Heel Puncture

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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 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 the 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 other than the great toe, as any of these sites may cause injury to nerves, tendons, and cartilage.
Warm puncture site if needed
Use only approved warming devices.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.Allow the site to air dry. The alcohol can cause a stinging sensation, contaminate the sample, hemolyze RBCs, and prevent formation of a rounded blood drop because blood will mix with the alcohol and run down the heel.
Securely grasp and puncture the heel.
Choose either side of the fleshy part of the heel.Avoid the center of the 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 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" 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. Invert tubes with anticoagulants 5 to 10 times.
Apply pressure to the puncture site to stop the bleeding. Use gauze to apply pressure to the puncture site.Bandages are not used for children younger than two years of age.
Label specimen Specimen must be labeled in the presence of the patient.Unlabeled specimens will be rejected by the laboratory.