Capillary Puncture

 Also known as SKIN PUNCTURE

 A mixture of arterial blood, venous blood and tissue fluid
 Contains interstitial and intracellular fluids
Parameter Characteristic of Capillary Blood
(in comparison to Venous Blood)
Packed Cell Volume Slightly Higher
RBC Count Slightly Higher
Hemoglobin Slightly Higher
WBC Count 15 – 20% Higher
Monocytes 12% Higher
Platelet Count Lesser

Preferred Sites:
1.) Fleshy portion of the last phalanx of the 3rd or 4th finger of the non – dominant hand
2.) Lateral plantar heel surface (newborn)

*****THE PUNCTURE ON THE FINGER SHOULD BE MADE PERPENDICULAR TO THE FINGERPRINT

LINES.

Application of Micro sample collection:

1.) Infants less than 6 months
2.) In young children (<1 year old)
3.) In adults with poor veins. (Extreme obesities, Severe Burns, Geriatric Patients)
4.) Patients with thrombotic tendencies
5.) Adults whose veins are reserved for therapeutic purposes

Equipment for Skin Puncture:

1.) Disinfectant
a.) 70% Isopropyl Alcohol  BEST
(Iodine tincture preparations are not recommended for disinfecting skin puncture sites
because they can falsely elevate potassium, uric acid, phosphorus)
2.) Puncturing Device (no longer used)
a.) Hagedorn Needle (a large needle with cord at one end)
b.) Glover’s Needle (3 cornered short needle)
3.) Appropriate Capillary Tubes
a.) Red Tip (heparinized)
b.) Blue Tip (no anticoagulant)
4.) Micro – containers

NOTES:

 The best method for blood gas collection in newborns is the INDWELLING UMBILICAL ARTERY
CATHETER
 The site of collection should be warmed to a temperature of no greater than 42° C for no longer
than 2 – 3 minutes (warming can increase the blood flow seven fold)
 Skin should be allowed to air dry after disinfection.
 1.75mm (length of lancet, is preferred to avoid penetrating the bone)

Prepared by: Gianleri V. Nor, RMT

  Depth of incision should be <2.0mm (infants) and 2-3mm (adults). But according to Rodak’s
Hematology; Clinical Principles and Applications 5th edition it should be (<2mm)
 Distance from the skin surface to the bone/cartilage in the middle finger is (1.5 – 2.4mm)
 First drop of blood should be wiped away (removed residual alcohol and tissue fluid
contamination)
 Capillary Tube length is 7cm (70mm) with a uniform bore of 0.1cm (1mm). It must be filled three
quarters (Rodak’s) or at least 5cm (50mm) (Henry’s Clinical Diagnosis and Management by
Laboratory Methods 23rd Edition)
 Most POC tests require about four to nine drops of capillary blood (approximately 40 – 90uL)
 Order of draw for tube collection
1.) Tube for blood gas analysis
2.) Slides (unless made from sample in the EDTA micro collection tube
3.) EDTA micro collection tube
4.) Other micro collection tubes with anticoagulants
5.) Serum micro collection tubes

CAPILLARY BLOOD SAMPLES ARE COMMONLY USED FOR THE FOLLOWING TESTS:

 Blood smears for a white blood cell differential count (manual method)
 Complete Blood Count (CBC), Hemoglobin and Hematocrit
 Electrolytes (Sodium, Potassium, Magnesium, Ionized Calcium)
 Neonatal blood gases
 Neonatal Bilirubin
 Neonatal Screening (using filter paper or blood spot testing)
 Point of care testing (POCT) or home or self – testing (glucose)

SPECIFIC LABORATORY TESTS FOR WHICH CAPILLARY PUNCTURES ARE NOT RECOMMENDED:

 Coagulation Studies (because of possible contamination with the interstitial fluid that caused
erroneous results)
 Blood Culture (because of volume requirements and sterility concerns about skin contamination)
 Erythrocyte Sedimentation Rate (ESR) determinations (because of blood volume requirements)

CLINICAL ALERT!!!!!! (The following sites are not generally recommended)

 The earlobe is not a preferred site due to possible interference with body or ear piercings; also,
because of the site’s close proximity to the eyes, a puncture device may cause undue anxiety to
a patient, resulting in a possible jerking of the head.
 Central arch area of an infant’s heel and posterior curve of the heel (because of risk of injuring
nerves, tendons, cartilage, and bone)
 Fingers of newborn or infant less than 1 year old (due to risk of hitting the bone and causing
infections)
 The fifth (pinky) finger (because the tissue of this finger is considerably thinner than that of the
others an there is a risk of hitting the bone)
 The thumb because it has pulse
 The index (pointer) finger (because it may be more sensitive or it may be calloused)
 Fingers on the side of mastectomy (because removal of lymph nodes during surgery may result
in excessive lymph fluid on the side of the surgery; consult with the ordering physician in the
case of a bilateral mastectomy)
 Plantar surface of the big toes (because there is no scientific evidence that supports its use)

Prepared by: Gianleri V. Nor, RMT