-Young child: placed on the lap of parent or
PMLS LAB COVERAGE guardian.
- Infant heel puncture: supine
ACTIVITY 7: CAPILLARY BLOOD COLLECTION 6. Select the puncture or incision site.
(SKIN PUNCTURE) FOLLOWING THE PROPER - General criteria
ORDER OF DRAW
• Skin is pink, normal in color, and warm.
Introduction • No scars, cuts, bruises, rashes, cyanosis,
edema or infection
There are instances when capillary blood specimen is
Adult & older children
collected. In little children whose veins are too small for
venipuncture collection and in some adults whose veins • Palmar surface of the distal, end segment of
are collapsed and difficult to locate, capillary puncture is the middle finger or ring finger of the non-
oftentimes done to obtain specimens for laboratory testing dominant hand
that requires a small amount of blood. There are tests, • Center or the fleshy portion of the finger
however, which do not warrant capillary blood collection
-Infants
such as coagulation studies, erythrocyte sedimentation
rate, blood cultures, and other tests that require a larger • Medial or Lateral plantar surface or of the
volume of blood. heel. No more than 2.0 mm deep
7. Warm the site, if Applicable.
Objectives • Warming increase blood flow up to sevenfold
• Wrap site for 3 to 5 minutes, with a warm
At the end of this activity, the students should be able to: washcloth or towel
• Recommended for heel sticks
1. describe the proper procedure for selecting the 8. Clean and air-dry the site.
puncture site and collecting capillary specimens • Cleanse site with an antiseptic (70%
from adults, infants, and children; isopropyl alcohol)
2. perform skin or capillary blood collection • Allow to air-dry
following the proper order of draw; and 9. Prepare the equipment.
3. prepare thick and thin blood smears for malarial • Don gloves if not already on
parasite miscroscopy. • Select collection devices & place in easy
reach
Materials • Open packages in front on the patient
10. Puncture the site and discard the lancet.
• Alcohol prep pads - Finger puncture
• Gauze pads or cotton balls
• Adhesive bandages or other bandaging materials • Grasp patient’s finger between non dominant
• Gloves thumb & index finger
• Place the lancet flat against the central fleshy
• Lancet/incision devices
part of the incision site
• Microcollection containers-small plastic tubes,
narrow capillary tubes, microhematocrit tubes, - Heel puncture
and sealants
• Grasp foot gently but firmly with
• Microscope slides nondominant hand
• Warming devices • Encircle heel by wrapping your index finger
• Sharps container around arch, thumb around bottom, & other
• Permanent marker or pen fingers around top of foot
• Place lancet flat against skin on medial or
Procedure lateral plantar surface of heel
11. Wipe away the First Drop Blood
The first four steps in venipuncture should be - first drop is typically contaminated with
followed: excess tissue fluid
12. Fill and mix tubes or containers in the order of draw.
1. Review the test request. • Collect slides, platelet counts, and other
2. Approach, identify, and prepare the patient. hematology specimens first to avoid clumping
3. Verify diet restrictions and latex sensitivity. & clotting
4. Sanitize hands and put on gloves. • Collect other anticoagulant containers next &
5. Position the Patient serum specimens
- Finger puncture: arm supported on firm surface, • Do not forget to collect drops of blood into
hand extended and palm up the collection tube/device.
13. Place gauze and apply pressure. 9. Count the number of blots and divide it by two to get
• Keep the incision site elevated. the bleeding time result in minutes.
14. Label specimen and observe special handling 10. Dispose of all the materials used.
instructions. - Normal Values: 2-4 minutes
15. Check the site and apply bandage.
16. Dispose of used and contaminated materials. ACTIVITY 11: COAGULATION TIME
17. Thank patient, remove gloves, and sanitize hands. DETERMINATION (SLIDE METHOD)
18. Transport specimen to the lab.
Introduction
ACTIVITY 10: BLEEDING TIME
DETERMINATION (DUKE'S METHOD) Clotting time measurement is usually requested with
bleeding time as among the pre-operation or coagulation
Introduction
therapy procedures. This test may also be performed by
trained phlebotomists. It is clotting (coagulation) reaction
Bleeding time measurement may also be performed at the
that completes hemostasis by reinforcing primary
patient's bedside by trained phlebotomists. Measurement
hemostasis induced by blood platelets. The final aim of
of the bleeding time is principally a test of the interaction
clotting reaction is the formation of fibrin which has a
between the platelets and the blood vessels. It is
leading role in secondary hemostasis. Prolonged
prolonged due to either a decrease in platelet count or the
coagulation time is observed in the presence of circulating
presence of a functional platelet disorder.
anticoagulants and deficiency of coagulation factors V,
Objectives VII, VIII, IX, and X.
At the end of this activity, the students should be able to Objectives
perform bleeding time determination, specifically to:
At the end of this activity, the students should be able to
1. make a standard puncture/incision on the patient's perform clotting time measurement, specifically to:
skin to allow free bleeding of blood;
1. puncture the skin to the correct depth; and
2. accurately measure the length (time) of bleeding
2. determine properly the time it takes for the blood
until hemostasis occurs; and
to coagulate.
3. correlate the results.
Materials
Materials
• Gloves
• Gloves
• Disposable blood lancet
• Disposable lancet
• Sterile gauze
• Cotton balls/gauze
• 70% isopropyl alcohol
• 70% isopropyl alcohol
• Stopwatch
• Stopwatch
• Clean glass slide
• Filter paper
• Permanent marker Procedure
Procedure 1. Identify the patient properly.
2. Prepare all the materials needed.
1. Identify the patient properly.
3. Clean the selected area with alcohol and allow it
2. Ask the patient if he/she has taken medications (e.g.,
to air-dry.
aspirin) during the past 2 weeks.
4. Puncture the selected site to a depth of 3 mm.
3. Disinfect the area for skin puncture (note: finger
5. Wipe off the first drop of blood.
puncture).
6. Start the timer once the second drop of blood
4. Puncture to a depth of 3 mm.
appears.
5. Start the timer immediately as soon as the first flow of
7. Place the second drop of blood onto the glass
blood appears.
slide.
6. Blot the flowing blood with filter paper every 30
8. Pass the tip of the lancet through the drop of
seconds. Do not let the filter paper touch the skin and
blood every 30 seconds and check for the
do not press the punctured area.
formation of fibrin strands.
7. Use a new area of the filter paper for every blot so
9. Stop the timer when fibrin strands are seen
that you can monitor the disappearance of blood.
attached to the tip of the needle.
8. Stop the timer as soon as the flow of blood
10. Record and interpret the results.
disappears.
- Normal Values: 2-4 minutes
ACTIVITY 7: CAPILLARY BLOOD COLLECTION
(SKIN PUNCTURE) FOLLOWING THE PROPER
ORDER OF DRAW
1. Enumerate the steps in skin puncture procedure.
2. To what type of patients does a finger puncture of
capillary blood collection apply?
3. To what type of patients does a heel puncture capillary
blood collection apply? Discuss why.
4. Explain why capillary blood specimens cannot be used
in other tests. Give examples of the tests.
5. List the order of draw in capillary blood collection and
explain why it is important.
6. Discuss the procedure in preparing thick and thin blood
smears for malarial parasite microscopy.
ACTIVITY 10: BLEEDING TIME
DETERMINATION (DUKE'S METHOD)
2. Why is there a need to puncture the skin at 3 mm depth
in doing the Duke's bleeding time test?
3. Why is touching the filter paper on the skin avoided
when blotting the flow of blood in doing bleeding time
determination?
ACTIVITY 11: COAGULATION TIME
DETERMINATION (SLIDE METHOD)
Why is it necessary to make a skin puncture to a depth of
3 mm?
