Tarangnan Community HospitalClinical Laboratory
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Document No.: WI-P-003-A-V0 | CONTROLLED COPY Do not copy or remove |
| Parent Document: SOP-P-003, Sections 5.2–5.6 | Version: V0 | ||
| Applies to: Medical Technologists, Phlebotomists, and Pediatric / Ward Nursing Personnel | Effective Date: MM-DD-YYYY | Supersedes: None | ||
Capillary Finger-Stick & Neonatal Heel-Stick Safe Puncture Card
Phlebotomy Section & Pediatric Care Units | Safe Anatomical Landmarks, Depth Limits & Microtainer Order of Draw
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1
Verify Patient & Warm Site If Poorly Perfused Confirm 2 identifiers (full name, MRN). Secure child immobilization with assistant or parent. If extremity is cold, apply a warm compress (≤ 42 °C) for 3–5 minutes to increase arterial blood flow up to 7-fold. SOP-P-003, Section 5.4.1–5.4.33–5 min
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2
Sanitize Skin & Air-Dry Completely (NO Povidone-Iodine) Cleanse site with 70% isopropyl alcohol using gentle friction. Allow to air-dry completely for 30 seconds. Never use povidone-iodine (causes artifactual elevation of potassium, phosphorus, and uric acid). SOP-P-003, Section 5.4.430 sec
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3
Locate Safe Puncture Landmark & Align Lancet Infants (< 1 yr): Medial or lateral plantar borders of heel only. Children ≥ 1 yr / Adults: Palmar surface of distal 3rd (middle) or 4th (ring) finger pad, oriented perpendicular to fingerprint whorls. SOP-P-003, Section 5.3.1, 5.3.2
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4
Trigger Retractable Safety Device & Discard Immediately Hold site firmly. Press automated retractable lancet flush against skin; trigger incision. Immediately discard used device into point-of-use sharps container. Never reuse or use manual surgical blades. SOP-P-003, Section 5.5.1
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5
Wipe Away the Very First Drop of Blood (MANDATORY) Firmly wipe away the first drop of blood with sterile dry gauze pad. The initial drop contains interstitial fluid, cellular debris, and tissue thromboplastins that alter hematology and chemistry results. SOP-P-003, Section 5.5.2WIPE DROP
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6
Collect Blood in Capillary Order of Draw (NO Milking or Squeezing) Allow large rounded drops to form. Touch microtainer scoop to drop; flow blood down wall. Apply gentle intermittent pressure only. Never milk or squeeze tissue (causes hemolysis and hemodilution). Max 2 attempts. SOP-P-003, Section 5.5.3, 5.5.4
Neonatal Heel Safe Zones & Device Depth
Safe Puncture Zones:
• Medial Plantar Border
• Lateral Plantar Border
Strictly Prohibited:
× Posterior heel curvature (bone depth < 2 mm)
× Central plantar arch (nerve/tendon damage)
× Earlobes, 5th finger, or swollen sites
| Patient Category | Device / Site | Max Depth |
|---|---|---|
| Pre-term / Low-Birth-Weight | Heel incision device | 0.85–1.0 mm |
| Full-Term Neonate (< 1 yr) | Automated heel lancet | 1.0–2.0 mm (Max) |
| Child (1 to 8 yrs) | Finger lancet (3rd/4th) | 1.5 mm |
| Adult / Older Child | Finger lancet (3rd/4th) | 1.8–2.0 mm |
Capillary Microtainer Order of Draw
Note: Capillary draw order differs from venous draw; EDTA is collected first to prevent platelet clotting.
| Order | Cap Color | Additive & Tests | Inversions |
|---|---|---|---|
| 1st | Lavender | K2 / K3 EDTA: CBC, Hemoglobin, Smear, Platelets |
10× Immediate |
| 2nd | Green | Lithium Heparin: Clinical Chemistry, Electrolytes |
8–10× Gentle mix |
| 3rd | Red / Gold | Serum Plain / Gel: Serology, Dengue, Chemistry |
5× Clot 20 min |
Post-Collection Hemostasis & Safety: Apply dry gauze for 1–2 minutes until sealed. Do NOT apply adhesive bandages on infants < 2 years (aspiration/choking and skin tear hazard).
| Prepared by: Chief Medical Technologist Signature: _______________________ Date: ________ |
Reviewed by: Pathologist Signature: _______________________ Date: ________ |
Approved by: Hospital Director Signature: _______________________ Date: ________ |