Neonatal sampling essentials

Heel site selection

Heel puncture site selection

  • The medial or lateral plantar surface is the recommended location1
  • Avoid the posterior curvature of the heel and central area of the foot (the arch) because the bone/growth plates are very near the surface and there is a risk of damage/infection
  • Avoid swollen areas and previous puncture sites2
The medial or lateral plantar surface is the recommended location for heel puncture site selection.

Expert Tip

Never use a toe for puncture. The heel is the preferred site for babies under six months old3*/ babies who are not yet walking

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. Guidelines for Newborn Blood Spot Sampling. London: Public Health England; 2016. First edition 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. 3. WHO guidelines on drawing blood: best practices in phlebotomy. World Health Organisation; 2010. * Weighing less than 10kg Punctures to this area may result in temporary or permanent injury to nerves, tendons or cartilage3.