STEPS FOR CAPILLARY PUNCTURE Flashcards by test knowledge

Capillary Puncture: Procedure

Review and accession test request
Approach, identify, and prepare patient
Verify diet restrictions and latex sensitivity
Sanitize hands and put on gloves
Position patient
Select the puncture/incision site
Warm site if applicable
Clean and air-dry site
Prepare equipment
Puncture the site and discard lancet
Wipe away the first drop of blood
Fill and mix tubes/containers in order of draw
Place gauze and apply pressure
Label specimen and observe special handling
instructions
Check the site and apply bandage
Dispose of used and contaminated materials
Thank patient, remove gloves, and sanitize hands
Transport specimen to the lab

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position patient

Adult (comfort and success)

Patient’s arm supported on a firm
surface with hand extended and palm up (Finger Puncture)

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First step and last step of capillary puncture procedure

Review accesion test request - first

transport specimen to lab - last

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position patient

Children

● Held in the lap by a parent or guardian,
restrains child with one arm and holds
the child

(finger/heel puncture)

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position patient

Infant

● Supine (lying face up) with foot lower
than torso

(heel puncture)

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best site

fingers of adults and heels of infants

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ADULT ANDCHILDREN
OLDER THAN
1YO
_____ has less calluses

non dominant hand

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ADULT AND
CHILDREN
OLDER THAN
1YO

location in finger

Palmar surface of the distal or end
segment of the middle or ring finger of non-dominant hand

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inflammation of bone and cartilage

osteochondritis

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inflammation of bone marrow and adjacent bone

osteomyelitis

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ADULT AND
CHILDREN
OLDER THAN
1YO

Site:

Central, fleshy portion slightly to the side of center and perpendicular to the grooves in the whorls of the finger print

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Infant

Heel (plantar surface of the heel, medial
or lateral)

Not to puncture bone (osteomyelitis, osteochondritis)

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TRUE OR FALSE
According to CLSI, capillary puncture must not be performed
on the fingers or earlobes of newborns or other infants under 1
year of age.

TRUE

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heel bone of small or premature infants may be as lethal as ____ below the skin surface on plantar and bottom surfaces of the heel and half distance of the ___

2mm ; posterior curvature

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best site appearance

warm, pink to normal color

free from bruises/rashes

not infected

not swollen/previous venipuncture

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FINGER PUNCTURE PRECAUTIONS

● Do not puncture fingers of infants and children under 1
year of age
● Do not puncture fingers on the same side of mastectomy.
● Do not puncture parallel to the grooves or lines of
fingerprint.
● Do not puncture the index finger.
● Do not puncture the side or very tip of the finger.
● Do not puncture the thumb

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Callus pressence in finger puncture precautions

● Do not puncture the index finger.
● Do not puncture the side or very tip of the finger.
● Do not puncture the thumb.

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KEYPOINT
● ___ increase in abundance below the _____,
so deeper punctures are more painful.

Pain fibers ; capillary bed,

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HEEL PUNCTURE LOCATIONS

LATERAL MEDIAL PUNCTURE HEEL

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HEEL PUNCTURE PRECAUTIONS

Do not puncture any deeper than ____

2.0mm

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HEEL PUNCTURE PRECAUTIONS

Do not puncture areas between the _____

imaginary
boundaries.

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HEEL PUNCTURE PRECAUTIONS

Do not puncture in the ________
other than the heel.

arch and any areas of the foot

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HEEL PUNCTURE PRECAUTIONS

Do not puncture severely_____

bruised areas

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HEEL PUNCTURE PRECAUTIONS

Do not puncture the ______

posterior curvature of the heel.

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HEEL PUNCTURE PRECAUTIONS Do not puncture through ____

previous puncture sites.

HEEL PUNCTURE PRECAUTIONS Do not puncture a site that is _____

swollen.

WARM SITE IF APPLICABLE

Warming the site dilates capillaries therefore increasing blood flow on the site

CAPILLARY BLOOD AFTER COLLECTING WITH WARMING DEVICE

ARTERIALIZED

BLOOD pH and BGA

WARM SITE IF APPLICABLE _______ with a washcloth, towel, or diaper

3-5 minutes

WARM SITE IF APPLICABLE

● Commercial heel warming device ● The material’s temperature must not exceed 42C (108oF)

WARM SITE IF APPLICABLE ● The material’s temperature must not exceed _____

42C (108oF)

CLEAN AND AIR-DRY SITE

70% isopropanol or 70% isopropyl alcohol

in clean an air dry site do not use ___

providone iodine it can cause bilirubin, uric acid, phosphorus, potassium

Allow site to air dry to ensure ____ and minimize chance of _____ of the specimen

maximum antiseptic action ; alcohol contamination

Allow site to air dry to ensure maximum antiseptic action and minimize chance of alcohol contamination of the specimen time limit

30 - 60 seconds

Allow site to air dry to ensure maximum antiseptic action and minimize chance of alcohol contamination of the specimen

● Stinging sensation and hemolysis ● Glucose testing

PREPARE EQUIPMENT

● Depends on the tests requested ● Place them within easy reach ● Prepare in view of patient or guardian

New, sterile lancet/incision device

● Intact packaging ● Open in aseptic manner ● Not touching/brushing any surface

Use sufficient pressure to keep device in place without deeply compressing the skin

PUNCTURE THE SITE AND DISCARD LANCET

Warn the patient about the puncture and activate release mechanism to trigger puncture

PUNCTURE THE SITE AND DISCARD LANCET

Remove the device immediately from the skin

PUNCTURE THE SITE AND DISCARD LANCET

Finger puncture ● Grasp the patient’s finger between the ______

non-dominant thumb and index finger

Place the lancet device _____ in the central, fleshy pad of the finger, slightly to the side of center and perpendicular to the fingerprint’s whorls

flat against the skin

In young children, it is usually best to grasp ___

three or four of the child’s fingers

Heel puncture ● Grasp the foot ______ with the _____

gently but firmly ; non-dominant hand

Heel puncture Wrap ______ around the ____

index finger ; arch

Heel puncture Thumb around the ______

bottom

Heel puncture ● Other fingers around the ___

top of the foot

Heel puncture Incision should be made at ________ angle to create _____

90 degrees ; “gap” puncture

“gap” punctur

puncture that opens when pressure is applied

WIPE AWAY THE FIRST DROP OF BLOOD

Downward position of the site to encourage blood flow (gentle pressure)

WIPE AWAY THE FIRST DROP OF BLOOD Heel puncture

● Contains interstitial fluid ● Contains alcohol (hemolyzed sample and unable to produce a good drop of blood)

WIPE AWAY THE FIRST DROP OF BLOOD Key point: Some POCT instruments may allow the use of ____________

first drop of blood

Fill and mix tubes/containers in order of draw

 Downward to enhance blood flow  Gentle, intermittent pressure

Fill and mix tubes/containers in order of draw CAUTION: Do not _____, use strong repetitive pressure or ____ the site, as ___ and ______

squeeze ; “milk” ; hemolysis ; tissue fluid contamination can result.

Always follow correct order of draw  You may need to _____ every now and then to let the blood settle at the bottom  Invert_____- times (depends on the manufacturer)

tap microtubes ; 8-10

Always follow correct order of draw CAUTION: Pay strict attention to ________-- containing anticoagulants

fill levels of microtubes

To fill a collection tube or device, touch it to the _____ formed on the ____

drop of blood ; surface of the skin

 If making a blood film

touch the appropriate area of the slide to the blood drop

will fill automatically by capillary action

A microhematocrit or narrow-bore capillary tube

To fill a microcollection container or microtube, hold it ____ just below the blood drop

upright

TRUE OR FALSE Do not use a scooping motion (CAUSES HEMOLYSIS AND CLOT FORMATION) against the surface of the skin and attempt to collect blood as it flows down the finger

TRUE

Place gauze and apply pressure

 Apply pressure until bleeding stops  Keep site elevated

 Label specimen and observe special handling instructions

 Label same as for Venipuncture  Label in view of patient/guardian  Affix labels directly to microcollection containers

Microhematocrit tubes- place in a ___ tube or appropriately sized ______, then label

nonadditive ; aliquot tube

Check the site and apply bandage

Check to verify if bleeding stops

if bleeding stops apply bandage and advise patient to keep it for atleast ______ (older child and adult)

15 minutes

CAUTION: Do not apply bandages to infants and children below 2 years of age because they pose ____

a choking hazard

If bleeding is more than ____ , notify nurse or physician

5 minutes

Transport specimen to the lab

Personal delivery pneumatic tube system courier service