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The page below is a sample from the LabCE course Dermal Puncture and Capillary Blood Collection. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Using the Heel for Dermal Puncture

A dermal puncture of the heel should only be performed on an infant or small child prior to the age of walking. The age limit for a heel puncture is approximately 12 months of age. After that time, the skin becomes very thick which could prevent the phlebotomist from obtaining a quality specimen for testing. The fleshy bottom of the heel toward the sides are acceptable sites for dermal puncture. Note in the illustration that the white areas are acceptable sites for heel puncture; any area that is red-striped in the image should not be used for blood collection.

DO NOT puncture the central area of the bottom of the foot (arch of the foot), the back curvature of the heel, or the toes. These sites must be avoided to prevent damage to nerves, tendons, and cartilage.