Procedural Step | Comment | Caution |
| Greet and positively identify patient | Always use at least two patient identifiers to ensure positive patient identification. | Never rely on name placards placed on or near the patient's bed or crib to identify the patient. If there is a discrepancy in identification, do not proceed until the discrepancy is resolved. |
| Explain the procedure | If the patient is a small child, be at eye level when explaining the procedure. Also, explain the procedure to the parent(s). | If the patient is aware of what will be happening, there is less chance of the patient suddenly jerking away their hand when the puncture occurs. |
| Position patient appropriately | An outpatient who is a small child should sit on the parent's lap. | If necessary, seek assistance for a finger puncture if the patient is a small child. |
| Cleanse hands and put on gloves | Use soap and water or alcohol-based gel to cleanse hands. | Cleanse hands before donning gloves and after removing gloves. |
| Warm puncture site, if needed | Use the method approved by the laboratory for prewarming the puncture site. | Never use a cloth that has been heated in a microwave, as this may cause injury to the patient. |
Gather appropriate equipment | Only have needed equipment at hand. | Keep track of ALL equipment to prevent patient injury. |
| Cleanse the puncture site | Use 70% isopropanol unless the patient is sensitive to alcohol. | Allow the site to air dry. Performing the puncture before the alcohol has dried may hemolyze the blood specimen and cause a stinging sensation for the patient. Also, alcohol can contaminate the sample and prevent formation of a rounded blood drop because blood will mix with the alcohol and run down the finger. |
| Securely grasp and puncture finger | Puncture the side edge of the fleshy pad of fingertip. | Avoid extreme side and tip of finger. |
| Discard puncture device into appropriate container | Puncture device should be discarded into a sharps container that is puncture-proof, has rigid sides, and has a lid. | Do not discard puncture devices into regular trash or biohazard bags; injury to personnel who handle these bags may occur. |
| Wipe away the first drop of blood | Use slight pressure to facilitate blood flow. | The first drop of blood contains tissue fluid that may contaminate or dilute the blood specimen and affect test results. |
| Collect blood into a container | Allow blood to flow freely into the collection device. Tap the container gently on a hard surface to move blood further down into the tube if necessary. | Do not "milk" the finger or scrape the collection device across the finger to obtain specimen; both actions may cause the specimen to hemolyze and may also contaminate the specimen with tissue fluid. Mix specimen immediately upon completion of the collection. |
| Apply pressure to the puncture site to stop the bleeding. | Use gauze to apply pressure to the puncture site. | It is not advisable to apply an adhesive bandage over the skin puncture site if the child is less than two years old, as the child may place the bandage in their mouth. The adhesive may also cause irritation to sensitive skin, particularly the fragile skin of a newborn or older adult patient. |
| Label specimen | Specimen must be labeled in the presence of the patient. | Unlabeled specimens will be rejected by the laboratory. |
