Fingerstick Skin Puncture Procedure

Principle

Skin punctures are particularly useful for both adults and pediatric patients when small amounts of blood can be obtained and adequately tested. Skin puncture is performed on adults when there are no accessible veins, to save veins for other procedures (i.e. chemotherapy), on obese patients, on burn patients, and those with fragile veins (i.e. geriatric patients). Skin puncture is the preferred method of collection for infants and children. In infants less than one year of age, the heel is the site of choice. Sometimes skin puncture cannot be used for tests requiring large amounts of blood or tests where results would be affected by the method itself. These may include most erythrocyte sedimentation rates, coagulation studies, blood cultures, and ammonia levels. When tests require more than a total of three microtainers, a venipuncture should be considered.

Equipment
  1. Gloves: non-latex or powder-free latex only
  2. Tourniquet
  3. Warming device (where appropriate)
  4. 70% isopropyl alcohol wipes
  5. Automated skin puncture device or sterile lancet
  6. Microcollection tubes
  7. Gauze squares
  8. Band aids, tape or coband where appropriate
  9. Sharps disposal unit
Procedure
  1. Review test requisitions
    1. Verify time and date of collection
    2. Check for any special draw requirements or patient restrictions
  2. Introduce self
  3. Identify patient
    1. Ask patient to state his or her name
      1. If patient is a child the parent or guardian may identify
      2. If patient is unable to identify self, proceed to next step
    2. Verify that the patient’s medical record on his/her armband matches the medical record number on the test requisition-if armband is missing and patient cannot verbally state name, do not proceed with fingerstick until proper identification is supplied by the appropriate hospital personnel.
  4. Assemble equipment and supplies
  5. Wash hands and put on gloves
  6. Choose a finger that is not cold, cyanotic or swollen.
    1. Puncture site should be in the palmer surface of the distal (end) of the middle or ring finger of the non-dominant hand
    2. Puncture should be made in the fleshy portion of the finger slightly to the side of center and perpendicular to the whorls of the fingerprint
  7. Gently massage the selected finger 5-6 times from the base to the tip to stimulate blood flow (a warming device may be considered if appropriate)
  8. With the alcohol wipe cleanse ball of finger to allow to air dry
  9. Using your thumb and index finger, grasp the patient’s selected finger and using appropriate skin puncture device, puncture skin
  10. Apply firm pressure towards the site and wipe away the first drop of blood that forms with a clean dry gauze square (this first drop of blood is likely to be contaminated with alcohol residue or tissue fluid)
  11. Position site downward and continue to apply moderate pressure proximal to the site avoid squeezing which may cause hemolysis and/or tissue fluid contamination
  12. Proceed to collect blood using appropriate tubes
    1. Collect lavender tubes first followed by other anticoagulated tubes, and finally non-additive tubes last
    2. Touch scoop of microtubes to the drop of blood letting drop run down the side of the tube rather than scraping the skin with the scoop, which will activate platelets and may cause hemolysis.
    3. If the puncture bleeds slowly, agitate additive tubes frequently to hasten contact with the anticoagulant.
    4. If the puncture bleeds slowly, wipe the site with a dry gauze and continue
  13. Cap tubes as filled and thoroughly mix additive tubes by inversion at least ten times
  14. When collection is complete, apply pressure to the site with a clean dry gauze square until bleeding stops
  15. Apply appropriate post phlebotomy care
    1. Do not place band aids on children under the age of five years because they tend to put fingers in mouth and may choke on the band aid
    2. If parent or guardian of child requests a band aid, give it to them and allow them to apply it
  16. Label tubes and dispose of biohazard materials taking care to place the micro collection device in the sharps disposal unit
  17. Remove gloves and wash hands
  18. Thank patient (or parent/guardian where appropriate) and ask if you can provide further assistance
  19. Transport tubes
References

McCall, R.E. & Tankersley, C.M., Phlebotomy Essentials, Second Edition, Lippincott-Williams and Wilkins

Garza, D. & Becan-McBride, K., Phlebotomy Handbook: Blood Collection Essentials, Fifth Edition, and Appleton & Lange

 

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