PRINCIPLES OF MEDICAL LABORATORY SCIENCE 2

College of Allied Health Sciences

Bachelor of Science in Medical Laboratory Science
Second Semester, A.Y. 2022-2023

[TRANS] PMLS UNIT 7: CAPILLARY PUNCTURE EQUIPMENT AND PROCEDURES

100 mm in length (100 µL) ; green band
OUTLINE (sodium heparin)
 Stirrers – or fleas; small metal bars or filings;
I Capillary Puncture Equipment aid in mixing the anticoagulant
II Composition of Capillary Blood  Magnet – both ends are sealed; magnet is
III Order of Draw used to mix the specimen
IV Capillary Puncture Steps  Plastic caps – used to seal CBG tubes
COMPOSITION OF CAPILLARY SPECIMENS
 Capillary specimens
CAPILLARY PUNCTURE o Mixture of arterial, venous, and capillary blood,
 Capillary Puncture/Skin Puncture along with interstitial fluid and intracellular from
o A method that uses a lancet to make a small the surrounding tissues.
incision into the capillary bed of the skin to obtain  Arterial Blood
a small volume of blood specimen. The following o Bright red blood found in the pulmonary vein, left
are the pieces of equipment used for capillary chamber of the heart, and the arteries
collection o Oxygenated blood in the circulatory system
o 2 types:  Venous Blood
 Finger Puncture
o Blood that travels from the peripheral veins passing
 Heel Puncture through the venous system then through the right
CAPILLARY PUNCTURE EQUIPMENT chamber of the heart.
 Lancet/Incision Devices o Dark red in color because it is deoxygenated
o Sterile, disposable, sharp instrument that either  Capillary blood
punctures or makes an incision in the skin/heel o Contains a higher proportion of arterial blood
o Intended for one-time use only than venous blood.
o Laser Lancet o The preferred specimen for infants, young
 Type of lancet that produces a small hole in the children, elderly patients, and patients with
skin by vaporizing water in the skin severe burns
 Eliminates the risk of sharp injury because o Extracted from the venules and arterioles found in
cauterizing the skin is not necessary the capillary bed
 Microcollection containers  Interstitial Fluid
o Microtubes or bullets o Fills the spaces around the cells, filtered from the
o Special small plastic tubes used to collect the tiny blood capillaries, and drained away as lymph
amounts of blood o Found inside the cells
o It has markings on the side that show the minimum o Facilitates the movement of fluid in the membrane
and maximum fill levels and occasionally, comes and blocks the entrance of unwanted materials
with a narrow capillary puncture REFERENCE VALUES DIFFER FROM VENOUS
o Have color-coded stoppers
o Measured in µL (250 and 500)
BLOOD
 Glucose is higher than venous blood
 Microhematocrit tubes and sealants
o Microhematocrit tubes  Total protein(TP), calcium (Ca⁴⁺), and potassium(K⁺) are
 are disposable, narrow-bore plastic-clad lower than venous blood
glass capillary tubes INDICATIONS FOR CAPILLARY PUNCTURE
 hold 50 to 75 µL of blood  Capillary specimens
 Use: for manual hematocrit (Hct) or packed o A good alternative to venipuncture for adults and
cell volume (PCV) determinations older children under the following circumstances
 tubes are coated with ammonium heparin  Veins are fragile and not accessible because
(red or green band) or plain (blue band) of scars and burns
o Sealants  Veins are reserved for another procedure such
 plastic or clay as Chemotherapy
 used to seal one end of microhematocrit tubes  Patient has thrombotic or clot-forming
 Microscope slides tendencies
o Used to make blood films for hematology  Patient is apprehensive or has an intense fear
determinations of needles
 Warming Devices  There are no accessible veins
o Warming the site increases blood flow as much as  Veins will be used for glucose monitoring or
seven times oral glucose tolerance test (OGTT)
o Temperature must not exceed 42ᵒC CAPILLARY PUNCTURE IS IDEAL FOR DRAWING
o Towel or diaper dampened with warm tap water BLOOD FROM INFANTS
 Capillary Blood Gas Equipment  Capillary puncture is the preferred way to obtain blood
o Special equipment used for Capillary Blood Gas from infants and very young children for the following
(CBG) Specimen reasons:
 CBG collection tubes - are long thin narrow- o Infants have a small blood volume (health risks
bore capillary tubes; most common tubes are such as anemia and cardiac arrest).

TETSUYA, KUROKO | SEIRIN HIGH 1

 TRANS: PMLS 2 Unit 4

o Requires only a small volume of blood Packages should be opened in front of the
o Infant or child venipuncture is difficult and can patient.
damage veins and surrounding tissues. 10. Puncture the site and discard the lancet.
o An infant or child can be injured by the restraining o When doing the finger puncture, the phlebotomist
method used during venipuncture. should hold the finger between the thumb and the
o Puncturing deep veins can result in hemorrhage, index finger of the non-dominant hand. He/she
venous thrombosis, infection, and gangrene. should then place the lancet flat against the
o Capillary blood is the preferred specimen for central fleshy part of the incision site.
some tests, such as newborn screening tests o With the very young children, it is usually best to
(NBS). grasp 3 or 4 of the child’s fingers
TESTS THAT CANNOT BE COLLECTED BY o For heel puncture, he/she should hold the foot
CAPILLARY PUNCTURE gently but firmly and proceed to encircling the
 Erythrocyte sedimentation rate (ESR) heel using the index finger near the arch. The
 Coagulation studies thumb should be place at the bottom, and the rest
 Blood cultures of the fingers around the top portion of the foot.
Then the lancet is positioned in the medial or lateral
 Tests that require large volume specimen requirement
plantar of the heel.
ORDER OF DRAW (CLSI) 11. The first blood drop should be wiped away
 Blood gas specimens (CBGs) o The first blood drop may be contaminated with
 EDTA specimens excess tissue fluid
 Other additive specimens o It may also contain alcohol residue that can
 Serum specimens hemolyze the specimen.
 KEY POINT: Specimens for newborn screening tests 12. Fill and mix tubes or containers in the order of draw
should be collected separately. o The phlebotomist should prioritize the collection of
CAPILLARY PUNCTURE STEPS slides, platelet counts, and other hematology
1. Review and check accession test request. specimens to avoid clumping and clotting.
2. Approach, identify, and prepare the patient. o The anticoagulant containers should be followed
3. Verify diet restrictions and latex sensitivity. by serum specimens
4. Sanitize hands and put on gloves. o Do not forget to collect drops of blood into the
5. Position the patient. collection tube/device.
o During finger puncture, the patient's arm should be 13. Place gauze and apply pressure. Keep the incision site
placed on a firm surface. His/her arms should be elevated.
extended, and his/her palms are facing up. o Apply pressure with a clean gauze pad until
o If the patient is a young child, he/she should be bleeding stops.
placed on the lap of his/her guardian. o Keep the site elevated while applying pressure.
o The infant heel puncture should be performed with 14. Label specimen and observe special handling
the baby in a supine position and his/her foot not instruction
lower than his/her torso. o Bedside labelling
6. Select the puncture or incision site. o Microhematocrit tubes can be placed in a
o As a general criterion, the skin of the incision site nonadditive tube or an appropriately sized aliquot
should be pink, normal in color, and warm. The tube.
selected area should be free from scars, cuts, 15. Check the site and apply bandage
bruises, rashes, cyanosis, edema, or infection. o If bleeding persists beyond 5 minutes, notify the
o If the patient is an adult or an older child, the patient’s nurse or physician.
palmar surface of the distal, end segment of the o If the bleeding has stopped, apply bandage and
middle finger or ring finger of the non-dominant advise patient to keep it in place for at least 15
hand should be used. The center or the fleshy minutes.
portion of the finger should be used. 16. Dispose of used and contaminated materials
o For infants, the incision site should be less than 2.0 o Equipment packaging and bandage wrappers –
mm deep. To avoid bone damage, the incision regular trash
recommended site should be on the plantar surface o Contaminated items – biohazard containers
of the heel, or on the median or lateral edge 17. Thank patient, remove gloves, and sanitize hands
7. Warm the site, if necessary 18. Transport specimen to the lab
o Warming the incision site increases the blood
circulation in the area for up to seven times.
o With a warm washcloth or towel, the site should be
warmed for 3 to 5 minutes.
o Warming is usually done when the specimen is for
pH or blood gas specimen collection. It is also
recommended for heel sticks.
8. Clean and air-dry the site.
o The incision site should be cleaned and sanitized
using antiseptic or 70% isopropyl alcohol.
9. Prepare the equipment.
o The phlebotomist must wear gloves before
arranging the sterilized collection devices and
placing them in an area that is easy to reach.

TETSUYA, KUROKO | SEIRIN HIGH 2