PMLS 2 Lesson 7

Principles of Medical Laboratory Science 2
Lesson 7: Capillary Puncture Equipment and Procedure

Capillary puncture or skin puncture is a method that uses a
lancet to make a small incision into the capillary bed of the
skin to obtain a small volume of blood specimen.
Type of Equipment for Capillary Specimen Collection:
v Lancet/Incision devices - sterile, sharp instruments that are intended for
one-time use only. They are designed for use in making cuts in the skin for
finger or heel puncture.
v Laser lancet - this type of lancet produces a small hole in the skin by
vaporizing water in the skin; there are two types: finger puncture lancet
and heel puncture lancet
v Micro collection container - also known as microtube, this is a small
plastic tube used to hold blood speciments collected in the capillary
puncture.
v Microhematocrit tubes and sealants - narrow bore tubes made of
either plastic or glass typically used for hematocrit determinations.
One end is sealed with sealants made of clay or plastic.
v Microscope slides - these are used for blood films for hematology
determinations.
v Warming devices - used to increase the blood flow seven-fold by
warming the puncture site.
v Capillary blood gas (CBG) equipment - special equipment for
collecting CBG; contains CBG collection tubes, stirrers, magnet,
and plastic caps.
Composition of Capillary Blood Specimen adn the Test and Capillary

Reference Value:
v Capillary blood specimen is a mixture of different types of blood and
body fluids: arterial blood, venous blood, capillary blood, interstitial fluid, and intracellular
fluid.
v The capillary reference values may vary from the venous values; glucose is higher while
the total protein, calcium, and potassium concentrations are lower
Indications of Performing Capillary Puncture on Adults, Children, and Infants:
Adults and Older Children:
1. Veins are fragile and not accessible because of scars and burns
2. veins are reserved for another procedure such as chemotherapy
3. clotting tendencies
4. extreme fear of needles
5. veins will be used for glucose monitoring or oral glucose tolerance test
(OGTT)
Indications of Performing Capillary Puncture on Adults, Children, and Infants:
Infants and Young Children:
1. health risks such as anemia and cardiac arrest
2. requires only small volume of blood
3. Venipuncture could damage veins and tissues surrounding the site
4. puncturing could result in hemorrhage, thrombosis, gangrene, and
infections
5. risk of injury because of the restraint needed in venipuncture
6. capillary blood is the preferred specimen
Order of Draw for Collecting Capillary Specimen:

1. Capillary blood gas specimens
2. EDTA specimens
3. Other additive specimens
4. serum specimens
Procedure for Selecting the Puncture Site and Collecting Capillary Specimens
from Adults, Infants, and Children:
Capillary Puncture Steps:
v Step 1: Review and check accession test request
v Step 2: Approach, identify, and prepare the patient
v Step 3: Verify diet restrictions and latex sensitivity
v Step 4: Sanitize hands and put on gloves
v Step 5: Position the patient
ü During finger puncture, the patient’s arm should be placed on a
firm surface, with arms extended, and palms facing up
ü Young children should sit on parent/guardian’s lap. The heel
puncture should be performed with the baby in a supine position,
with the foot not lower than the torso
v Step 6: Select the puncture or incision site
ü the skin of the puncture site should be pink, normal in color, and warm
ü selected area should be free from scars, cuts, bruises, rashes, cyanosis,
edema, or infection
ü if the patient is an adult or older child, the palmar surface of the distal,
end segment of the middle finger or ring finger of the non-dominant
hand should be used. The center or fleshy portion of the finger should be
used
ü for infants, the incision site should be less than 2 mm deep. to avoid
bone damage, the incision recommended site should be on the plantar
surface of the heel, or on the median or lateral side.
v Step 7: Warm the site
ü warming the puncture site increases the blood circulation in the area up to
seven times
ü with a warm washcloth or towel, warm the site for 3-5 minutes
v Step 8: Clean and air-dry the site
ü the incision site should be cleanse and sanitized with antiseptic or 70% alcohol
Step 9: Prepare the equipment
ü the phlebotomist should wear gloves before arranging sterilized equipment and
placing them in an area that is easy to reach. Packages should be opened in
front of the patient
v Step 10: Puncture the site and discard the lancet
ü In doing the finger puncture, the phlebotomist should hold the finger between
the thumb and index finger of the non-dominant hand; the lancet should then be
placed flat against the fleshy part of the incision site
ü For heel puncture, the phlebotomist should hold the foot gently but firmly and
proceed to encircle the heel using the index finger near the arch; the thumb
should be placed at the bottom and the rest of the fingers around the top
portion of the foot, then the lancet is positioned in the medial or lateral plantar
of the heel
v Step 11: The first drop of blood should be wiped away because it may be
contaminated with excess tissue fluid
v Step 12: Fill and mix tubes in the order of draw
ü the phlebotomist should prioritize the collection of slides,
platelet counts, and other hematology specimens to avoid
clumping and clotting
v Step 13: Place gauze and apply pressure, keep the incision site elevated
v Step 14: Label the specimen and observe special handling instructions
v Step 15: Check the site and apply bandage
v Step 16: Dispose used and contaminated materials
v Step 17: Thank patient,remove gloves, and sanitize hands
v Step 18: Transport specimen to the laboratory
Reasons for Making Routine Thin and Thick Blood Smear Preparation:
v Routine blood film/smear preparation is a blood test used to check
abnormalities in the blood cells. A small drop of blood is placed near the
frosted end of the glass slide. Another slide is used to spread the blood in
a thin film over the slide. It is then air-dried and stained.
v Thick blood smear preparation is used to determine if the patient has
malaria. A large drop of blood is spread until it is about the size of a dime
using a cover slip or another slide. This is air-dried for at least 2 hours
before staining(THICK-quantity, THIN-CLEAR)
Collection of Specimen for Capillary Blood Gas, Neonatal Bilirubin,

and Newborn Screening Tests and Its Significance:
v Capillary blood gas specimen by heel puncture is recommended
for infants and small children. The blood samples are collected on
the same site as routine capillary puncture specimens.
v Neonatal bilirubin collection is used to help determine any liver
disorder in infants. This is collected with a heel stick
v Newborn/neonatal screening is done as part of the routine check
for infants to determine inborn disorders such as phenylketonuria,
hypothyroidism, galactosemia, and cystic fibrosis. This is done 24-
48 hours after the baby is born.

PMLS 2 Lesson 7

Uploaded by

Copyright:

Available Formats

PMLS 2 Lesson 7

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

PMLS 2 Lesson 7

Uploaded by

Copyright:

Available Formats

Principles of Medical Laboratory Science 2

Lesson 7: Capillary Puncture Equipment and Procedure

Composition of Capillary Blood Specimen adn the Test and Capillary

Order of Draw for Collecting Capillary Specimen:

Collection of Specimen for Capillary Blood Gas, Neonatal Bilirubin,

You might also like