CAPILLARY PUNCTURE

EQUIPMENT AND PROCEDURES

Chapter 10
 Objectives
▣ List and describe the various types of equipment needed
for capillary specimen collection
▣ Describe the composition of capillary specimens,
identify the tests that have different reference values
when collected by capillary puncture methods, and name
tests that cannot be performed on capillary specimens
▣ Identify indications for performing capillary puncture on
adults, children, and infants
▣ List the order of draw for collecting capillary specimens
▣ Describe proper procedure for selecting the puncture site
and collecting capillary specimens from adults, infants,
and children
 Capillary Puncture Equipment
▣ Lancet/Incision Devices
◼ Finger puncture
◼ Heel puncture
◼ Laser lancet
 Capillary Puncture Equipment
▣ Collection Devices
◼ Microcollection Containers
◼ Microhematocrit tubes
 Capillary Puncture Equipment
▣ Plastic/clay sealant
▣ Capillary blood gas collection equipment
◼ Collection tubes/caps
◼ Stirrers/magnets
▣ Microscope slides
▣ Warming devices
 Capillary Puncture Principles
▣ Composition of capillary puncture blood
◼ Arterial blood
◼ Venous blood
◼ Capillary blood
◼ Interstitial fluid
◼ Intracellular fluid
▣ More closely resembles arterial blood
▣ Reference (normal) values for capillary puncture blood
▪ Higher in capillary puncture blood
● glucose
▪ Lower in capillary puncture blood
● total protein
● calcium
● potassium
 Capillary Puncture Principles
▣ Indications for performing
capillary puncture
◼ Adults ◼ Children and Infants
🢭 No accessible veins
🢭 To save veins for
chemotherapy
🢭 Clotting tendencies
🢭 POCT procedures such as
glucose monitoring
🢭 To prevent anemia
🢭 To prevent cardiac arrest
from removal of large
quantities of blood
🢭 Venipuncture too difficult
🢭 To prevent injury
🢭 When capillary blood is
preferred
 Capillary Puncture Procedures
▣ Tests that cannot be performed by capillary
puncture
◼ Erythrocyte sedimentation rate (ESR)
◼ Coagulation studies that require plasma
◼ Blood cultures
◼ Tests that require large volumes of serum or plasma
 Capillary Puncture Principles
▣ Order of Draw
◼ Slides
◼ EDTA specimens
◼ Other additive specimens
◼ Serum specimens
 Capillary Puncture Steps
▣ Step 1: Review test request
▣ Step 2: Approach, identify, and prepare patient
▣ Step 3: Verify diet restrictions and latex sensitivity
▣ Step 4: Sanitize hands and put on gloves
▣ Step 5: Position patient
◼ For finger: hand extended, palm up
◼ For heel: supine with foot lower than torso
 Capillary Puncture Steps
▣ Step 6: Select puncture/incision site
◼ General criteria
🢭 Should be warm, normal color, and free from scars, cuts,
bruises, or rashes
🢭 Do not choose cold, cyanotic, infected or edematous site
🢭 Finger for adult/older child, heel for infant
 Capillary Puncture Steps
◼ Adults and older children (over 1 year old)
🢭 Use the palmar surface of the distal or end segment of the
middle or ring finger of the nondominant hand
🢭 Do not
🢝 Use same side as mastectomy
🢝 Use finger on child less than 1 year old
🢝 Puncture side or tip of finger
🢝 Puncture thumb, index, or little finger
🢝 Puncture parallel to whorls of fingerprint
Capillary Puncture Steps
 Capillary Puncture Steps
▣ Step 6 cont:
◼ Infants (less than 1 year old)
🢭 Use the medial or lateral plantar surfaces of the heel
🢭 Do not
🢝 Puncture earlobes, finger, or big toe
🢝 Puncture deeper than 2.0 mm
🢝 Puncture posterior curvature of heel (calcaneous bone)
🢝 Puncture between imaginary line or on arch
🢝 Puncture in bruised areas
 Capillary Puncture Steps
▣ Step 7: Warm site if applicable
◼ Increases blood flow to site making collection easier
especially in infant heel sticks
◼ “Arterializes” blood;essential for capillary blood gases
◼ Helps with finger puncture collection when patient has
cold hands
▣ Step 8: Cleanse and air-dry site
◼ Do not use iodine; its yellow color interferes with uric
acid, phosphorus, and potassium
▣ Step 9: Prepare equipment
 Capillary Puncture Steps
▣ Step 10: Puncture the site and discard lancet
◼ Finger puncture: fleshy area, slightly off center,
perpendicular to whorls of fingerprint
◼ Heel puncture: medial or lateral plantar surface
◼ For both finger and heel punctures
🢭 Place lancet firmly against site
🢭 Warn patient
🢭 Depress lancet trigger
◼ Discard lancet in sharps container immediately
 Capillary Puncture Steps
▣ Step 11: Wipe away first blood drop
▣ Step 12: Fill and mix tubes/containers in order of
draw
◼ Gentle intermittent pressure, do not milk, position site
downward to enhance flow
◼ Slide first, then EDTA, other additives, serum
◼ Microhematocrit tube: use capillary action
◼ Microcollection containers: touch blood drop, do not
“scoop” or touch site
◼ Mix gently
▣ Step 13: Place gauze and apply pressure
 Capillary Puncture Steps
▣ Step 14: Label specimen and observe special handling
instructions
◼ Label with appropriate information
◼ Apply label directly to microcollection container
◼ Place microhematocrit tubes in nonadditive tube then
label that tube
◼ Ice, body temperature, protect from light, etc.
 Capillary Puncture Steps
▣ Step 15: Check the site and apply bandage
◼ Do not bandage children less than 2 years old

▣ Step 16: Dispose of used and contaminated materials

▣ Step 17: Thank patient, remove gloves, and sanitize hands

▣ Step 18: Transport specimen to lab

Special Capillary Puncture Procedures
▣ Capillary blood gases (CBG)
◼ Less desirable than ABG— exposed to air during collection,
contains tissue fluid, rarely done on adults
◼ Desirable for infants and small children to avoid hazards of
arterial puncture
◼ Warm site for 10-15 minutes to maximize arterial flow
◼ Minimize exposure to air during collection
Special Capillary Puncture Procedures
▣ Neonatal bilirubin collection
◼ Done routinely on jaundiced (yellow) infants
◼ Minimize exposure to light during collection and transport
◼ Avoid hemolysis

▣ Newborn/neonatal screening
◼ Done routinely to detect inborn disorders
◼ PKU, hypothyroidism, galactosemia
◼ Blood drops collected on filter paper, fill circles from 1
side of the paper, air-dry horizontally