Title of Manual: Specimen Collection Document Number: GPA.SPC.45.0

Transcription

1 Capillary Blood Page 1 of 5 I. PURPOSE This procedure provides guidelines on the proper technique for collecting diagnostic capillary blood specimens via skin puncture or heel puncture (infant only). Blood specimens obtained by skin puncture are especially important in pediatrics as small but adequate amounts of blood can be obtained for laboratory testing with this technique. This is to be performed by all personnel who are authorized and trained to perform phlebotomy. 1. Pediatric: Non adult patient 1 year of age or older 2. Infant: Patient less than 1 year old 3. Automated Skin Puncture Device: A single use device that punctures or cuts the skin with a lancet or blade that automatically retracts into a protective housing. Used for the collection of capillary blood specimens. 4. Lancet: sharp needle like device used to puncture skin to obtain blood from a finger or heel. II. MATERIALS Reagents Supplies Equipment III. PROCEDURE Lancet Alcohol Prep Pads 2x2 Non-Sterile Gauze Bandage Blood Micro-collection Container Sharps Container Skin Puncture Technique Guidelines a. Review orders to determine what is to be collected and if special collection or handling is required b. Identify the patient as outlined in the patient identification procedure. c. Verify the patient is free of latex allergies. d. Verify any patient diet restrictions, as appropriate. e. Position the patient. f. Cleanse hands and put on gloves. g. Verify orders and assemble supplies, collection tubes, and skin puncture device.

2 Capillary Blood Page 2 of 5 h. Choose the puncture site. i. Choose a finger that is not cold, calloused, cyanotic (blue) or edematous. If the patient has cold or calloused hands, they may run warm water on their hands to soften and warm them up or use a heel warmer. j. Warm the puncture site using a commercial heel warming device, warm moist towel or glove filled with warm water. k. Apply a massaging motion to the fleshy portion of the finger or heel. Repeat this massaging processing 5-6 times. l. Cleanse the puncture site with an alcohol prep pad and allow to air dry. NOTE: if an alcohol level is being collected, clean the site with a nonalcohol antiseptic. m. Remove the skin puncture device (ie BD Genie Lancet) from its packaging without contaminating the end. Remove/release the trigger lock feature according to the manufacturer s directions. n. Press the end firmly to the end of the finger. Do not use heavy pressure or make an indentation in the skin. o. Hold the patients finger or heel to prevent sudden movement. Hold the heel firmly avoiding restricting blood flow or causing bruising to the area. p. Position the device on the patient s skin. q. Notify the patient of the imminent puncture. r. Activate the release mechanism. s. Remove the device from the skin and discard it into an appropriate sharps container. t. Wipe away the first drop of blood with gauze as it is likely to contain tissue fluid. u. If an adequate puncture has been performed, ml of blood can be collected from a single site. v. If blood does not flow freely, increase blood flow by holding the puncture site downward and gently applying intermittent pressure to the surrounding tissue. Strong repetitive pressure (milking) must not be applied as it may cause hemolysis or tissue fluid contamination. Collect the specimen(s) in the appropriate container(s) a. Drops of blood should be allowed to flow freely into the collection top and down the walls of the tube. b. If a drop of blood becomes lodged inside the collector top, gently tap the tube on a hard surface to move the blood down into the tube. c. When collecting a anticoagulant specimen, the specimen should be adequately mixed by gentle inversion after the tube closure. d. Avoid vigorous shaking as hemolysis may result.

3 Capillary Blood Page 3 of 5 e. Anticoagulant tubes must be filled properly; overfilling may lead to clot formation while under filling can cause excess anticoagulation. Order of Draw: This differs from that of a venipuncture collection. a. If multiple specimens are to be collected, the EDTA specimen is collected first to ensure adequate volume and accurate hematology test results. b. Other additive specimens are collected next c. Specimens requiring serum (non additive) are collected last. d. When collection is complete, apply pressure to the puncture site with a clean gauze pad. e. For patients <2 years old, the puncture site should be elevated above the body and a clean gauze pad pressed against the site until the bleeding stops. f. It is not advisable to apply an adhesive bandage over the puncture site of patients <2 years old. Bandages may cause skin irritation or may be ingested. g. If an insufficient sample has been obtained, the puncture may be repeated at a different site using a fresh skin puncture device. h. In the presence of the patient, label the tubes with the patient name, DOB, and Unique patient identifier. i. Process and submit to the laboratory. Selection of the Puncture Site a. Do not puncture through previous puncture sites which may be infected. b. For finger stick punctures, choose a puncture site on the palm surface of the last segment of the finger, usually the ring finger or middle finger. c. The cut should be made across the fingerprints, when the area is wiped dry the blood should well up into a large rounded drop. If a cut has been made on the line with the fingerprint, blood will stream down the finger. d. For heel stick punctures, perform puncture on the most medial or lateral portion of the plantar surface (see gray areas in the diagram). e. Do not perform puncture on the posterior curvature of the heel.

4 Capillary Blood Page 4 of 5 IV. QUALITY CONTROL V. CALCULATIONS/CALIBRATION VI. INTERPRETATIONS VII. METHOD PERFORMANCE SPECIFICATIONS VIII. REFERENCES Procedures for the collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard 5 th Edition NCCLS, Wayne, PA, 2004 Vol. 24, H4-A5. IX. RELATED DOCUMENTS

5 Capillary Blood Page 5 of 5 X. DOCUMENT HISTORY Minor Revision (Laboratory Director s Signature on Original Subsequent Document Attached) Major Revision (Requires Laboratory Director & Department Director Signature - where applicable) Reason for Change 2/10/14 New Document Control Format 06/23/14 Moved procedure to Manual Laboratory Director: Natalie Depcik-Smith, M.D. Department Director: Robert M. Gay, M.D. Designee: