24

SKILL 6

Capillary Blood Draw (Heel and Finger Stick)

NOTE: Use of alcohol for skin preparation may lead to rapid hemolysis. Povidone-iodine interferes with readings of Chemstrip and Dextrostix. 6. Let area dry completely before puncture. Damp area may dilute blood sample or hemolyze it, causing distorted values. 7. Gently massage base of finger or heel, stroking toward selected puncture site. Do not touch the puncture site. Massaging increases blood flow to the area. Excessive squeezing causes bruising, produces a sample that contains more plasma than cells, and can lead to hemolysis, causing falsely elevated potassium levels. 8. Isolate the puncture site using the nondominant hand to hold the hand or foot. Hold the selected site in a dependent position. Increases blood supply to the puncture site. (Figures 9A and 9B) a. Heel: Support dorsum of foot with thumb and ankle with other fingers. b. Toe: Grasp foot across dorsum, support toe with thumb on plantar surface. c. Finger: Keep finger to be used extended and pointed downward.

EQUIPMENT Lancet Cleansing solution Cotton balls or 2 2 sponges, sterile Gloves, nonsterile Adhesive bandage Appropriate sample container Labels Completed laboratory requisition forms GENERAL GUIDELINES FOR SPECIMEN COLLECTION 1. Check physicians order. Ensures appropriate specimen obtained from the correct child. 2. Check child for allergies to any materials used, e.g., povidone-iodine. 3. Prepare child and family. Enhances cooperation/participation; reduces anxiety/fear. NOTE: Have an assistant hold/comfort the child as necessary and in accordance with agency policy. 4. Gather equipment. Promotes organization and efficiency. 5. Wash hands. Don gloves. Reduces transmission of microorganisms. PROCEDURE 1. Steps 15 of General Guidelines. 2. Select site. a. Heel: (Infants younger than 1 year of age): Plantar surface beyond lateral and medial calcaneous. Avoids arteries and veins; reduces risk of scar tissue formation, which may be painful when the infant begins to walk. b. Great toe: (children older than 1 year of age). c. Finger: Side of ball of finger (3rd or 4th finger) across the fingerprint. Avoids damage to nerve endings and calloused areas of the skin. If stick made along lines of fingerprint, blood will run down the finger. 3. Apply moist compress to area for 515 minutes: Facilitates blood supply to the area. 4. Put on nonsterile gloves. Reduces exposure to bloodborne pathogens. 5. Remove compress and wash selected site with soap and water or antiseptic solution as specified by agency policy. Reduces transmission of microorganisms.

FIGURE 9A U-shaped area denotes area to puncture with lancet.

continued
Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

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SKILL 6

Capillary Blood Draw (Heel and Finger Stick)

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13. Wipe site with sterile cotton ball or 2 2 and apply pressure for 23 minutes. Controls bleeding. 14. Apply bandage if appropriate. NOTE: Use bandage with caution in infant and young children. Child may aspirate or swallow the bandage. 15. Discard equipment in appropriate container. Consistent with handling of body fluids. 16. Label specimen, place in appropriate bag or container along with laboratory requisition slips. Ensures specimen is properly identified and appropriate test performed. 17. Remove gloves. Wash hands. Reduces transmission of microorganisms. 18. Send specimens to laboratory. DOCUMENTATION 1. Time, source/site, specimen sent to lab (specify for what test).

FIGURE 9B Position that allows blood to drip. 9. Using the dominant hand, puncture the site at a 90 angle to the skin using a quick, forceful motion. Remove the lancet immediately. Do not use a slashing motion. Provides blood sample with minimal discomfort to the child. 10. Wipe away the first drop of blood using a sterile cotton ball or 2 2. 11. Allow blood to collect at puncture site. 12. Collect specimen allowing blood to flow into the collecting tube. (Figure 10)

2. Record results of any test performed on the unit.

FIGURE 10 Position used when performing needle stick.

Copyright 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.