1. CAPILLARY BLOOD COLLECTION PROCEDURE

2. This procedure gives an alternative method of specimen collection
This procedure gives an alternative method of specimen collection. There are many contributing factors of when and why to collect a specimen using a fingerstick method. (pg. 325)
Maximum amount of venipuncture attempts reached resulting in no viable specimen obtained. (follow facility policy)
Inaccessible veins do to sclerosis, heavily burned or bandaged patients.
Pediatric collection where only a small amount of specimen is required.
CLSI states a capillary puncture must not be performed on the fingers or earlobes of newborns or other infants under 1 year of age.

3. Some tests cannot be performed on skin puncture specimens
Erythrocyte sedimentation rate (ESR)
Coagulation studies (e.g. PT, PTT, D-Dimer etc.)
Blood cultures
Tests that require large amounts of plasma or serum
When in doubt, ask one of your friendly MTs!!

4. Order of draw
The order of draw will change when a capillary collection is performed.
Blood gas specimens (CBGs)
EDTA
Other additive specimens (PST)
Serum specimens (no additive)

5. Patient identification
The identification of each patient must be verified by two identifiers before performing any type of procedure that will result in a laboratory, microbiology, or pathology specimen.

6. Selection of puncture site
The site should be pink in color, free of scarring, cuts, bruises, or rashes and should not be edematous (swollen).
The middle or ring finger of the non-dominant hand is preferred
The fifth finger (pinky) must not be used due to the tissue depth being insufficient and bone injury is a possibility.
The puncture site should be in the central, fleshy portion of the finger, slightly to the side. The lancet should make a cut across the fingerprint, not vertical to them.

7. The cut

9. Preparation of the finger
Warm the site
Apply a warm heating source for three minutes to the intended puncture site.
A heel warmer works best but you could also use a warm moist towel or fill a glove with warm water and tie off the top.
Warming the site will help increase blood flow to the capillaries.
The temperature of the device used to warm the site must not exceed 42˚C (108˚F)

10. Increase blood supply to the hand
Have the patients hand positioned below their heart facing downward with the palm up.
This will allow the capillaries to fill with an ample supply of blood.

11. Disinfect Disinfect the site
Cleanse the intended puncture site using antiseptic (70% Isopropyl Alcohol).
The site must be allowed to air dry, this will provide effective disinfection and prevent possible hemolysis by residual alcohol.

12. Perform fingerstick Puncture
Keeping the hand in a downward position with the palm up, grasp the finger by placing your thumb on the patients nail and your three fingers circling around the patients finger.
This technique gives you optimal control over the finger and makes it easy to apply intermittent pressure as you obtain the specimen.
Position the lancet firmly against the skin, ensuring the cut will cross the print, and trigger the lancet.
Discard lancet into OSHA approved sharps container.

14. Collect the specimen Collection
Discard the lancet, gently massage from the hand to the puncture site. Continue to keep the patients hand below the elbow to maintain adequate blood supply to the capillaries.
Wipe away the first drop of blood using a gauze pad. This drop may contain an excess of tissue fluid that can cause erroneous test results.
Place the microtainer tube at a slight angle with the scoop edge against the skin so that the droplets can flow freely into the tube.

15. Collect the specimen Continued
Pay strict attention to fill levels of microtubes containing anticoagulants. Do not over fill or under fill tubes.
Once each tube is full, place the cap on and invert the tube 5 to 10 times to ensure adequate mix of the additive with the blood.

16. Filling microtainer or pipet

17. Completing procedure Complete Procedure Label Specimen
Once all specimens have been collected, wipe the site and apply direct pressure with a gauze pad until the bleeding has stopped. Dispose of all materials used in an OSHA approved biohazard container.
Label Specimen
Follow the established policy for specimen labeling. Patients name and date of birth (follow facility policy). Specimens must be labeled in the patients presence, never move unlabeled specimens from patient.
Follow any special handling required, such as place on ice(ammonia), transport at body temperature(cold agglutinin), or protect from light(bilirubin).

18. Bandage Patient
Once all specimens are labeled, check the puncture site to see if bleeding has stopped. If still bleeding, apply good pressure to the site and hold above the patients heart. If bleeding persists beyond 5 minutes, notify the patient’s nurse or physician. If bleeding has stopped, apply a bandage and advise the patient to keep it in place for at least 15 minutes.
Do not apply bandages to infants or children under 2, this can cause a choking hazard.

19. Transport Specimen
Prompt delivery of the specimen to the lab protects specimen integrity and ensures timely processing of the specimen. EDTA tubes must be tested within 4 hours of collection, once the specimen is greater than 4 hours old, the specimen begins to degrade and testing can not be performed.