1.0 mm) used for term infants
tenderfoot

preemie (puncture depth 0.85 mm) used for premature and
low birth weight infants
tenderfoot
micropreemie (puncture depth 0.65 mm) used for extreme

premature and very low birth weight infants

- 12 -
INSTRUCTIONS FOR CAPILLARY BLOOD SAMPLING
1. Check health care provider order and process order. (Ensure appropriate
labels and forms for correct infant)
2. Explain procedure to mother/family. If mother/family have significant
concerns involve health care provider who is providing care to the infant
3. Gather all equipment listed; including appropriate collection tubes or
Newborn Screening requisition
Note: for volume of blood required for specimens refer to Collection Tubes
& Blood Volumes starting on page 18
4. Select the appropriate heel for sampling (see Site Selection, page 7)
5. Optional for the Normal term infant - Arterialize site selected (see
information on warming on page 8)
6. Check the PIN number on the label and the PIN number on the infants
identification bracelet before beginning the procedure (J# - SJHC)
7. Wash hands and put on nonlatex gloves
8. The ideal posture for this procedure is with the infant in a supine position (A
term infant will benefit from gravity-assisted bloodflow ie. heel lower than the
head). Immobilize the limb by holding the heel with the forefinger at the
arch and thumb proximal to the puncture site at the ankle. The limb is held
downward to promote blood flow
9. Clean the selected area of the heel with an antiseptic wipe. Wipes with
chlorhexidrine must NOT be used for Newborn Screening and
prealbumin sampling. Allow the heel to air dry (1 min). Once cleansed do
not touch the incision site or allow the heel to come into contact with any
non-sterile item or surface (figure 1)

- 13 -
10. Remove the appropriate sized tenderfoot device from its blister pack,
taking care not to rest the blade slot end on any non-sterile surface
(figure 2)
11. Remove the safety clip. Once the safety clip is removed, DO NOT push the
trigger or touch the blade slot (figure 3)
Note: The safety clip may be replaced if the test is momentarily delayed.
However prolonged exposure of any tenderfoot
device to uncontrolled
environmental conditions, prior to use, may affect its sterility

- 14 -
12. Raise the foot above the infants heart level and carefully select a safe
incision site (avoid any edematous area or site within 2.0mm of a prior
wound)

13. Place the blade-slot surface flush against the heel so that its center point is
vertically aligned with the desired incision site (figure 4)

- 15 -

14. Ensure that both ends of the device have made light contact with the skin
and depress the trigger, immediately remove the device from the infants
heel (figure 5)

15. Using a dry sterile 2x2 gauze, gently wipe away the first droplet of blood that
appears at the incision site (figure 6)

- 16 -
16. Taking care not to make direct wound contact with the collection container
or capillary tube, collect the required specimen volume (figure 7). Newborn
screening samples require blood to be placed directly on the indicated
spots and then dried.

17. Following blood collection, gently press a dry sterile 2 x 2 gauze to the
incision site until bleeding has ceased. This step will help prevent a
hematoma from forming (figure 8)

- 17 -
18. Comfort and reposition the infant when the procedure is completed. Involve
mother/family in providing comfort
19. Remember to complete required information on lab slips or Newborn
Screening Requisition
20. Identify the specimen containers and capillary tubes with the appropriate
labels and place them into a plastic biohazard bag. Samples that need to
be transported on ice, such as lactate and blood gases, should not go in the
same biohazard bag as those samples that do not require ice. CBC and DIC
results can be negatively affected if the samples have been transported on
ice
21. Notify a Porter (or Attendant SJHC) to take the specimens to the lab as
soon as possible or tube specimen to the lab (LHSC)
22. Clean the patient care area and dispose of tenderfoot
device(s) in the
sharps container
23. Ensure that there is no further bleeding from the incision site & apply a small
bandaid
24. Remove and dispose of gloves
25. Wash hands
26. Document time and test drawn on the Newborn kardex/Newborn Physical
Assessment record. (Document name of newborn & time of test in Newborn
Screening Tracking binder)

CAPILLARY BLOOD SAMPLING FOR CBCS

* If other samples need to be obtained, Blood Gases and CBC should be
drawn first (it is more difficult to obtain a CBC when it is one of a number of
samples being drawn).
* To ensure a quality sample, a CBC must be obtained in 5 minutes and sent
immediately.

1. Follow the sampling procedure as outlined previously. When preparing your
equipment include the appropriate purple-top micro-container for collection
(with EDTA anticoagulant)
2. Wipe away the first drop of blood
3. Apply a thin layer of Petrolatum to heel. (Petrolatum prevents blood
clots from interfering with your sampling. Applying the Petrolatum too
thick can also clog the scoop)
4. Collect a drop of blood by touching the scoop to the drop or allowing the
drops to fall into the micro-container. (Capillary action and gravity with help
draw the blood into the container). Do not scrape the blood off the heel.
(Limiting contact with the skin will reduce the chance of clotting and you
want to avoid removing the Petrolatum)
- 18 -
* If you are not able to collect droplets, you likely dont have enough
blood volume available to collect the sample
5. Rotate the scoop or micro-container every few drops to ensure proper
mixing of blood with EDTA (the anticoagulant properties will prevent the
sample from clotting)
6. Flick the micro-container with your finger to ensure the blood drops fall to
the bottom.
7. Collect the appropriate amount of blood (see Collection Tubes Table pg 20)
8. Complete sampling procedure as outlined previously

CAPILLARY BLOOD SAMPLING FOR NEWBORN SCREENING

* Ideal time to collect sample is between 48-72 hours of age, but >24 hours is
acceptable. If infant will be discharged <24 hours of age, a sample should still be
collected but a repeat sample will need to be obtained within 5 days

1. Follow the sampling procedure as outlined previously. When preparing your
equipment include the Newborn Screening Requisition (check expiry date
on card)
Write infants demographics on requisition prior to sampling. Include date &
time of birth & collection, birth weight, babys OHIP#. (if OHIP# unknown,
leave blank)
2. Completely fill each circle on the filter paper/card without touching card to
the skin. View the reverse side of the card to ensure complete saturation.
Do not apply pressure to help the blood soak through. (If the blood hasnt
soaked through, it may not be an adequate volume for testing)
3. Complete sampling procedure as outlined previously
4. Allow blood spots to dry, 4-6 hours, and submit sample within 48 hours.
5. Record in Newborn Screening Logbook for tracking purposes and document
completion on infants Newborn Physical Assessment record

Examples:

Satisfactory Sample:

- 19 -
Unsatisfactory Samples (require a repeat):

Not Sufficiently Filled Supersaturated (over-filled)
(not saturated to the back)

Wet or Discoloured Blood Spots Serum Rings (from over-squeezing)

Scratched or Abraded Blood Spots Clotted or Layered Blood Spots

- 20 -
COLLECTION TUBES AND BLOOD VOLUMES TABLE

SAMPLE ORDER TUBE or CONTAINER
VOLUME of
BLOOD
EXPLANATION
CHEMISTRY

Blood Gas (ice)
Glucose (STAT)
Ionized Calcium(ice)
Potassium
Sodium

Glass clinitube
(heparinized)
Mixing wire (flea)
Caps
Magnet

125 l Non Clotted Specimens:
do first for best
arterialized specimen
(best flow)
avoid air bubbles as they
will alter gas results
affects pO2
when done collecting
blood apply caps tightly to
both ends of clinitube
mix blood with metal flea
by running magnet up
and down full length of
tube, multiple times, to
prevent clotting
all gas samples must be
sent to lab on ice
Albumin
Copper
Creatinine
Glucose
Liver Function
Magnesium
Triglycerides
Urea
Total Bilirubin
(LHSC)
Direct Bilirubin
(LHSC)
TSH (LHSC)
PreAlbumin (LHSC)

Green top
Micro-container

0.25-0.3 mL

0.5 mL minimum
will do 3 tests

(add 0.15 mL for
each additional
test)

Clotted specimens:
these tests are done on
serum so sometimes, if
the babys hematocrit is
really high, the 0.3mL
may not be enough to
yield enough serum to do
the test. If this is the
case, the lab may report
back and say that the
volume was NSQ (non
sufficient quantity) and
ask you to redraw the test
with a slightly greater
volume of blood
turn off phototherapy
lights prior to drawing
sample
place Bili samples in a
paper bag for transport
use an amber tube when
combining collection with
a bilirubin sampling (SJHC
only)
- 21 -
VOLUME of
BLOOD
EXPLANATION

Lactate (ice)

Gray Top
Micro-container

0.3 mL 0.5 mL

sample must be sent to
lab on ice

HEMATOLOGY

CBC/Diff

Reticulocyte Count

Purple top
Micro-container

0.25 mL 0.3 mL

0.3 mL

Non Clotted Specimens:
this tube has coated
sides with an
anticoagulant to prevent
the sample from clotting.
Therefore, rotate the
container after each
blood drop to allow
blood to mix with the
anticoagulant
flick the tube during
collection to encourage
the blood to drop to the
bottom and mix with the
anticoagulant
cap sample
do a final mix by gently
rocking sample back
and forth
visually check for clots
in sample prior to
sending to lab do not
remove clots, take
another sample

Turn off phototherapy lights prior to drawing sample.
- 22 -
VOLUME of
BLOOD
EXPLANATION

DIC Screen

Microfuge tube
(50 l citrate)

0.5 mL

call the core lab so they
can provide you with a
fresh microfuge tube for
each sample
have porter pickup the
tube up from the lab and
bring it to the unit
fill tube to the designated
line that has been
predetermined by the lab
collect sample as per
instructions for CBC/Diff
sampling
do not add extra blood to
the container as the
anticoagulant is pre-
measured to only work
with a maximum volume
of 0.5 mL

ENZYMES

Alk Phosphate
ALT
AST
CK
GGT
LDH
Phosphate
SGTP

Green top
Micro-container

0.2 mL each

minimum
0.5 mL total

Clotted Specimens:

case the lab may report
volume was NSQ (non
ask you to redraw the
test with a slightly greater
volume of blood.

- 23 -
VOLUME of
BLOOD
EXPLANATION
DRUGS

Caffeine
Gentamicin
Phenobarb
Tobramycin
Vancomycin

Green top
Micro-container

0.5 mL

Clotted Specimens:

case the lab may report
volume was NSQ (non
ask you to redraw the
test with a slightly greater
volume of blood.

BLOOD BANK

GS & GSO, Direct
Antiglobulin Test
(DAT or Coombs)

Purple top
Micro-container

0.3 mL

sample required prior to
first blood transfusion or
first request for blood on
reserve
second specimen
required for infants
greater than 4 months of
age
phone blood bank with
infants weight prior to
sending first sample

- 24 -
VOLUME of
BLOOD
EXPLANATION
Collection Device

Pipette

Natelson Tube
(heparinized)

Clotted Specimens:

may be used in the
collection of clotted
samples only
do not use for collecting
blood gases,
prealbumins, CBC/Diff or
DIC samples
it is best not to use this
device when collecting
blood for the Newborn
Screening test as it may
tear the filter paper

NUTRITION
CARE SETS

PARENTERAL

Ionized Calcium

ALK Phosphate
ALT
AST
GGT
Phosphate
Urea

Bili Total/Direct
Pre Albumin

Glass clinitube
(heparinized)

Green top
micro-container

125 L

0.5 mL

Clotted Specimens:

the test. If this is the case
the lab may report back
and say that the volume
was NSQ (non sufficient
quantity) and ask you to
redraw the test with a
slightly greater volume of
blood

- 25 -
VOLUME of
BLOOD
EXPLANATION
NUTRITION
CARE SETS

ENTERAL

Ionized Calcium

Alk Phosphate
Ionized Calcium
Phosphate
Urea

Pre Albumin

Glass clinitube
(heparinized)

Green top
micro-container

125 L

0.5 mL

turn off phototherapy
lights prior to drawing
sample
when combining with
other blood work always
use this micro-container
instead of the green top
micro-container

- 26 -
COMPUTER GENERATED LABELS

Computer generated labels are printed from the printer at the main desk in the
NICU and from the Nursing desks on the Mother/Baby unit. Bloodwork ordered for
now will be printed within minutes; routine bloodwork will print 45 minutes prior to
the time entered. At LHSC, printers closest to the infant having blood sampling
should be used.

INSTRUCTIONS FOR LABELLING

Tests often need to be re-done due to incorrect or absent labeling. Please see
below for the preferred way to apply labels. If a label will not stick to the container
when applied in this fashion it may require an elastic (do not tape). Ultimately, the
most important factor is that every specimen gets to the lab with a label
attached. The lab cannot analyze a sample that has not been labeled or is
labeled incorrectly. The lab has a zero tolerance policy.
Ensure that the bar code is easily seen when putting the labels on the specimen
container.
Ensure that you have completed the lab slip with the date/time and user name
the tubes need to be labeled by the nurse collecting the sample.

LABELLING SPECIMEN TUBES

The position of the label is extremely important in reducing test turnaround times.
To ensure your tests are not delayed, please compare the labelling to the photos below.

The label must be as close to the
coloured lid as possible and reads
from left to right.
Use a single label per tube.
Make certain the label does not touch
or cover the coloured tube top
Do not reverse the label

- 27 -
LABEL REQUIREMENTS

Print only the time of collection if it is the same calendar day as on the
printed label.
Print the date and time if it is a different calendar day.
Clearly print your Cerner / Power Chart login ID (maximum 8 characters)
(Person collecting sample)
If there is more than one label per patient, only the top one has to be
completed
- 28 -
LABORATORY MEDICINE MANUAL REQUISITION

- 29 -
References

Folk, L & Short, M. (2007). Guide to Capillary Heelstick Blood Sampling in
Infants, Advances in Neonatal Care, 7 (4) 171-178.

Janes, M., Pinelli, J, Landry, S., Downey, S., Paes, B. (2002) Comparison of
Capillary Blood Sampling Using Automated Incision Device With and
Without Warming the Heel. Journal of Perinatology 22:154-158

London Health Sciences Centre(2005) Capillary Blood Sampling, Self
Directed Learning Package

London Health Sciences Centre (2005) Venipuncture Self Directed Learning
Package

Ontario Newborn Screening Program (2010). Information for Health Care
Providers. Blood Spot Collection Resource. www.newbornscreening.on.ca.

tenderfoot Package Insert, ITC, 2000

- 30 -
Appendix I

- 31 -
Appendix I (continued)

- 32 -

- 33 -

- 34 -

- 35 -
Appendix II

For Older Infants - Preferred Site of Toe Sampling
Only for use in the infants over four months of age and only if unlikely to
obtain sample from the heel
Skin puncture should be made at the centre of the great toe pad (avoid the side
or the tip of the toe. It is more painful and there is a decreased thickness from
skin to bone increasing the risk of damage to bone, nerves, cartilage)

Preferred site
centre of great toe.
Toe site for capillary sampling.

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Bilirubin

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CAPILLARY

micropreemie (puncture depth 0.65 mm) used for extreme

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