While these individuals have theoretical and practical qualifications for performing blood sampling procedures ( 12), most are not systematically taught Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO) standardized procedures for capillary sampling. In this country, capillary sampling is performed mainly by nurses, laboratory technicians, and individuals with undergraduate degrees in laboratory medicine ( 11). This highlights the need for standardized procedures, yet capillary blood sampling procedures are not standardized in Croatia ( 10, 11). In addition, the small volumes involved and the variability in sample quality based on puncture site and technique make capillary sampling particularly susceptible to errors during the pre-preanalytical phase, which are beyond the control of clinical laboratory personnel ( 7- 9). If carried out incorrectly, capillary blood sampling can cause inaccurate test results, pain and tissue damage ( 6).
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Skin puncture blood sampling is also recommended for adult patients with severe burns, those who are obese or older or anxious about sampling, those with a tendency toward thrombosis, those whose surface veins need to be spared for intravenous therapy, those with fragile or inaccessible veins, and those who self-test their blood, such as for glucose ( 3). Thus, 56% of all procedures in the neonatal unit are performed using capillary blood samples, making it the most frequent invasive procedure performed during the neonatal period ( 4, 5). Obtaining blood by skin puncture instead of venipuncture can be especially important in pediatric patients in order to avoid the effects of blood volume reduction ( 2) and reduce the risk of anemia ( 3). This technique has become more and more popular, especially with the widespread use of point-of-care testing (POCT), which has become the fastest growing area in laboratory medicine ( 1). It enjoys several advantages over venous blood sampling: it is less invasive, it requires smaller amounts of blood volume and it can be performed quickly and easily. We hope that these recommendations will be a useful contribution to the standardization of capillary blood sampling in Croatia.Ĭapillary blood sampling, which refers to sampling blood from a puncture on the finger, heel or an earlobe, is increasingly common in medicine. Our recommendations are based on existing available standards and recommendations (WHO Best Practices in Phlebotomy, CLSI GP42-A6 and CLSI C46-A2), which have been modified based on local logistical, cultural, legal and regulatory requirements. This document has been produced by the Working Group for Capillary Blood Sampling within the Croatian Society of Medical Biochemistry and Laboratory Medicine. The aim of this document is to provide recommendations for capillary blood sampling.
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A recent nationwide survey of policies and practices related to capillary blood sampling in medical laboratories in Croatia has shown that capillary sampling procedures are not standardized and that only a small proportion of Croatian laboratories comply with guidelines from the Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO). The capillary blood sampling procedure can influence the quality of the sample as well as the accuracy of test results, highlighting the need for immediate, widespread standardization. It is also frequently used to obtain small blood volumes for laboratory testing because it minimizes pain. Capillary blood sampling is a medical procedure aimed at assisting in patient diagnosis, management and treatment, and is increasingly used worldwide, in part because of the increasing availability of point-of-care testing.