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Heel Puncture

The heel of the foot is the preferred site for dermal puncture and capillary blood collection for infants less than 12 months old.

CAUTION: In premature infants, the bone may be as close as 2.0 mm under the skin of the plantar surface of the heel. The bone may be even closer--maybe half this distance-- on the back curve of the heel. Any puncture more than 2.0 mm may risk a puncture of the bone causing severe consequences to the infant. Only use approved preemie puncture devices on small infants.

Procedural Step



Positively identify patient

Always use at least two patient identifiers to ensure positive patient identification.

Never rely on name placards that are placed on or near the infant's crib to identify the patient.

If there is a discrepancy in identification, do not proceed until the discrepancy is resolved.

Position patient appropriately

Position the infant so that the heel can be easily accessed.If necessary, seek assistance to stabilize baby's foot during the blood collection.

Cleanse hands and put on gloves and any other required PPE.

Use soap and water or alcohol-based gel to cleanse hands. Cleanse hands before donning gloves and after removing gloves.

Choose puncture site

Use the area of heel that is not striped (the white area) in the image on the left.Do not use the center portion of the heel, the arch of the foot, or toes as any of these sites may cause injury to nerves, tendons, and cartilage.

Warm puncture site if needed

Use only approved warming device.Never use a moist 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.Allow the site to air dry. Performing the puncture before the alcohol has dried may hemolyze the blood specimen.

Securely grasp and puncture the heel.

Choose either side of the fleshy part of heel.Avoid center of heel and arch of the foot.

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 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" or squeeze the heel excessively. Do not scrape the collection device across the heel to obtain specimen; these actions may cause the specimen to hemolyze. Mix specimen immediately upon completion of the collection to prevent clots.

Apply pressure to the puncture site to stop the bleeding.

Use gauze to apply pressure to the puncture site.Use a bandage only if this is an acceptable procedure in your facility.

Label specimen

Specimen must be
labeled in the presence of the patient.
Unlabeled specimens will be rejected by the laboratory.