NURSING PATIENT CARE POLICY & PROCEDURE
February 2, 2015
Nursing Manual (Red)
Policy #: 11.12 P
Title: Capillary Blood Specimen Collection P
To define the procedure for obtaining capillary blood specimens.
Procedure may be performed by a provider, registered nurse, or phlebotomist.
A. Infant heel warmer (CS# 2200084)
B. Lancet appropriate for patient size
C. Alcohol swab
D. Chlorhexidine skin prep (NICU)
E. Sterile saline wipe (NICU)
F. 2 x 2 gauze
G. Capillary tube/s, fleas, and caps
H. Microtainers appropriate for specimen being drawn
J. 4 x 4 gauze to wrap capillary tube for transport
K. 60 mL syringe for transport to laboratory (CS#309653)
L. Non-sterile Gloves
M. Patient label (s) and lab requisition
A. Capillary Blood Specimen Collection
1. Verify provider order.
2. Identify patient using two forms of identification according to UWHC Clinical
Laboratory Policy, 1502.5.06 Acceptance Policy for Specimen Identification.
3. Select appropriate site. For newborns or infants who haven't begun to walk,
heel is the best choice. Rotate puncture sites each time a new specimen is
drawn. Avoid swollen, bruised or edematous sites.
a. Heel: Infant heel site should be on the plantar surface medial to a line
drawn posteriorly from the mid-great toe to the heel, or lateral to a line
drawn posteriorly from between the fourth and fifth toes to the heel.
b. Toe: plantar surface of big toe.
c. Finger: palmar surface of distal phalanx of finger.
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4. For infants, warm site for at least 5 minutes with infant heel warmer. Warming
increases blood flow to area to ensure a high quality specimen.
5. Perform hand hygiene according to UWHC Hospital Administrative Policy
13.08, Hand Hygiene.
6. Follow standard and transmission based precautions according to UWHC
Hospital Administrative Policy 13.07, Standard Precautions & Transmission-
based Precautions (Isolation).
7. Assemble equipment.
a. Loosely mount a capillary cap on one end of the capillary tube.
b. Insert a flea into the capillary tube, allowing it to slide to the same end
as the loosely mounted capillary cap.
8. Cleanse site:
a. For infants, use alcohol swab and then dry with gauze. Site must be
completely dried as alcohol could cause rapid hemolysis.
b. For NICU infants, cleanse with chlorhexidine skin prep and then wipe
with sterile saline.
9. Puncture site with appropriate size lancet. Puncture should penetrate the major
skin vasculature and not risk puncture of the bone. Puncture depth for infants
and newborns varies from 0.65-1.0 mm, depending on lancet used.
10. Wipe away the first drop of blood as the first drop may be diluted with tissue
11. Hold puncture site downward and apply gentle continuous pressure to
surrounding tissue. CAUTION: Application of strong repetitive pressure will
cause hemolysis, contamination with tissue fluid, or falsely lower pH and gases
12. Fill the capillary tube with blood from the middle of the blood drop to prevent
air from getting into the capillary tube. The tube must be full and free of air
13. Tighten the capillary cap, and then lightly mount a capillary cap on the other
end of the capillary tube.
14. Move the mixing flea 20 times along the full length of the capillary tube using
the magnet to mix the blood and the anticoagulant together.
15. Obtain a second capillary tube in the same manner (not required for premature
16. When the collection is completed, apply pressure to puncture site using a 2 x 2
gauze until bleeding stops. For prolonged bleeding, contact provider.
17. Do NOT apply adhesive bandage to puncture site.
18. Discard lancet into sharps container.
19. Wrap 4x4 gauze around one end of capillary tube(s) and gently slide wrapped
capillary tube/s into the barrel of a 60 mL syringe. Place the patient label on
the barrel of the syringe. Label the specimen with the ID badge number of the
collector and the date and time of collection if not correct on the label. Please
include ID badge number of the collector on the request form.
20. Place syringe container in a plastic bag and a red zip-n-fold bag in a pneumatic
tube carrier. Send immediately via pneumatic tube system to Core Laboratory
with the lab requisition form. Specimens need to be received within 30 minutes
B. Drawing Labs into Microtainers
1. Follow steps 1-11 as described above.
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a. Touch only drops of blood, not the site.
NOTE: Hold microtainer below drop of blood and let blood drip into
microtainer. Alternately, use microtainer specific straw to fill tube via
capillary action by touching the straw to the drop. Cap with
b. Gently tap tube to mix blood with anticoagulant as the microtainer is
filled. After container is filled, roll the container to completely mix
blood with additive. NOTE: Specimen collection that takes more than
2 minutes will frequently result in poor quality specimens and higher
incidence of micro clotting in additive tubes.
2. Apply pressure to puncture site using 2 x 2 gauze until bleeding stops. For
prolonged bleeding, contact provider.
3. Do NOT apply adhesive bandage to puncture site.
4. Discard lancet into sharps container.
5. Label tube(s) according to Clinical Laboratory Policy, 1502.5.06 Acceptance
Policy for Specimen Identification.
V. UWHC CROSS REFERENCES
A. Clinical Laboratory Policy, 1502.5.06 Acceptance Policy for Specimen
B. Hospital Administrative Policy 13.07, Standard Precautions & Transmission-
based Precautions (Isolation)
C. Hospital Administrative Policy 13.08, Hand Hygiene
D. Lab Test Directory
A. Clinical and Laboratory Standards Institute (CLSI) (2008). Procedures and
Devices for the collection of Diagnostic Capillary Blood Specimens; Approved
Standard - Fifth Edition. Document H4-A7, Vol. 24, No. 21.
B. Grover, M. (2007). Skin puncture for collection of blood samples: Fingerstick and
heelstick. In Verger, J. T. & Lebet, R. AACN Procedure Manual for Pediatric
Acute and Critical Care. St. Louis, MO: Saunders Elsevier.
C. Radiometer Medical (2004). Radiometer Package Insert Instructions.
D. Verklan, M. T., & Walden, M. (Eds.) (2009). Core Curriculum for Neonatal
Intensive Care Nursing (4th Ed.). St. Louis, MO: Saunders Elsevier.
VII. REVIEWED BY
Director Lab Services, Clinical Laboratories
Clinical Nurse Specialist, General Pediatrics
Clinical Nurse Specialist, Universal Care Unit
Nursing Patient Care Policy and Procedure Committee, January 2015
Beth Houlahan, MSN, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer