INTRODUCTION TO CAPILLARY BLOOD COLLECTION - PMLS LAB

REQUISITIONS
All blood collection procedures begins with a What should you do upon receiving
request for a test from the treating physician requisitions?
 Examine to make sure that each has all
 The most important step in blood collection is the necessary information are listed in the
positive identification (ID) of the patient. This requisition.
is done by matching the information on the
requisition with, for inpatients, the information  Check for duplicates.
on the patient's id or band and for outpatient,
the information provided by the patient.  Prioritize the requisition (stat, timed
collection, routine).
 For out patients, the laboratory process the
physician's request and generates a  Examine to make sure that each has all
requisition, a set of labels for collection tubes the necessary information are listed in the
or both. Tests for outpatients may also arrive requisition. . Check for duplicates.
in a paper requisition.
 Prioritize the requisition (stat, timed
 Procedures for inpatients arrive in the collection, routine).
laboratory through a computer system and no
paper requisition is generated. Only a set of  Collect all equipment you need for the
labels is printed. collections you will be performing.

 The phlebotomist uses the requisition or

labels to determine what type of sample to PATIENT IDENTIFICATION
collect from the patient.  Correct identification of the patient is the
most important step in any blood collection
procedure.
Requisitions have the following
information:  When blood is collected from a wrong
 Patient demographics. patient, the test result for that blood will be
attributed to the wrong person.
 If in-patient, hospital ID number and room
/ bed number  NEVER take any shortcut in identifying
your patient
 Name of requesting physician
 Three most important identifiers are the
 Test status (e.g ., STAT, fasting) . Name following:
of tests requested *Patient's Name
*Date of Birth
*Hospital issued ID number (in-patient)
PATIENT IDENTIFICATION

Ask the patient to state his / her

name. The patient must state his
/ her name without any prompting
from you.
 CAPILLARY BLOOD PATIENTS WHOM CAPILLARY
COLLECTION PUNCTURE MAY BE CONSIDERED
Also called as dermal puncture or skin
puncture and is the usual collection for *Children, especially younger than age 2
infants. In adults, it is an alternative *Geriatric patient
collection procedure when minute *Obese patient
amounts of blood are needed for *Patients for whom only one blood test has
testing or for patients for whom been ordered for which a dermal puncture
venipuncture is not advisable or is appropriate.
impossible. *Patients requiring frequent blood tests.

The depth of the puncture must be *Patients undergoing frequent glucose

carefully controlled to produce monitoring.
adequate flow while avoiding contact
with underlying bone. Skin puncture *Patients with burns or scars over
devices deliver a precise incision. venipuncture site.

REMEMBER!
REASONS FOR Not all laboratory tests can be performed on
PERFORMINGCAPILLARY capillary blood samples *Blood culture
COLLECTION . *Routine coagulation tests
*ESR
 When venipuncture is not
advisable or impossible. Capillary blood samples may not be
appropriate for severely dehydrated patients
 When newborn or infant are because test results may not be accurate.
requested for several laboratory
Results of tests may also vary from a
tests (e.g ., bilirubin, newborn
capillary blood compared with a venous
screening, cbc) . In point of
blood.
care testing (e.g ., ancillary
Hgb HCT>VB K+
blood glucose)
 SITE SELECTION DERMAL PUNCTURE IN ADULTS
Capillary collection should be performed
on warm, healthy skin that is free of The puncture should be made near the
scars, cuts, bruises and rashes. fleshy center of the chosen finger.
Avoid the edge of the fingers as the
The site must be easily accessible and underlying bone is too close to the
have good capillary flow near the skin surface.
surface but there must be enough
clearance above the underlying bone to The puncture should be made
prevent the lancet from accidentally perpendicular to (across) the ridges of
contracting it. the fingerprint which lessens the flow of
the blood into the grooves.
Avoid the skins that damaged, callused,
scarred, burned, infected, bruised, and
edematous.

PUNCTURE
DEPTHANDWIDTH
To minimize the risk of inflammation
and infection, the lancet should
never penetrate more than 3.0 mm.

For heel puncture, the maximum

depth is 2.0 mm. . For premature
babies, the recommended depth is
0.65 to 0.85 mm.

CAPILLARY
COLLECTIONSITES FOR
ADULTS AND OLDER
CHILDREN
For adults and children older than one
year, dermal punctures are almost
performed on the fingertips of the non-
dominant hand.

The best sites are the palmar surface of

the distal segments of the third (middle)
and fourth
(ring) finger.

If fingers can't be used, the big toe may

be an option, but you need to consult the
policy of your lab regarding this.
 CAPILLARY BLOOD COLLECTION

STEP 1: GREET AND I DENTIFY YOUR PATIENT

STEP 2: ASSEMBLE YOUR EQUIPMENT Use the patient's age and the tests ordered to
determine which type of collection tube you will need and what type of skin puncture device to use
and whether to use a warming device.

STEP 3: SELECT AND CLEAN THE SITE Warm the area first if necessary. Use 70% isopropyl
alcohol to clean the site and allow it to dry completely Massaging the finger proximal to the
puncture site can help increase blood flow. to avoid hemolysis, massage gently and do not
squeeze

STEP 4: POSITION AND HOLD THE AREA Hold the finger or heel firmly. this prevents it from
moving during the puncture and reassures the patient. Grasp the patient's finger with its palmar
surface up, holding its between your thumb and index finger.

STEP 5: MAKE THE PUNCTURE, AND DISPOSE OF THE BLADE PROPERLY Align the device
so the cut is made across the fingerprint ridges or free lines. Puncture the skin slightly lateral to the
center of the finger so that the hand can be tilted for easier blood flow in the container. Do not lift
the device immediately after the puncture is complete, count to two before lifting the device to
ensure that the blade has made the puncture to full depth and then fully retracted. Dispose the
blade immediately in an appropriate collection container.

STEP 6: PREPARE TO COLLECT THE SAMPLE Wipe away the first drop of blood with a clean
gauze pad to prevent contaminating the sample with tissue fluids. Keep the finger in a downward
position to help encourage the blood flow. Apply and release firm pressure proximal to the site to
increase flow, but avoid constant massaging as this will cut off the flow, cause hemolysis and
introduce tissue fluid back into the sample.

STEP 7: COLLECT THE SAMPLE Once blood is flowing freely, position the container for collection tub
should be slanted downward. Lightly touch the scoop of the tube to the blood drop, and allow blood to
run into the tube. Tap the container lightly to move blood to the bottom. Close the lid after the sample
has been collected and invert the tube 8 to 10 times after filling if additives are present. Be careful not
overfill the microcollection tube containing anticoagulant because the ratio of anticoagulant to blood wi
exceed and microclots will form.

STEP 8: COMPLETE THE PROCEDURE Apply pressure to the puncture site using a clean gauze.
Once bleeding has stopped, you can bandage the site for older children and adults.
Do
\ not use a bandage on children younger than age 2 as they may remove the bandage and
choke on it. Label the microsample container. Don't forget to thank the patient.