D E R M A L

P U N C T U R E

“Nobody travels on the road to success without a puncture or two”

WHAT IS DERMAL PUNCTURE?

Dermal puncture may be used for obtaining
specimens in infants or in adults where
venipuncture is difficult. Specimens from
infants under the age of 6 months are typically
collected by heelstick. Patients over the age of
6 months should have capillary specimens
collected by fingerstick. Capillary specimens
are collected in microtainers with colored caps
that are used to identify the microtainers'
additive.

laboratory tests involving dermal puncture

Blood smears for manual white blood cell count Electrolytes Neonatal screening
Complete blood count (CBC) Neonatal blood gasses Glucose
Hemoglobin & hematocrit (H&H) Neonatal bilirubin Hemoglobin A1C
Infectious diseases (eg, HIV) Lipids Triglycerides

HOW TO PERFORM DERMAL PUNCTURE?

Select the puncture site
The selected site may be warmed with an infant
heel warmer prior to performing the puncture if
necessary
Cleanse the puncture site with alcohol and allow
to air dry
Puncture the skin with a finger puncture device,
and wipe off the first drop of blood as this may
contain intracellular and interstitial fluid
Collect the blood into the required collection
containers
Work quickly to minimize the chance of
microclots forming in the tube
Once you have collected the specimen(s),
apply adequate pressure until the blood flow
has stopped. Apply a bandage to the site
Label the specimen with correct patient
information
EQUIPMENTS USED IN DERMAL PUNCTURE
ADVANTAGES
easy to obtain
Dermal puncture is easy to obtain
because capillaries are close to
the skin's surface, requiring
minimal tissue penetration for
access, resulting in reduced
discomfort. Its simplicity makes it
an accessible method for blood
collection, particularly in
situations where venous access
might be difficult or for routine
diagnostic purposes.
several collection sites
There are several collection sites in
dermal puncture because different
sites offer varied advantages in
terms of blood volume, ease of
access, and patient comfort.
Utilizing multiple sites, such as
fingertips, heels, or earlobes,
ensures a diverse range of options
for blood sampling, especially in
pediatric, geriatric, or challenging
venous access scenarios.
can be done at home
Dermal puncture can be done at home
because it requires minimal equipment,
involves a relatively simple procedure, and
typically necessitates only a small blood
sample obtained from easily accessible
areas like the fingertip. Its user-friendly
diagnostic tests. Inadequate mixing of the
nature and low invasiveness make it
suitable for self-administration by
individuals needing routine monitoring,
such as diabetic patients checking blood
glucose levels.
DISADVANTAGES
limited amount of blood can be
drawn
Dermal puncture yields a limited
amount of blood due to the small
size and low blood flow rate of
capillaries located near the skin
surface. The capillaries' size and
accessibility allow for only a small
volume of blood to be collected,
often necessitating minimal
puncture depth to avoid tissue
damage or discomfort.
procedure has some risks
Dermal puncture, despite being
minimally invasive, carries certain
risks such as the potential for
infection or tissue damage if not
performed properly or in a sterile
manner. Additionally, incorrect
puncture depth or excessive
pressure during sample collection
might cause discomfort, bruising, or
hematoma formation at the
puncture site.
may result in inaccurate results
Dermal puncture may yield inaccurate
results due to factors like insufficient
sample volume, hemolysis (rupturing of
red blood cells), or contamination,
affecting the reliability of certain
sample or errors in collection technique
can also impact the accuracy of test
results obtained from capillary blood
samples.
 MAY BE PERFORMED IN ADULTS WITH
THE FOLLOWING CASES:

Burned or scarred patients Patients with inaccessible veins

Patients with thrombotic tendencies Obese patients
Patients recovering from chemotherapy Apprehended patients
POCT tests
Geriatric or patients with very fragile veins

SITES TO BE AVOIDED
Edematous Area Cyanotic Area
Traumatized Area Scarred Area
Fingers on the side of mastectomy Heavily callused area

PRECAUTIONARY MEASURES IN
PERFORMING DERMAL PUNCTURE

Carefully select the puncture site based on the patient's age, condition,
and the specific test requirements, ensuring it's clean and free from
visible abnormalities or scars.
Use sterile equipment, perform the puncture at the correct depth to
avoid excessive pain or injury, and follow established protocols to
minimize contamination risks. Dispose of sharps safely after use.
 Educate and prepare the patient, particularly in cases of self-
administration, to ensure they understand the procedure and can provide
a suitable blood sample.
Thoroughly clean the puncture site with an appropriate antiseptic to
minimize the risk of infection before the puncture.
Ensure proper collection techniques to obtain adequate blood samples
without causing excessive trauma or hemolysis. Label the samples
accurately and handle them according to established guidelines to
maintain sample integrity.
Apply appropriate pressure to the site after collection to minimize
bleeding, and provide post-procedural care instructions to the patient to
prevent complications and promote healing.

CLSI ORDER OF DRAW

REFERENCES