Dermal Puncture and Capillary Blood Collection
Continuing Education Credits
Phlebotomists and point-of-care instrument operators (laboratory, nursing and respiratory therapy personnel) frequently need to perform dermal punctures to collect capillary blood specimens for testing. This course discusses procedures that should be used to ensure a successful and safe heelstick on an infant or fingerstick on an older child or adult. The course also highlights several tests that use capillary blood where collection technique is particularly important to obtain a quality specimen, including metabolic testing on newborns, capillary blood gases, and lead levels.
Objectives
Define venous, arterial and capillary blood.
- Locate the acceptable sites for puncture and collection of capillary blood on a finger and infant heel.
- Identify and select the appropriate dermal puncture device and other equipment needed to perform capillary blood collection on adults, children, and infants.
- List and explain all procedural steps required to positively identify the patient and safely perform a capillary puncture.
- Discuss risks and special circumstances associated with the dermal puncture procedure.
Course Outline
- Introduction
- Introduction
- Safety First
- Protect Yourself and Your Patient
- Which of these pieces of personal protective equipment (PPE) is always required when a dermal puncture is performed to collect a capillary blood specimen?
- Get Ready for the Collection
- What is the difference?
- Venous, Arterial, and Capillary Blood Specimens
- Dermal Puncture vs Venipuncture
- Which of these patients may NOT be a candidate for capillary blood collection by dermal puncture?
- Site Selection
- Using the Fingers for Dermal Puncture
- Using the Heel for Dermal Puncture
- True or False: The recommended finger for capillary blood collection is the index finger (the finger next to the thumb).
- Equipment Needed
- Puncture Devices
- Miscellaneous Equipment
- A heel puncture that is performed on a small infant should not exceed what depth?
- Obtaining the Specimen
- Patient Identification
- Site Preparation
- Let Gravity Be Your Friend
- Finger Puncture
- Heel Puncture
- Properly Filling and Mixing a Microcollection Container
- Order of Draw
- Positioning the Puncture Device for a Fingerstick
- Which of these methods should be used to verify the identification of an infant in the nursery prior to collecting a blood specimen?
- A lavender top microcollection container that has EDTA as an anticoagulant is used to collect a capillary hematology specimen for a complete blood count (CBC). If additional specimens are also collected with the same dermal puncture into a green top and a red top container, at what point should the lavender top for the CBC specimen be collected?
- Procedure Notes and Cautions
- Oh No...The Blood Has Stopped Flowing
- Inappropriate Sites/Patients for Capillary Puncture
- Infants and Geriatric Patients: Monitor the Amount of Blood Obtained
- Protect Me From the Light
- True or False: If blood has stopped flowing from the finger puncture site, you should re-puncture the same site to re-establish the blood flow.
- Special Circumstances
- Filter paper Collection
- The Need for Metabolic Testing on Newborns
- Capillary Blood Collection for Metabolic Testing
- Processing Filter Cards after Collection
- The directions for this testing facility require filling all five circles on the filter card.Which of the cards that were collected for metabolic testing on newborns is filled correctly?
- Specialized Capillary Blood Testing
- Hematology Specimens
- Capillary Blood Gases
- A patient has an order for microhematocrit testing. Which of the following should be collected for this testing?
- Lead Collection
- Lead: An Important Public Health Concern
- Sucrose Solution
- Using Sucrose as an Analgesic Prior to Heel Puncture and Capillary Blood Collection
- References
- References
Additional Information
Level of instruction: Basic
Intended audience: This program is designed as an educational and training tool for laboratory personnel, phlebotomists, and other healthcare personnel who perform dermal punctures for capillary blood collection or point-of-care testing. This course is also appropriate for clinical laboratory science and phlebotomy students.
Author information: Mary Ertl Dettmann, MA, CLS, MLS(ASCP) is the education supervisor for Wheaton Franciscan Laboratory in Wauwatosa, Wisconsin. She holds a Master of Arts degree in Health Care Administration from Central Michigan University. She has created several interactive, adult-learning courses in laboratory-related subjects including phlebotomy.
Beth Kratzer, CLS, MLS(ASCP) is a Clinical Trainer in the Education Department at Wheaton Franciscan Laboratories in Wauwatosa Wisconsin. She earned her Bachelor’s degree from the University of Wisconsin Eau-Claire in 1981 and obtained a Certificate of Professional Training from the University of Wisconsin-Milwaukee in 2004. In addition to many years of technical experience in the hospital environment, Beth has been involved in the creation, implementation, and facilitation of educational and training programs for healthcare associates since 2001.
The authors have no conflicts of interest to disclose.
Reviewer information: Carol Becker, MS, MLS(ASCP)CM is a retired Program Director for the Clinical Laboratory Science program and Histology program at OSF St. Francis Medical Center located in Peoria, Illinois. Carol received her Master's degree at the University of St. Francis in Joliet, Illinois and her Bachelor's degree in Medical Laboratory Science from the University of Illinois.
Judi Bennett, BSM, MLS(AMT), MLT(ASCP), is an Education Developer with MediaLab by Vastian, bringing over 30 years of experience as a medical laboratory scientist. Before joining MediaLab in 2010, she held key leadership roles, including Clinical Laboratory Manager, Microbiology Supervisor, and Senior Systems Analyst at Gwinnett Health System in Lawrenceville, Georgia. Her extensive knowledge of laboratory operations and a strong commitment to health care quality and education fuel her passion for developing engaging and effective learning tools for the next generation of laboratorians.