Pediatrics – Capillary Blood SamplesSECTION: 20.01

Strength of Evidence Level: 3__RN__LPN/LVN__HHA

PURPOSE:

To obtain a laboratory specimen of blood from a child's foot or finger.

CONSIDERATIONS:

  1. For an infant less than 6 months old, the appropriate puncture site is the outer aspect of the heel. Identify the appropriate puncture site by drawing an imaginary line from between the fourth and fifth toes that runs parallel to the lateral aspect of the heel.

For an infant older than 6 months old use pad of fingertip of middle finger on non-dominant hand. Heels or fingers utilized should be rotated.

  1. If appropriate, allow the child to make some decisions and look at some of the equipment (self-adhesive bandages etc.); or try a demonstration on a toy or stuffed animal first.
  2. Laboratory should be consulted on guidelines for volume of blood required, type of tube needed for collection, and any special handling requirements.
  3. A slight bruise may appear at the puncture site but is not considered a complication.

EQUIPMENT:

Sterile lancet or automatic lancet devise

Pedi “bullet” lab tubes

Alcohol sponge

Gauze

Self-adhesive bandages

Gloves

Trash bags

Puncture-proof container

PROCEDURE:

1.Adhere to Standard Precautions.

2. Label and date the specimen tube.

3.Identify the patient and explain procedure to caregiver and patient, if age appropriate. Have caregiver hold child to keep him/her still.

4.Choose appropriate site, outer aspect of the heel or finger pad. Dilate the vessel using warm compresses for a three minutes and squeeze to engorge with blood.

5.Cleanse puncture site with alcohol using circular motion.

6.Grasp lancet or automatic lancet devise with thumb and forefinger of dominant hand; stabilize and apply pressure to puncture site with other hand. With a quick, firm motion, penetrate site with lancet at 90 degree angle and withdraw immediately, or use automatic device per manufacturer’s instructions. Puncture deep enough to get free flowing blood, but never deeper than 2.00 mm.

7.Place tip of capillary tube scoop on lab tube to puncture site. Collect blood drops without scraping, which breaks down red blood cells.

8.If bilirubin level is being drawn, protect specimen from light.

9.If bleeding stops before all tubes are filled, try lowering extremity.If needed prepare site to repeat puncture.

10.When finished, press gauze over site until bleeding stops. Apply self-adhesive bandage.

11.Send or deliver labeled specimen and laboratory requisition to the laboratory.

12.Discard soiled supplies in appropriate containers.

AFTER CARE:

1.Document in patient's record:

a.Patient's response to procedure.

b.Complications and management.

  1. Time drawn, amount of blood drawn, type of test being ordered by physician, and name of laboratory and location of drop-off of specimen.

2.Instruct caregiver on signs and symptoms reported to nurse or physician.