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Importance of capillary blood sampling

Capillary blood sampling and its relevance to obtain correct hemoglobin measurements

Capillary blood sampling (fingerstick) is being increasingly used around the world due to the increasing availability of portable hemoglobin analyzers at the point of patient care.

Considering that 25% of the world population is affected by anemia, with a much higher prevalence in developing countries, hemoglobin analysis is the most frequently performed test in hematology. This test is also used routinely by blood collection services (blood banks) to ensure safe donation. At the same time, hemoglobin (Hb) values ​​are among the most likely to be affected by pre-analytical errors, so to avoid generating misleading hemoglobin results, health personnel who draw blood must adhere to blood collection techniques. Strict and standardized blood tests to ensure accurate and consistent results that are comparable to laboratory techniques.

Why is it important to have good capillary blood collection procedures for hemoglobin testing?

• The use of capillary sampling is increasing worldwide as the use of diagnostic tests develops at the point of patient care
• Hemoglobin is the most frequently performed test in point-of-care hematology
• Hemoglobin results are prone to being affected by pre-test errors

Taking capillary blood sample performed incorrectly is the most common reason leading to inaccurate results hemoglobin at the point of patient care

• Understand the common causes of pre-analytical errors
• The variability in reported hemoglobin values ​​can be caused by a series of physiological factors such as dehydration, smoking habits or altitude, and can be significantly affected by pre-analytical errors arising due to an incorrect capillary blood collection technique. Here are some of the most common sources of error that healthcare personnel should be aware of.
• Correct lancet option : The lancet must be of minimum dimensions so that when performing a puncture it guarantees an adequate blood flow. For adults, a depth of 1.85 to 2.25 mm is recommended. The thickness of the lancets should be 21G , which guarantees a blood volume range of 75 - 125 microliters
• Correct selection of the puncture site : The middle or ring finger should be used, ideally from the non-dominant hand, as they are generally less callused and less sensitive to pain compared to the index finger or thumb. The thumb should also be avoided due to its pulse (arterial presence). In the little finger, the distance between the surface of the skin and the bone is too small. The puncture should be done slightly off-center from the central fleshy part of the fingertip, near the side where the skin is thinner with fewer nerve endings and less pain sensation, but not on one side of the finger. Selecting the correct finger and puncture site will ensure consistent good blood flow and minimize pain for the patient.
• Cleaning, disinfection and drying : Cleaning and disinfection of the puncture site is essential to remove any potential contamination that could affect the test or put patient safety at risk. The puncture site should also be thoroughly dried, after cleaning, to remove any residual alcohol solution that will dilute the blood sample and cause false low readings.
• Applying too much pressure around the puncture site : The finger can be gently massaged before and after puncture to stimulate blood circulation, but not past the first knuckle. Maintaining light pressure when drilling ensures effective penetration. However, the finger should not be pressed too hard as this will push fluid from the tissue into the blood and cause false low readings.

The importance of time and blood flow
Another key factor influencing hemoglobin measurement is capillary flow. Typically for hemoglobin, the first 1-3 drops after puncture show a greater degree of variability in hemoglobin concentration, regardless of the analytical device used for the test. It is for this reason that these first drops of blood must be discarded.

Generally, the highest precision is achieved from the fourth drop after puncture, when good capillary flow is achieved over a period of 30-45 seconds. Blood draws obtained after this time may result in inaccurate hemoglobin results.

The most important factor to reduce pre-analytical errors is the presence of a free spontaneous blood flow, especially since neither the size of the drop nor the moment of taking after the puncture are well defined and the manufacturer's recommendations on this subject vary.

A step-by-step guide to capillary blood sampling best practice
The following steps demonstrate how to collect an appropriate capillary blood sample to ensure accurate hemoglobin measurements at the point of patient care. :

• Wash your hands well and put on tight-fitting gloves (they do not need to be sterile). Make sure that all items for capillary blood sampling and testing are available and within easy reach.
• Select the middle or ring finger, ideally the non-dominant hand. The patient should not wear a finger ring as it can obstruct blood circulation.
• Ensure that the patient's hand is warm and relaxed and that the patient is comfortably seated. Puncture should be done slightly off-center from the fleshy portion, near the side of the fingertip.
• Disinfect and completely dry the puncture site. Alcohol can dilute the sample. Dry well before taking.
• Gently massage finger towards tip to increase blood flow. Avoid passing the first knuckle.
• Make the incision on the fingertip side, palm up, to facilitate filling of the hemoglobin cuvette. Apply only light pressure towards the fingertip until a drop of blood appears. It may take a few seconds after the puncture for blood flow to begin.
• Wipe off the first 2-3 drops and make sure there is a free flow of blood before filling the cuvette. Stop holding your finger when wiping a drop.
• Make sure you have a drop of blood large enough to fill the cuvette. Fill the bucket completely in one go. Avoid air bubbles. Always refer to the instructions for use provided by the manufacturer of the hemoglobin analyzer.

Venipuncture

It is the collection of blood from a vein. In most cases, it is done for laboratory tests.

How the test is performed
Most of the time, the blood is drawn from a vein located on the inside of the elbow or the back of the hand.

• The site is cleaned with a disinfectant (antiseptic).
• An elastic band is placed around the upper arm to apply pressure to the area. This causes the vein to fill with blood.
• A needle is inserted into the vein.
• The blood is collected in an airtight vial or in a tube attached to the needle.
• The elastic band is removed from the arm.
• The needle is removed and the site is covered with a bandage to stop the bleeding.

In infants or young children, a pointed instrument called a lancet may be used to puncture the skin and cause it to bleed. Blood is collected on a slide or test strip. A bandage may be placed over the area if there is any bleeding.

Preparation for the exam
The steps you need to take before the test depend on the type of blood test you are having. Many tests do not require special measures.

In some cases, your healthcare provider will tell you if you need to stop taking some medications before doing this test or if you need to go fasting. Don't stop or change your medications without talking to your provider first.

How the test will feel
You may feel slight pain or sting when the needle is inserted. You may also experience some throbbing at the site after the blood is drawn.

Reasons the test is done
Blood is made up of two parts:

• Liquid (plasma or serum)
• Cells

Plasma is the liquid part of the blood in the bloodstream that contains substances such as glucose, electrolytes, proteins, and water. Serum is the liquid part that remains after blood is allowed to clot in a test tube.

Blood cells include red blood cells, white blood cells, and platelets .

• Blood helps move oxygen, nutrients, waste, and other materials through the body. It also helps control body temperature, fluid balance and acid-base balance of the body.

Tests done on your blood or parts of it can provide important clues about your health to your provider.

Normal results
Normal results vary according to the specific type of exam.

Meaning of abnormal results
Abnormal results also vary according to the specific test.

Alternative names
Blood collection; Phlebotomy