SKIN PUNCTURE

M A R V I N R A E C . L A S A P, R M T, M T ( A S C P I ) , M S C .
S CHO O L O F MEDICAL T ECHN O LO GY
E A C - C AV I T E
Dermal Puncture
•Dermal puncture is an alternative collection
procedure when small amounts of blood are
needed, or when venipuncture is inadvisable or
impossible.
•It is the usual collection procedure for infants and
children under 2 yrs. of age.
•It is also used for bleeding times, ancillary blood
glucose testing, and obese patients.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

Dermal Puncture
• It is used for geriatric patients, those at risk for
venous thrombosis, and those with burns or scars
over venipuncture sites.
• It is also used for patients with only one test
ordered, those receiving IV therapy, frequent blood
tests, and those who might be at risk for injury from
restraints that might be needed for a venipuncture.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

Dermal Puncture
•Dermal punctures cannot be done for blood cultures,
sedimentation rates and coagulation tests.
•It should not be done on dehydrated patients or those
in shock, or on sites that are swollen or where
circulation is compromised such as in a mastectomy.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

Venous vs. Capillary Blood
• Capillary blood is a mixture of arterial blood,
venous blood, and tissue fluid. It is more arterial
when warmed.
• Hemoglobin and glucose values are higher in
capillary blood.
• Potassium, calcium, and total protein values are
higher in venous blood.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5

 Skin Puncture Devices
• Skin puncture devices come in
different types and sizes to
meet different needs.
• To meet safety regulations,
devices now have retractable
blades that lock to prevent
being used a second time.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

Microsample Containers
Containers come in microcollection tubes,
capillary tubes, and micropipets.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

Dermal Puncture
•Warming devices will increase capillary circulation
and blood flow.
• Wash cloths or commercial heel warmers can be
used.
•Temperature should not exceed 42o C and should
be applied for 3 to 5 minutes.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Dermal Puncture Width and Depth
•Depth should not exceed 2.0 mm in infant heels;
0.65 to 0.85 mm in premature infants.
•Care should be taken to not puncture the calcaneus
(heel) bone.
•A wider puncture cut will increase blood flow, but
puncture width should not exceed 2.4 mm.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9

 Dermal Puncture Sites in Adults &
Older Children
•Punctures should be done on
the palmar surface of the distal
segments of the middle or ring
finger of the nondominant hand.
•Punctures with blades should be
made perpendicular to the
ridges in the fingers to keep the
blood from flowing into the
grooves.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Dermal Puncture in Infants
For infants under one year old
and not walking, use the medial
or lateral portion on the plantar
(bottom) surface of the heel.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Dermal Puncture Procedure
•Follow standard precautions making sure to wash
hands and put on gloves.
•Always greet patient and parents, if present, obtain
consent, and identify patient as you would for a
venipuncture.
•On inpatient infants, the armband may be on the
ankle.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Dermal Puncture Procedure
1. Document on the requisition that you are
performing a dermal puncture.
2. Assemble your equipment.
Use the patient age, size and tests ordered to
determine puncture device needed.
3. Select and clean the site, warming first, then
cleaning with 70% isopropyl alcohol.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

Dermal Puncture Procedure

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

Dermal Puncture Procedure
4. Hold the finger firmly to
prevent moving during the
puncture.
5. Make the puncture. Count
to two before lifting the
blade to make sure that
the blade has made a
complete puncture and
retracted. Dispose of
lancet in sharps container.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

Dermal Puncture Procedure
6. Prepare to collect the sample.
- Wipe away the first drop with a clean gauze to
prevent tissue fluid contamination of the
specimen.
- Keep the finger in a downward motion
applying a “squeeze and release”
pressure to the finger.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16

Dermal Puncture Procedure
7. Collect the sample.
- Touch the scoop of the tube to the drop,
allowing it to run into the tube. Make sure to
mix the number of times required by the
manufacturer.
- Hold capillary tubes horizontally without
touching the skin so as to prevent tissue fluid
contamination.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Dermal Puncture Procedure

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Dermal Puncture Procedure
- Order of collect for dermal puncture:
* Slides first to minimize the effects of
platelet clumping.
* Lavender tubes for CBCs.
* Other tubes with anticoagulants.
* Serum tubes last.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

Dermal Puncture Procedure
8. Complete the procedure.
- Apply a bandage after bleeding has stopped. Do
not bandage children under 2 years of age since they
could remove and choke on the bandage.
- Make sure that equipment has been picked up
and bed rails are up.
- Label specimen, remove gloves and wash hands.
- Thank the patient.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20