Capillary pmls

• Procedure 10-4 Capillary Puncture


  1. Step 4: Verify Collection Requirements and Identify Sensitivities and Potential Problems

  2. Step 5: Sanitize Hands and Put On Gloves

  3. Step 6: Position Patient

  4. Step 7: Select the Puncture Site

  5. Step 8: Warm Site If Applicable

  6. Step 9: Gather Supplies and Equipment

  7. Step 10: Clean and Air Dry Site

  8. Step 11: Prepare Equipment Aseptically

  9. Step 12: Grasp the Finger/Heel Firmly

  10. Step 13: Position the Lancet, and Puncture the Site, and Discard the Lancet

  11. Step 14: Lower the Finger/Heel, and Apply Gentle Pressure Until a Blood Drop Forms

  12. Step 15: Wipe Away the First Blood Drop

  13. Step 16: Label Specimens, Confirm Labeling Information, Prepare Specimens for Handling and Transport

  14. Step 17: Place Gauze, Apply Pressure, Elevate Site

  15. Step 19: Check the Site and Apply Bandage

  16. Step 20: Discard Used Materials, Thank Patient, Parent, or Guardian. Dismiss Outpatients

  17. Step 21: Remove and Discard Gloves, Sanitize Hands
• Procedure 10-1 Fingerstick Procedure
• Procedure 10-2 Heelstick Procedure
• Special Capillary Puncture Procedure


  • Used to check abnormalities in the blood cells
  • A small drop of blood is placed near the frosted end of the glass slide
  • Another slide is used to spread the blood in a thin film over the slide
  • It is then air-dried and stained
• Thick blood smear preparation


  • Used for Malaria
• Specimen for Capillary Gas, Neonatal Bilirubin, and Newborn Screening Tests


  • Capillary blood gases
  • Neonatal bilirubin collection
  • Neonatal or newborn screening
• Blood spot collection is done 24-48 hours after the baby is born to determine disorders that are not apparent at birth that could lead to disability or even death
• Capillary Puncture/Skin Puncture


  Method that uses a lancet to make small incision in the capillary bed in the skin to obtain a small volume of blood specimen
• Type of Equipment for Capillary Collection


  • Lancet/Incision devices
  • Laser lancet
  • Microcollection containers
  • Microhematocrit tubes and semant
  • Microscopic sides
  • Warming devices
• Composition of Capillary Blood Specimen


  • Arterial Blood
  • Venous Blood
  • Interstitial Flid
  • Intracelular Fluid
• Indications of Performing Capillary Puncture on Adults, Children, and Infants

  • Veina are fragile and not accessible
  • Puncturing could result to hemorrhage, thrombosis, gangrene, and infection
  • Risk of injury because of the restraint needed in venipuncture
  • Capillary blood is the preferred specimen
• Order of Draw for Collecting Capillary Specimen

  1. Blood gas an

  2. EDTA specimens

  3. Other addi

  4. Serum sped
• CLSI Standards Order of Draw
• Veins are reserved for another procedure such as chemotherapy
• Clotting tendencies
• Extreme fear of needles
• Veins will be used for POCT such as glucose monitoring
• Preferred Method for Infants and Young Children Because of the Following Reasons


  • Health risks such as anemia and cardiac arrest
  • Requires only a small volume of blood
  • Venipuncture could damage veins and tissues surrounding sites
• Procedure for Selecting the Puncture Site and Collecting Cap Mary Specimen from Adults, Infant, and Children


  1. Receive, Review & Accession Test Request

  2. Approach, Greet, Identify Patient

  3. Explain Procedure and Obtain Consent
• Capillary specimen collection is useful for pediatric patients
• collecting small amounts of blood by capillary puncture is called microcollection
• microcollection containers also called microtubes
• The most common site for collecting capillary specimens is the heel or finger
• Microhematocrit Tubes


  Disposable, narrow-bore plastic or plastic-clad glass capillary tubes that fill by capillary action and typically hold 50-75 μL of blood
• Microhematocrit Tubes


  • Used primarily for manual hematocrit (Hct), also called packed cell volume (PCV), determinations
  • Come coated with ammonium or sodium heparin for collecting Hct tubes directly from a capillary puncture, or nonadditive, to be used when an Hct is prepared using blood from a lavender-top ethylenediaminetetraacetic acid (EDTA) tube
• Microhematocrit Tubes


  • Heparin tubes typically have a red or green band on one end; nonadditive tubes have a blue band
  • Smaller microhematocrit tubes designed for use with special microcentrifuges, such as those available from StatSpin, Inc. (Norwood, MA), require as little as 9 μL of blood and are often used in infant and child anemia screening programs and pediatric clinics
• Sealants


  Plastic, clay, or wax-type sealants that come in small trays and are used to seal one end of microhematocrit tubes
• Traditionally, the dry end of the tube was inserted into the clay to plug it. Because of safety concerns, it is now 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.
• Capillary action


  The ability of a liquid to flow into a narrow space or thin tube without the use of, or even in opposition to, an external force such as gravity
• Capillary Blood Gas (CBG) Collection Tubes


  • Long, thin, narrow-bore capillary tubes, normally plastic for safety, available in different sizes to accommodate volume requirements of various testing instruments
  • The most common CBG tubes are 100 mm in length with a capacity of 100 μL
  • The inside of the tube is coated with heparin, typically identified by a green band on the tube
• Stirrers


  • Small metal bars inserted into the CBG tube after the blood is collected to aid in mixing the anticoagulant
• Magnet


  • Used to mix the CBG specimen after both ends of the tube have been sealed, by slipping it over the capillary tube and moving it back and forth along the tube length, pulling the metal stirrer with it and mixing the anticoagulant with the blood
• Plastic Caps


  • Used to seal CBG tubes and maintain anaerobic conditions in the specimen
• Glass microscope slides are occasionally used to make blood films for hematology determinations
• Heel-warming Devices


  • Commercially available devices that provide a uniform temperature not exceeding 42°C to warm the heel when performing heel punctures on newborns
• A towel or diaper dampened with warm tap water can also be used to wrap a hand or foot before skin puncture, but care must be taken not to get the water so hot that it scalds the patient
• Capillary Puncture Risks


  • Bruising
  • Hematoma
  • Infection
  • Puncture site calcification
  • Scarring
• Capillary Specimens


  A mixture of arterial, venous, and capillary blood, along with interstitial fluid (tissue fluid from spaces between the cells) and intracellular fluid (fluid within the cells) from the surrounding area
• Capillary blood contains a higher portion of arterial blood than venous blood, and more closely resembles arterial blood than venous blood in composition, especially if the area has been warmed
• Reference values may differ between capillary and venous blood, with most differences being minor, though clinically significant differences in some analytes have been reported