Collection procedure for heel samples
- After puncturing the skin use a clean gauze to wipe away the first drop of blood to avoid specimen dilution with interstitial fluid1,2 (test dependent)
- Hold the foot with your thumb placed along its length being careful to avoid bending the foot back towards the shin, which could cause injury
- Gently massage along the length of the foot towards the heel using a light squeeze-and-release motion to allow large droplets of blood to form and encourage continuous blood flow2
- If you are using blood collection paper allow a large drop to form. Carefully fill each circle from the front side of the card using only a single drop of blood. Avoid touching the heel to the blood collection paper while applying blood to the circle
- If you are using a capillary tube hold one end horizontally and touch it to the blood droplets at the puncture site. Fill the tube while trying to minimise air infiltration and air bubbles in the tube. Gently massage the heel to maintain a continuous blood flow. When sufficient blood has been collected, place caps on both ends of the tube to allow for mixing and to minimise air contamination
- Alternatively, you may need to collect the sample in a specially-designed blood collection tube by allowing blood droplets to drip and flow into the tube by natural capillary action. It is also important not to use a scraping or scooping motion here


EXPERT TIP
These materials have been produced in consultation with key opinion leaders and follow global guidelines, but the user should use his or her professional judgement when using any technique or method described in these materials and should take into account all applicable national, regional and institutional guidelines and regulations
1. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organisation; 2010.
2. Clinical and Laboratory Standards Institute (CLSI) document GP42-A6 (former H04-A6): Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard – Sixth Edition. Clinical and Laboratory Standards Institute; Wayne, Pennsylvania, USA: 2008.
Selecting a safety puncture device with a suitable puncture depth
-
For the average 3kg/6.6lb baby, the heel puncture, at the recommended sites† must not penetrate
deeper than 2.0mm to avoid puncturing the bone 1 - For the safety of an infant of below average weight, use a safety puncture device designed with a puncture depth suitable for heel puncture of that infant
- Puncture and motion blade devices are available for heel sampling. Motion blade devices are designed to deliver maximum comfort2 and optimal blood flow


EXPERT TIP
These materials have been produced in consultation with key opinion leaders and follow global guidelines, but the user should use his or her professional judgement when using any technique or method described in these materials and should take into account all applicable national, regional and institutional guidelines and regulations
1. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organisation; 2010.
2. Shah V. et al. Evaluation of a New Lancet Device (BD Quikheel) on Pain Response and Success of Procedure in Term Neonates. Arch Pediatr Adolesc Med 2003; 157: 1075-1078
3. Clinical and Laboratory Standards Institute (CLSI) document GP42-A6 (former H04-A6): Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard – Sixth Edition. Clinical and Laboratory Standards Institute; Wayne, Pennsylvania, USA: 2008.
4. Guidelines for Newborn Blood Spot Sampling. London: Public Health England; 2016. First edition. * Weighing less than 10kg † Medial and lateral heel.
Selecting a safety puncture device with a suitable puncture depth
- For the average 3kg/6.6lb baby, the heel puncture, at the recommended sites†, must not penetrate deeper than 2.0mm to avoid puncturing the bone1
- For the safety of an infant of below average weight, use a safety puncture device designed with a puncture depth suitable for heel puncture of that infant
- Puncture and motion blade devices are available for heel sampling. Motion blade devices are designed to deliver maximum comfort2 and optimal blood flow


EXPERT TIP
These materials have been produced in consultation with key opinion leaders and follow global guidelines, but the user should use his or her professional judgement when using any technique or method described in these materials and should take into account all applicable national, regional and institutional guidelines and regulations
1. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organisation; 2010.
2. Shah V. et al. Evaluation of a New Lancet Device (BD Quikheel) on Pain Response and Success of Procedure in Term Neonates. Arch Pediatr Adolesc Med 2003; 157: 1075-1078
3. Clinical and Laboratory Standards Institute (CLSI) document GP42-A6 (former H04-A6): Procedures and Devices for the Collection of Diagnostic Capillary Blood Specimens; Approved Standard – Sixth Edition. Clinical and Laboratory Standards Institute; Wayne, Pennsylvania, USA: 2008.
4. Guidelines for Newborn Blood Spot Sampling. London: Public Health England; 2016. First edition. * Weighing less than 10kg † Medial and lateral heel.
Preparation procedure prior to heel puncture
- Consult institutional guidelines for specific information on the type of test being performed
- Gather all the equipment needed which may include gloves, alcohol pads, clean gauze, safety lancets, bandages, blood collection paper, capillary tubes or other capillary blood collection tubes and a biohazard sharps container
- Identify the infant/baby according to patient safety standards which requires asking the parent or guardian to verify a minimum of two identifiers such as last name, first name and date of birth of the infant/baby
- Consider warming the puncture site to facilitate blood flow when the site is cold or if a larger blood volume is required for testing
- Cover the puncture site with a warming device (commercial device or warm, moist towel) not to exceed a maximum temperature of 42°C or 107°F2. Be careful not to scald the infant/baby
- Disinfect the site according to institutional guidelines. If alcohol is used ensure it has completely air-dried before puncture (do not wipe the site dry). This will help to avoid haemolysis of the specimen which may cause inaccurate results and/or the need to re-collect the specimen1,2
- Preparation of the site is now complete and ready for puncture and sampling


EXPERT TIP
These materials have been produced in consultation with key opinion leaders and follow global guidelines, but the user should use his or her professional judgement when using any technique or method described in these materials and should take into account all applicable national, regional and institutional guidelines and regulations.