CAPILLARY PUNCTURE

(Materials and Procedure)

IMPORTANCE
 method of choice in children under 1 year of age and for adults
whose veins are inaccessible
 Importance

Patients with cancer whose veins are reserved for therapeutic

purposes
Importance
Importance

Patients who are severely burned

Importance
 Importance

Patients who are obese and whose veins are too deep to locate
Importance
 Importance

Geriatric patients
(or patients with inaccessible veins or very fragile veins)
Importance
Importance
Importance

POCT testing
Patients performing the tests on themselves
Importance
Importance

Special procedures that require capillary blood

(e.g. Malarial test)
LIMITATIONS
 Limitations
Severely dehydrated patients
Patients with poor circulation (those in shock)
Patient who is extremely cold – rectified by the phlebotomist

1. Warm wet washcloth – should be warm to your touch but not so hot that it
burns you (42°C); Wrap the washcloth around the patient’s arm for 3 to 5
minutes.
2. Dry heat or Heat pack
3. Massaging patient’s finger
Effect: enlarges the capillaries; blood flows faster
MATERIALS
MATERIALS
 MATERIALS

Lancets
• sterile, disposable, sharp-pointed or bladed instrument that either punctures or
makes an incision in the skin to obtain capillary blood specimens for testing.
MATERIALS
MATERIALS

70% Isopropyl alcohol

(Alcohol pads)
MATERIALS
 MATERIALS

Microtainer tubes (Micro evacuated tubes)

• microtubes, are special small plastic tubes used to collect the tiny amounts of
blood obtained from capillary punctures.
MICRO EVACUATED TUBES
MICRO EVACUATED TUBES
MATERIALS
MATERIALS

Blue capillary tubes – Plain (No anticoagulant)

Red capillary tubes - Heparinized
PUNCTURE SITE
Sites for puncture

Adults : palmar surface of

the distal phalanx of either
the ring finger or middle
finger
Infants : heel
Burned patients : earlobe
 Sites for puncture
Side or tip of the finger
should not be punctured
(half as thick as the tissue in
the center of the finger)
Site must be warm
Finger must not be swollen
(edematous)
 Cleaning the site for puncture
Recommended antiseptic : 70% isopropyl alcohol
Allow the puncture site to airdry

Alcohol may cause specimen to be hemolyzed

Do not use povidone-iodine (Betadine) – elevated potassium,
phosphorous, or uric acid
 Things to remember
One error: puncture not deep enough and not obtain a good
bleed
If puncture is adequate, 0.5mL of blood can be collected
Wipe the first drop of blood
Blood flow can be enhanced by applying continuous pressure to
surrounding tissues
Rapid milking does not enhance blood flow
Excessive pressure may cause hemolysis or contamination with
tissue fluid
 Things to remember
The capillary tube or micro-container tube should not touch the
puncture site.
 Depth of puncture for adults is approximately 3mm
 Capillary puncture for babies
Plantar surface of the heel

Depth of puncture: 2mm

 Precautions
Excessive crying of the infant can lead to elevated leukocyte
count.
Hemolysis
Alcohol not allowed to completely air dry
Finger or heel squeezed too vigorously
Newborns have increased RBC fragility
Blood was scraped off