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DERMAL PUNCTURES
When venipuncture is inadvisable, it is possible to perform a majority of laboratory
tests on micro samples obtained by dermal (skin) puncture, or a DBS (dried blood
sample). With the exception of ESR, blood cultures and other tests that require a large
amount of serum. Dermal puncture may be done on both pediatric and adult patients.
Microtainer are commonly used to obtain these samples. To prevent cross-
contamination of chemicals in these micro trainers the phlebotomist must follow the
dermal order of draw for these tubes.
DERMAL ORDER OF DRAW: EDTA tubes are first, serum tubes are last.

Dermal puncture Infants:
The heel is used for dermal punctures on infants less than 1 year of age. Areas
recommended are the medial and lateral areas of the plantar surface of the foot. These
are determined by drawing imaginary lines medially extending from the middle of the
great toe to the heel and laterally from the middle of the fourth and fifth toes to the
heel.

Older children and Adults
The distal segment of the third or fourth finger of the non-dominant hand is the recommended
site. Puncture is made in the fleshy portion of the finger slightly to the side of the center
perpendicular to the lines of the fingerprint.

Warming the site for a minimum of three minutes can increase the blood flow up
to seven times the normal amount.

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