Capillary Blood Sampling Procedure for Accurate Results

Since there is a high potential for lead contamination of specimens during collection, the
Centers for Disease Control and Prevention—the CDC—and others have suggested a special
protocol that would help reduce the likelihood of contamination.

Logical Steps to take that will help Reduce Contamination:

►Scrubbing of the hands and fingers first with soap and water
►Wiping the finger with an alcohol swab that has been treated with two or three drops of a 1%
nitric acid solution
►Wiping off the first drop of blood with a sterile cotton ball before filling the collection container

Materials needed
Collect the materials needed for the test.

This list includes the following:

●Soap
●Alcohol swabs
●1% nitric acid solution
●Sterile cotton balls or gauze pads
●Examination gloves
●Lancets (personal preference but sterile)
●Lead-free Plastic Collection containers (Check the laboratory for their preference)
●Adhesive bandages
●Clearly identified medical waste trash bags and bag for sharps
●Storage or mailing containers (Consult laboratory or, if necessary, the shipper for regulations)
●Laboratory coat and protective glasses

All materials used must be lead free. The laboratory will most likely recommend or supply
collection materials and may also check the equipment for lead contamination prior to use.

Notes:
There are a number of plastic microcontainers between 150 and 250 microliters now available
and used to collect capillary blood from young children. Plastic is preferred over glass
microhematocrit tubes since glass easily breaks and can cause injury to laboratory personnel.

Several types of lancets are suitable for puncturing the child’s finger ranging from small manual
blades to spring-loaded assemblies and disposable self-contained units. These self-contained
units are especially attractive since the blade retracts into the holder after use, reducing the risk
of injury.

A. Preparing for Blood Collection

1. All personnel collecting specimens should be trained and thoroughly familiar with the
collection procedure and the use of universal precautions against the transmission of
blood-borne pathogens.

2. Make certain the equipment is within easy reach and readily available. As expected,
make certain the environment is clean, secure and as nonthreatening to the child as
possible.

3. Check to make certain all the required consents are signed prior to specimen collection.
 4. Explain the procedure to the child and to any attending parent or guardian.

B. Preparing the Finger for Puncture

1. Collection personnel should wear protective gloves since there is a potential for blood
contact. If these gloves are covered with powder, rinse this off using tap water.

2. Wash (or have the parent help to wash) the child’s hands with soap and water, then dry
them with a clean, low-lint towel. Plain, unprinted, non-recycled towels are
recommended.

3. Select a finger that is free of visible infection or wounds.

4. Once washed, keep the finger free from contact with other objects, including other
fingers.

5. Massage the finger to stimulate circulation before puncturing with the lancet.

6. Place two or three drops of 1 percent nitric acid on an alcohol swab, then wipe the finger
with the swab.

Note: Consider using a heel or toe puncture for any infant—those younger than one year of
age.

C. Puncturing the Finger

1. Once the finger is prepared, select a puncture site that is slightly lateral to the ball of the
finger since this region is generally less calloused making the puncture easier and less
painful to the patient.

2. Grasp the finger and quickly puncture it with a sterile lancet. Work quickly and make the
puncture swiftly, cleanly and deep enough to allow for adequate blood flow. A well-
beaded drop of blood should form at the puncture site.

3. Remove the first drop of blood with a sterile gauze or cotton ball---since this contains
tissue fluid and will produce inaccurate results.

4. Quickly fill the container with the capillary blood. Any delay can make the collection more
difficult since the blood may clot or the child may resist.

5. Hints to assist in blood collection:

►Blood flows better when the punctured finger is kept lower than heart level.
►Inadequate blood flow is improved by gently massaging the proximal portion of the
finger (between the puncture site and the hand) in a distal direction (towards the
puncture site), then pressing firmly on the distal joint of the punctured finger restricting
blood flow to the fingertip while gently squeezing at the sides of the fingertip.
►Avoid excessive squeezing since this causes tissue fluid to be expressed,
compromising the specimen.
►Do not use blood that flows down the finger or around the fingernail.
D. Filling the Collection Container
1. Continuing to grasp the finger, touch the tip of the collection container to the beaded
drop of blood.

2. Draw the blood into the container. To facilitate blood flow, many procedures call for the
collection material to be held nearly horizontal with a slight downward angle. Consult
with the laboratory for the manufacturer’s recommendations to assure specimen integrity
and suitability for analysis.

3. When the container is appropriately filled, cap or seal it. The best procedure for filling
and capping the collection container is specific to the container used. As a general rule,
though, avoid any skin contact with the container.

4. Agitate the specimen to mix the anticoagulant with the blood. To prevent clotting of the
specimen, thoroughly mix the specimen with the anticoagulant after filling the container.
That can range from gentle rocking to vigorous shaking, depending on the container and
anticoagulant used. It’s best to check with the laboratory for their specific anticoagulant
mixing requirements.

5. Check that the container is properly labeled and place it in an appropriate storage area.

6. Stop the bleeding and cover the finger with an adhesive bandage. Bleeding should stop
quickly. If the bleeding is slow to stop, apply pressure to the puncture site with a sterile
gauze or cotton ball. If bleeding continues after three to five minutes after applying
pressure, consult a physician.

Note: For those collectors familiar with finger stick blood collection for other tests such
as hematocrit or CBC, there is a tendency to not agitate the sample too strongly so as
not to rupture the red blood cells. For the blood lead tests, however, vigorous agitation is
not an issue because it is more important to prevent clotting than cell rupture.

For other information about LEAD in our environment, please refer to the Allegheny County
Health Department website: http://www.achd.net/lead/index.html