CAPILLARY PUNCTURE,

EQUIPMENT AND PROCEDURE

MARLYN L. VICERRA, RMT, MS, LPT

Associate Professor
College Secretary
UERMMMCI-CAHP
DEFINITION

• Capillary (dermal or skin) puncture

is method of obtaining blood by puncturing or
making incision in the capillary bed in the dermal
layer of the skin with a lancet, other sharp device or
laser

Why capillary puncture?

 small amount of blood is needed
 technology, laboratory instrumentation wise, several
tests can be done with small amount of blood
sample
Capillary Puncture Equipment
• Lancet • Is a sterile,
Disposable,
Sharp-pointed or bladed
instrument that either punctures or
makes an incision in the skin to
obtain capillary blood.

• Are available in a range of lengths

and depths to accommodate
various specimen collection
requirements

• Selection depends on the age,

collection site, volume of
specimen needed, puncture depth
needed without injuring bone
Capillary Puncture Equipment
• Laser Lancets • Typically vaporizes water in the
skin to produce a small hole in
the capillary bed without
cauterizing delicate capillaries.

NOTE: no sharp instrument is

involved, no risk of accidental
sharps injury, no need for sharps
disposal

• For use on the fingers of adults,

Children 5 years of age or older
Microcollection Containers
• Aka microtubes • Are small plastic tubes used to
collect the tiny amounts of blood
obtained from capillary
punctures.

• Often referred to as “bullets”

• Most have color-coded bodies

or stoppers that correspond to
color-coding of ETS blood
collection tubes, and markings
for minimum and maximum fill
levels measured in microliters
(µl), such as 250 µl, and 500 µl
Microhematocrit Tubes and Sealants
• Microhematocrit tubes • Are disposable, narrow-bore
plastic or plastic-clad glass
capillary tubes that fill by
capillary action, and typically
hold 50 to 75µl of blood.

• Primarily used for hematocrit

(Hct) or the packed cell volume
(PCV), determinations.

• Heparin tubes typically have red

or green band on one end
• Blue for non-additive tubes
Microhematocrit Tubes and Sealants
• Plastic or clay sealant • Is used to seal one end of
microhematocrit tubes

• Traditionally, the dry end of the

tube was inserted into the clay
to plug it.

• NOTE: for safety concerns, it is

recommended that sealing
methods be used that do not
require manually pushing the
tube into the sealant or products
be used that measure Hct
without centrifugation.
Microscope Slides

• Occasionally used to make

blood films for hematology tests.
Composition of Capillary Blood
• Mixture of : • In principle:
arterial, Since arterial blood
venous, and enters capillaries under
capillary blood along pressure, capillary
with blood contains higher
proportion of arterial
interstitial fluid and blood than venous
intracellular fluid from blood, therefore more
the surrounding tissues closely resembles
arterial blood in
composition
Reference Values
• Following the principle, • In principle:
therefore: Since arterial blood
enters capillaries under
• Higher concentration pressure, capillary
of glucose; and lower blood contains higher
concentrations of TP, proportion of arterial
Ca+, and K+ are blood than venous
observed. blood, therefore more
closely resembles
arterial blood in
composition
Capillary Puncture Steps
FINGERSTICK OR HEEL PUNCTURE
• 1 – review and accession test request
• 2 – approach, identify, and prepare patient
• 3 – verify diet restrictions and latex sensitivity
• 4 – sanitize hands and put on gloves
• 5 – position patient
• 6 – select the puncture/incision site
6. select the puncture/incision site
• Warm
• Pink or normal color
• Free of scars
• Cuts
• Bruises or rashes
• Not cyanotic
• Not edematous or infected
• Swollen or previously punctured sites should be avoided
• Capillary puncture location: fingers for adults and heels
for infants
Adults and Older Children
• Adults and children • Palmar surface of the
older than 1 year distal end segment of
the middle or ring
finger of the non-
dominant hand,
• Central
• Fleshy portion
• Slightly to the side of
center and
perpendicular to the
grooves in the whorls
Infants
• Heel – for infants less than 1 year old
Puncture of the bone may arise and cause the ff:
1. osteomyelitis
2. osteochondritis

• Safe areas of heel:

1. Plantar surface of the heel
2. medial to an imaginary line extending from the
middle of great toe to the heel or
3. lateral to an imaginary line extending from between the
fourth and fifth toes to the heel
Capillary Puncture Steps
7 – warm the site if applicable
8 – clean and air-dry site
9 – prepare equipment
10 – puncture the site and discard lancet
11 – wipe away the first blood drop
12 – fill and mix tubes/containers in order of draw
13 – place gauze and apply pressure
14 – label specimen and observe special handling
instructions
Capillary Puncture Steps
15 – check the site and apply bandage
16 – dispose of used and contaminated materials
17 – thank the patient, remove gloves, and sanitize hands
18 – transport specimen to the lab
THANK YOU
FOR
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