5.3 Capillary and Pediatric Collection

NHA Certified Clinical Medical Assistant CCMA

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1 Chapter 1: CCMA Exam Orientation and Official Sources

1.1 Official Sources and What the CCMA Credential Measures 1.2 Exam Format, Scoring, and the Current Test Plan 1.3 Eligibility, Registration, Cost, and Scheduling 1.4 Test-Day Rules, Results, Retakes, and Renewal 1.5 Study Strategy by Official Domain

2 Chapter 2: Foundational Knowledge, Terminology, and Basic Science

2.1 Health Care Systems, Settings, and Team Roles 2.2 Medical Terminology, Abbreviations, and Documentation Language 2.3 Anatomy, Physiology, Homeostasis, and Disease Basics 2.4 Basic Pharmacology and Medication Safety 2.5 Nutrition, Supplements, Food Labels, and Disease-Related Diets 2.6 Psychology, Development, Stressors, and Behavioral Health

3 Chapter 3: Patient Intake, Vitals, and General Clinical Care

3.1 Clinical Patient Care Domain Map and Intake Workflow 3.2 Vital Signs Measurement Technique 3.3 Anthropometrics, Pain, and Screening Measures 3.4 Positioning, Draping, and Procedure Preparation 3.5 Medication Administration Support 3.6 Wound Care, First Aid, and Emergency Response

4 Chapter 4: Infection Control, Safety, and OSHA Concepts

4.1 Standard Precautions, PPE, and Hand Hygiene 4.2 Medical Asepsis, Surgical Asepsis, Disinfection, and Sterilization 4.3 Sharps, Biohazards, and Bloodborne Pathogen Exposure Response 4.4 Emergency Supplies, Equipment Checks, and Environmental Safety 4.5 Infection Control Scenario Drills

5 Chapter 5: Phlebotomy, Specimens, and Lab Testing

5.1 Phlebotomy Workflow and Order Verification 5.2 Venipuncture Sites, Tube Selection, and Order of Draw 5.3 Capillary and Pediatric Collection 5.4 Specimen Labeling, Processing, Storage, and Transport 5.5 Point-of-Care Testing and CLIA-Waived Procedures 5.6 Urinalysis, Pregnancy, Rapid Tests, and Quality Control 5.7 Lab Error Recognition and Remediation

6 Chapter 6: EKG and Cardiovascular Testing

6.1 EKG Patient Preparation and Lead Placement 6.2 EKG Artifact Troubleshooting 6.3 Cardiovascular Red Flags and Escalation 6.4 Ambulatory Monitoring and Cardiovascular Documentation

7 Chapter 7: Administrative Assisting, Coordination, and Communication

7.1 Scheduling, Registration, and Patient Flow 7.2 EHR Documentation and Record Integrity 7.3 Insurance, Billing, Prior Authorization, and Denials 7.4 Referrals, Transitions of Care, and Community Resources 7.5 Patient Education and Health Literacy 7.6 Telehealth, Patient Portals, and Electronic Communication 7.7 Customer Service, Conflict Resolution, and Teamwork

8 Chapter 8: Law, Ethics, Calculations, and Final Exam Readiness

8.1 Scope, Delegation, Consent, and Legal Boundaries 8.2 HIPAA, Confidentiality, and Release of Information 8.3 Ethics, Bias, Boundaries, and Professionalism 8.4 Mandatory Reporting, Incident Reports, and Risk Management 8.5 Calculations, Conversions, and Dosage Math 8.6 Mock Exam Pacing and Error-Log Remediation 8.7 Final Test-Day Readiness Checklist

9 Chapter 9: Mixed Scenario Labs and Full Exam Readiness

9.1 Intake and Vitals Simulation Lab 9.2 Infection Control and Safety Simulation Lab 9.3 Phlebotomy and Lab Testing Simulation Lab 9.4 EKG and Cardiac Escalation Simulation Lab 9.5 Administrative and Communication Simulation Lab 9.6 Law, Ethics, HIPAA, and Scope Simulation Lab 9.7 Calculations and Final Review Simulation Lab 9.8 Full Exam Readiness Simulation Lab

10 Chapter 10: Domain Mastery and Score Repair

10.1 Blueprint-Based Domain Prioritization 10.2 Foundational Science and Anatomy Mastery 10.3 Clinical Patient Care Mastery: Intake, Vitals, and General Care 10.4 Clinical Patient Care Mastery: Infection, Lab, Phlebotomy, and EKG 10.5 Coordination, Education, and Administrative Mastery 10.6 Communication and Customer Service Mastery 10.7 Law, Ethics, and Risk Management Mastery 10.8 Final Week Score Repair Plan

11 Chapter 11: Final Quick Reference Checklists

11.1 Vital Signs Reference Checklist 11.2 Medication and Injection Reference Checklist 11.3 Infection Control Reference Checklist 11.4 Phlebotomy and Specimen Reference Checklist 11.5 Point-of-Care and Urinalysis Reference Checklist 11.6 EKG and Cardiovascular Reference Checklist 11.7 Legal, Administrative, and Communication Reference Checklist

5.3 Capillary and Pediatric Collection

Key Takeaways Explain This Topic AI

Adult and older-child fingersticks use the side of the third or fourth fingertip, slightly off-center.

Infant heelsticks use only the medial or lateral plantar heel surface, never the arch or back curve.

Wipe away the first drop of blood because it contains excess tissue fluid that dilutes the sample.

Heelstick lancet depth must not exceed about 2.0 mm to avoid striking the calcaneus (heel bone).

Capillary microtube order of draw differs: EDTA first, then other additives, then serum.

Last updated: June 2026

Capillary Collection Has Its Own Rules

Capillary (dermal) puncture is used for small-volume testing, point-of-care glucose, hemoglobin, newborn screening, and patients with poor venous access. The technique and even the order of draw differ from venipuncture, so the CCMA cannot simply transfer venipuncture habits.

Site Selection by Age

Patient Site Avoid

Adult / child > 1 year Side of fingertip, 3rd or 4th finger, off-center Thumb, index, 5th finger, fingertip center, side of finger

Infant < 1 year Medial or lateral plantar heel surface Heel arch, posterior curvature, previous puncture

The fingertip puncture is made across the fingerprint lines , not parallel to them, so the drop forms instead of running down the grooves. The thumb and index finger are avoided because they are calloused and have more nerve endings; the fifth finger has too little tissue over the bone.

For infants, the puncture stays on the plantar heel medial or lateral to an imaginary line drawn from the great toe and from between the fourth and fifth toes. The lancet depth must not exceed roughly 2.0 mm (less for premature infants) so the blade does not strike the calcaneus , which can cause osteomyelitis.

Technique Steps

Warm the site for 3–5 minutes when needed to increase blood flow (especially for heelsticks).

Clean with alcohol and let it dry completely — residual alcohol hemolyzes the sample and causes a stinging, inaccurate glucose.

Puncture with a single firm motion using a retractable safety lancet, then dispose of it immediately in the sharps container.

Wipe away the first drop , which is contaminated with tissue fluid and can falsely dilute the result.

Collect subsequent drops without excessive squeezing.

Why Milking Is Wrong

Vigorously squeezing or "milking" the finger forces interstitial tissue fluid into the sample, diluting it and falsely lowering values and sometimes causing hemolysis. The correct technique applies gentle intermittent pressure well behind the puncture site and lets gravity assist.

Capillary Order of Draw

The order of draw reverses the additive priority for microtubes because platelets clump quickly at a small puncture:

• # Microtube Reason
• 1 Blood gas (if collected) Minimize air exposure
• 2 EDTA (lavender) Fill before platelets aggregate

3 Other additive tubes Heparin, etc.

• 4 Serum tubes Clotting is acceptable last
• Pediatric Comfort and Safety

A crying, moving child is a safety risk. Use a caregiver to comfort and gently secure the child, explain the steps in simple terms, and keep all sharps out of the child's reach before and after the puncture. Document the site used. A common scenario trap is choosing the infant heel arch or repuncturing the same spot, both of which raise injury and bruising risk.

Indications, Newborn Screening, and Comfort Technique

Knowing when to choose a capillary puncture over a venipuncture is itself tested. Capillary collection is preferred for point-of-care glucose monitoring, for patients with fragile or inaccessible veins, for severely burned or thrombotic patients, for those at risk from repeated venous draws, and especially for infants , in whom large venous draws can cause anemia. It is contraindicated when a large volume is required, for many coagulation studies, and for blood cultures, which need a sterile venous draw.

Newborn screening is a high-yield example. The heelstick blood is applied to a special filter-paper card by touching a large drop to each printed circle and letting it soak through to fill the circle completely from one side only. Layering drops, touching the paper to the heel, or filling from both sides invalidates the card and forces a repeat stick on the infant. The card must air-dry flat and be sent within the required window. These details appear on the exam because a botched screening card delays detection of conditions such as phenylketonuria and congenital hypothyroidism.

Capillary blood is a mixture of arterial, venous, and capillary blood with interstitial fluid, so reference ranges differ slightly from venous values; glucose tends to run a bit higher and some other analytes lower. The CCMA should know the specimen type is not interchangeable for every test.

Comfort and safety technique is also assessed. For infants and young children, swaddling or a parent's gentle hold steadies the limb; for older children, honest simple explanation and distraction reduce fear and movement. The lancet is a single-use retractable safety device that is activated once and dropped directly into the sharps container — never set down within reach of a child and never reused. Warming a heel with a commercial warmer or warm cloth (not hot) for a few minutes increases blood flow and improves the yield from a single stick, sparing the infant a repeat puncture.

Exam-Day Recall

The testable core of capillary work is site safety by age, lancet depth limits, the discard-the-first-drop rule, and the reversed microtube order with EDTA first. Pair each fact with its consequence: wrong heel site risks bone injury, too-deep lancet risks the calcaneus, milking dilutes with tissue fluid, and a delayed EDTA microtube clots. When a stem describes an infant or a difficult-access adult, confirm the chosen site and technique before reacting to the result, and keep every sharp controlled. These habits convert a memorized list into the applied judgment NHA rewards.