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Iowa Neonatology Handbook: Procedures
Obtaining Blood Via Heel Stick
Iowa Neonatology Fellows
Peer Review Status: Internally Peer Reviewed
I. Adequate quantities of serum may be obtained via heel stick in
almost any neonate. If done properly, hemolysis should not be a
significant problem. The skin's blood supply is located at the
junction of the dermis and subcutaneous tissue, 0.35 to 1.6 mm from
the skin surface.
II. Prewarming with the commercially-available heel warmers or
with a diaper which has been warmed under a warm faucet and taped
around the heel often increases the blood supply and arterializes the
sample. The area should be cleaned thoroughly with alcohol swab. The
person performing the procedure should wear appropriately fitting
gloves.
III. The heel puncture should be done on the most medial or
lateral portions of the plantar surface of the heel, not on the
posterior curvature, to avoid the calcaneous. The lancets are
designed to enter no deeper than 2-3 mm. If using a scalpel blade,
the blade should enter the skin no more than 2-3 mm. After the
puncture, wipe the first small drop off to rid the skin of the tissue
juices that may increase clotting at the site.
IV. Hold the ankle area with the 3 fingers on your ulnar side
while placing your thumb behind the heel and your second finger just
below the ventral surface of the toes. By alternately pressing the
lateral three fingers , followed by a milking motion of the second
finger, blood can be expressed. The fingers should be relaxed for a
few seconds periodically to allow refilling. To prevent bruising,
caution should be used to limit squeezing with the finger tips. To
prevent hemolysis, allow large droplets to form, collecting the drops
as they form into the microtube, not scraping the blood into the
tube.
V. Fingerstick sampling is used for capillary blood gas analysis
in our NICU and may be used for additional laboratories as well. The
technique is similar to heelstick in that only the medial and lateral
aspects of the finger are stuck. The milking motion includes the
whole finger and even portions of the hand.
References:
Blumenfeld, et al: Recommended site and depth of newborn heel skin
punctures base on anatomical measurements and histopathology. Lancet
1979;1:230.
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