1. Chapter 10 Capillary Puncture Equipment and Procedure
Lancet
Site
Grip

3. OBJECTIVES
Define the key terms and abbreviations listed at the beginning of this chapter.
List and describe the various types of equipment needed to perform skin puncture.
State the composition of skin puncture blood, identify which tests have different reference values when collected by skin puncture methods, and name tests that cannot be performed by skin puncture.
State indications for performing skin puncture on adults, infants, and children.

4. OBJECTIVES
Describe the proper procedure for selecting a skin puncture site and indicate precautions associated with site selection.
Describe the proper procedure for collecting skin puncture specimens from adults, infants, and children.
List the order of draw for collecting skin puncture specimens.
Describe the procedure for making both routine and thick blood smears and reasons for making them at the collection site.

5. 72. List 4 Capillary puncture equipment
Lancets
Finger-stick lancets
laser lancet – Children > 5
yrs
Heel-stick lancets—special depth to prevent
injury

6. Skin Puncture Equipment (continued
Collection Devices
Micro-collection containers
Micro-hematocrit tubes

7. Skin Puncture Equipment (continued)
Plastic/Clay Sealant
Capillary Blood Gas Collection Equipment
Micropipet Dilution System
Warming Devices

8. Skin Puncture Equipment (continued)
Micro-hematocrit tubes
Notice improper technique!!!!

9. 73. A capillary specimen is a mixture of
-arterial, venous and capillary blood
Interstitial fluid ( fluid in the tissue spaces between cells.
Intracellular fluid ( fluid within cells) from surrounding tissue.

10. 74. Which test(s) is higher or lower due to this specimen type?
Reference (normal) values for skin
puncture blood
higher in skin puncture blood
glucose
lower in skin puncture blood
total protein
calcium
potassium

11. 75. List 4 reasons for adults & older children to get a capillary puncture
no accessible veins
to save veins for chemotherapy
clotting tendencies
home-testing procedures

12. Indications for performing skin puncture (continued)
Infants & Children
venipuncture too
difficult
may damage veins
chance of injury
when restrained
large quantities of blood removed may lead to anemia

13. Skin Puncture Site Selection Criteria
General criteria
Site should be warm, normal color, and free from scars, cuts, bruises, or rashes
do not choose cold, cyanotic, or edematous
Infants
Older children and adults

14. Site Selection for Infants
Heel
Recommended site
Plantar surface of the heel
Medial or lateral
High risk areas
Calcaneus
Osteomyelitis
Osteochondritis
Posterior curvature

15. 76. When is a capillary puncture preferred?
It Depends upon:
- amount of blood required
- test(s)

16. 77. What is the “Order of Draw” for capillary puncture?
EDTA tubes—minimize clotting and effects on
cells for CBC
Other additive specimens
Serum specimens

17. 78. List 7 “Do Not’s” for a capillary puncture, from adults or older children
Side of a mastectomy
Infant or child, under 1 yrs. (bone injury likely)
Side or very tip – (bone vs skin)
Index finger – (sensitive / calloused)
Ring or little finger – (bone vs skin likely)
Thumb – has pulse
Parallel to grooves – won’t get a tear droplet

18. 79. List 7 “Do Not’s for an infant capillary puncture
Earlobes
Deeper than 2.0mm (bone injury)
Previous sites (painful, infection)
Between imaginary borders
Posterior curvature (bone close to surface)
Arch, other foot area ( arteries, nerves, tendons, cartilage)
Bruised ( painful, impaired circulation, by products can affect the specimen

19. Heel Puncture Precautions
Do not puncture deeper than 2.0 mm
Do not puncture through previous punctures
Do not puncture the area between imaginary boundaries
Do not puncture the posterior curvature of heel
Do not puncture in the arch
Do not puncture areas of the foot other than the heel

20. Skin Puncture Principles

21. 80. What must be done for all “Heel” stick prior to the puncture?
Warm the Site (dilates
capillaries)

22. 81. What does “PKU” indicate and explain the importance of this test
Phenylketonuria - presence of certain genetic metabolic (chemical changes within living cells) either hormonal and functional disorders, which can lead to mental handicaps if not detected.
PKU, hypothyroidism – required by law for all
newborns

23. Newborn Screening PKU Hypothyroidism Neonatal Bilirubin Collection
Result of defect in enzyme that converts phenylalanine to tyrosine
Cannot be cured,but treated
If untreated can lead to brain damage
Hypothyroidism
Inherited and noninherited forms
Positive results are confirmed by TSH levels
Treated with missing thyroid hormone
Neonatal Bilirubin Collection
To detect & monitor increased bilirubin levels associated with
HDN
Abnormal liver function

24. Special Skin Puncture Procedures (continued)
Newborn Screening
To test for the following genetic or inherited diseases (state specific)—usually will use blood droplet on specially designed filter paper
PKU
Hypothyroidism
Galactosemia
Homocystinuria
Maple syrup urine disease
Sickle cell

25. Example of a Newborn Screening Policy
Here is some sample content from Newborn Screening (NBS):       POLICY: Newborns will have a screening for metabolic disorders prior to discharge. GENERAL INSTRUCTIONS: All newborns will have a screen drawn per the following criteria: Hours of age; recommend as close to 24 hours as possible Do not do a newborn screening on babies that are less than 12 hours old………………………………………

26. More congenital diseases
Miscellaneous multisystem diseases
Cystic fibrosis (CF) > 1 in 5,000
Congenital hypothyroidism (CH) > 1 in 5,000
Biotinidase deficiency (BIOT) > 1 in 75,000
Congenital adrenal hyperplasia (CAH) > 1 in 25,000
Classical galactosemia (GALT) > 1 in 50,000

27. Tests that cannot be performed by skin puncture
Erythrocyte sedimentation rate (ESR)
Coagulation studies that require plasma
Blood cultures
Tests that require increased volumes of serum or plasma