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33: Heelstick (Capillary Blood Sampling)

I. INDICATIONS

  1. Collect blood samples when only a small amount of blood is needed or when there is difficulty obtaining samples by venipuncture or other source. Common studies include complete blood count (CBC), chemistries, liver function tests, sickle cell anemia, thyroid, bilirubin levels, toxicology/drug levels, bedside glucose monitoring, and newborn metabolic screening. Coagulation studies, chromosomal analyses, immunoglobulin titers, and some other, more sophisticated tests cannot be done on capillary sampling.

  2. Capillary blood gas determination gives satisfactory pH and Pco2, but not Po2.

  3. Blood cultures when venous access or other access is not possible. Sterile technique is required but heelstick is not the preferred method.

  4. Newborn metabolic screen is ideally performed in the first 48–72 hours of life (however, can be done after 24 hours). It should be done before a transfusion and antibiotic therapy and ideally after receiving breast milk or formula to ensure accurate testing. See Chapter 15.

II. EQUIPMENT

Automated self-shielding lancets are preferred in neonates (Table 33–1); sterile manual lancets are not recommended but may be used in some units if automated lancets are not available (sizes: 2 mm for <1500 g and 4 mm for >1500 g). Capillary tube (for rapid hematocrit and bilirubin tests) or larger BD Microtainer™ collection tubes (if more blood is needed [eg, for chemistry determinations]), filter paper card for newborn screening (if appropriate), clay to seal the capillary tube, a warm washcloth or heel warming device (eg, a chemical activated packet), antiseptic solution, gloves, and a diaper.

Table 33–1.COMMONLY USED AUTOMATED SELF-SHIELDING LANCETS FOR SAMPLE COLLECTION IN NEWBORNS
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Table 33–1.COMMONLY USED AUTOMATED SELF-SHIELDING LANCETS FOR SAMPLE COLLECTION IN NEWBORNS
Device Infant Characteristics
Tenderfoot MicroPreemiea <1000 g Blue: depth 0.65 mm, length 1.40 mm Incision type
Tenderfoot Preemiea Low birthweight, 1000–2500 g White: depth 0.85 mm, length 1.75 mm Incision type
Tenderfoot Newborna Birth to 3–6 months, >2500 g Pink/blue: depth 1.0 mm, length 2.5 mm Incision type
BD Microtainer Quikheel Preemie Lancetb Low birthweight (>1.0 kg and <1.5 kg) premature infants or full term for lower blood volume Pink: depth 0.85 mm, length 1.75 mm Incision type
BD Microtainer Genie Lancetb,c Infant heelsticks for glucose testing Purple: 1.25 mm × 28 gPuncture type
BD Microtainer Quikheel Infant Lancetb Infants who need high flow, full term with high blood volume needed Teal: depth 1.00 mm, length 2.50 mm Incision type
babyLance Preemie: BLPd Preemie Green: depth 0.85 mm Incision type
babyLance Newbornd Newborn Blue: depth 1.00 mm Incision type

aITC Edison, NJ.

bBD, Franklin Lakes, NJ.

cBD Microtainer Genie Lancet (pink/green/blue) are for finger sticks and not for heelsticks in infants.

dMediPurpose, Duluth, GA.

III. PROCEDURE

  1. Automated self-shielding lancets are preferred in neonates ...

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