Skin Puncture
Document #2/version #03
Effective Date: 10/1/12
SKIN PUNCTURE SPECIMEN COLLECTION
Principle
When the test calls for a few drops of blood, the blood is obtained from a
skin puncture/incision. Obtaining a quality specimen for testing starts
with proper collection.
Scope
All employees performing phlebotomy as part of their assigned duties
must adhere to this procedure. All human blood specimens are to be
treated as infectious and handled according to “standard precautions” for
Centers for Disease and Control Prevention (CDC) and Columbus County
Health Department’s Exposure Control Plan. Employees will display
appropriate name badge to patients when presenting to the laboratory for
blood specimen collection.
Facilities
The venipuncture should be performed in a clean, well-lit, quiet, and
private environment, preferably in the phlebotomy draw station of the
PCHD laboratory. The room should have facilities to allow the collector to
wash his/her hands between patients. In settings where water is not
available, alcohol-based gels or liquids, and cleansing foams can be used.
Venipuncture chairs should be used when possible, for the maximum
comfort and safety of the patient. A means to readily communicate the
need for emergency assistance should be available. (Staff will orally
summon others if assistance is needed). At least one member of
healthcare personnel onsite should have extensive first aid training,
including cardiopulmonary resuscitation (CPR), so that medical attention
can be given to a patient in distress while medical help is en route.
Specimen
Specimens are obtained from the palmar surface of the middle and ring
fingers, not the sides. Only lab staff collect skin puncture specimens.
Only small amounts of blood can be obtained. Repeated examinations
require new specimen.
Materials
Equipment
 NA
Reagents

NA







Columbus County Health Department Laboratory, Whiteville, NC 28472
Supplies
Skin puncture
lancets
Needle Holders
Sharps Container
Specimen
collection
containers
Alcohol pads
gauze
Band aids
1
Skin Puncture
Document #2/version #03
Effective Date: 10/1/12
 PPE
ProcedurePre-specimen
Collection
Step
1
2
3
4
Collecting
The
Specimen
Step
1
2
3
Action
Blood specimen request and patient labels must be received
by lab and accessed in order to identify all paperwork and
supplies associated with each individual patient’s requested
analyses. The patient’s name and date of birth is used for
this identification.
Select correct type of microcuvettes or collection
containers. Ensure that the appropriate test forms are
labeled with the patient’s encounter label.
Identification of the patient is crucial. One must ensure
that the blood specimen is being drawn from the individual
designated on the request form. Ask the patient to state
his/her full name and date of birth. If patient is unable due
to age or other condition such as unconsciousness, mentally
incompetent or does not speak the language, have the
accompanying relative, friend, and or nurse to identify the
patient by name, identification number and/or date of birth.
Compare this information with the information on the
request form. If patients have same first and last names,
identification will be made by patient’s date of birth, social
security number and/or patient number. Resolve any
discrepancies before performing collecting any specimen.
One must gain the patient’s confidence, giving assurance
that, thought the skin puncture/incision will be a little
painful, and it will be of short duration.
Action
Ask the patient to be seated in the chair. Children will
need to sit in their parent’s or guardian’s lap.
Assemble named supplies.
Verify paperwork, collection container, and patient
identification information.
Columbus County Health Department Laboratory, Whiteville, NC 28472
2
Skin Puncture
Document #2/version #03
Effective Date: 10/1/12
4
5
6
7
8
a. Compare name on collection container with name on
test request form. If two do not match, check further to
determine which one is incorrect and make the
necessary correction.
b. Check the collection containers to make sure that the
appropriate kinds have been selected.
Prepare the skin site prior to puncture. Fingersticks (> 12
months of age) are on the fleshy pad of the middle and/or
ring finger, not the sides. Make incision perpendicular to
finger prints to prevent channeling of blood.
Clean the site with 70% isopropyl alcohol (wipe). Be sure
the site is thoroughly dried before using. Alcohol residue
causes rapid hemolysis.
Puncture or incision of the selected site.
a. Firmly grasp the retractable device.
b. Place the device against the site so that the skin
protrudes into the opening of the device.
c. Press down the activating button allowing an
instantaneous puncture/incision of the skin and blade
retraction.
d. Discard device into a sharps container.
e. Wait a few seconds to allow blood flow to begin.
f. Wipe away the initial drop of blood.
g. Collect the required amount of blood. If an adequate
puncture/incision is performed 0.5-1.0 ml of blood can
be collected from a single site. Blood flow is enhanced
if the site is held downward and gentle continuous
pressure is applied to the surrounding tissue. Avoid
strong, repetitious pressure (milking) which can cause
hemolysis or contamination of specimen with tissue
fluid.
Once blood collection is complete, apply pressure to stop
the bleeding and then apply bandage.
Remove and discard gloves: WASH HANDS.
Adverse
Patient Reactions
Issue
Needle Phobia
Action
To prevent the shock reflex in needle phobic patients,
have the patient lie flat with the legs raised.
Fainting/
Notify first-aid personnel.
Unresponsiveness If the patient faints while in a sitting position, lower
the patient’s head below the plane of the heart.
Where practical, lay the patient flat.
Loosen tight clothing.
A cold compress may be applied to the forehead or
Columbus County Health Department Laboratory, Whiteville, NC 28472
3
Skin Puncture
Document #2/version #03
Effective Date: 10/1/12
back of the neck.
Do not administer ammonia inhalants to patients who
lose consciousness, since this may trigger an
asthmatic attack in some individuals.
Nausea
Make the patient as comfortable as possible.
Instruct the patient to breathe deeply and slowly.
A cold compress may be applied to the patient’s
forehead.
Have an emesis basin handy.
Notify first-aid personnel.
Vomiting
Give the patient and emesis basin or carton, and have
tissues ready.
Give the patient water to rinse out his/her mouth.
Notify first-aid personnel.
Convulsions
Prevent the patient from injuring himself/herself. Do
not restrain the movements of the patient’s extremities
completely, but try to prevent him/her from being
injured.
Notify first-aid personnel.
If a patient experiences an adverse reaction during the venipuncture,
it is imperative that blood collection personnel have the presence of
mind to terminate the procedure before providing assistance to the
patient. Any delay in this step could result in an accidental exposure
to the employee.
Procedural
Notes






Incident
Reports
Gloves can be applied just prior to site preparation.
Punctures / incisions should not be performed on the same side of a
mastectomy.
If repeated incisions are necessary, it is best to do a puncture.
Scalpels and wire lancets are not acceptable for use per OSHA
guidelines.
Capillary order of draw:
o EDTA
o other additive tubes
o non-additive tube
Patient Problems: DO NOT leave patient alone; call for help if
needed.
Incident reports should be reported to Dwayne Sholar, Laboratory
Supervisor and documented on the Lab’s Problem Log.
Columbus County Health Department Laboratory, Whiteville, NC 28472
4
Skin Puncture
Document #2/version #03
Employee
Exposure
References
Related Documents
Effective Date: 10/1/12
Employees must immediately report an accidental needlestick or
contamination of a break in the skin to Dwayne Sholar, Laboratory
Supervisor and follow agency protocol.


Ernst, Dennis J., Szamosi, Diane I., Specimen-Collection standards
complete major revisions; MLO, Feb. 2005; Vol 37 No. 2.
Ernst, D. Applied Phlebotomy. Philadelphia, PA. Lippincott,
Williams & Wilkins, 2005.

Policy #2, Specimen Rejection Policy.
Author
Karen H. Wall, BSMT (ASCP), Technical Consultant
Approval
Signature
_____________________________
Name
Columbus County Health Department Laboratory, Whiteville, NC 28472
_____________
Date
5