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Heelstick Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Heelstick and links to relevant pages within the course.

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Dermal Puncture and Capillary Blood Collection
Introduction

A dermal (skin) puncture may be required when a venipuncture cannot be performed or may be the option of choice for some point-of-care test procedures. A dermal puncture may be a fingerstick or, in the case of small infants, may be a heelstick. Patient safety involves proper identification prior to specimen collection, care in preparing the collection site, proper technique during collection, and treatment of the puncture wound following collection. The technique that is used for collection of the specimen must also prevent the introduction of errors that could cause the specimen to be rejected and require recollection.

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Puncture Devices

A variety of disposable skin puncture devices are available that will ensure a safe procedure when used properly. Most devices have a spring loaded feature for the blade or the lancet. Once activated, the lancet will automatically puncture the skin using a quick motion. The lancet will immediately retract back into the housing of the device. This design eliminates the possibility of accidental needlestick injury to the phlebotomist. All devices are single use only and must be disposed of in an approved sharps container immediately after activation. An example of an approved sharps container is shown below.It is very important for the phlebotomist to use the puncture device that is designed specifically for the procedure that will be performed. Lancets are manufactured to ensure incisions to a safe depth and length. A special lancet designed for use on babies less than 5 pounds is available and should always be used when performing a heelstick on a premature infant. A lancet designed for puncture of a finger should not be used for the puncture of a heel. A heel incision device is set to a maximum penetration depth of 2.0 mm (some facilities may require even shallower penetration for premature infants). Fingerstick devices may exceed this maximum depth of penetration that is allowed for an infant heel puncture. The bottom image on the left illustrates a lancet style that is typically used for fingersticks. the bottom image on the right is one style of puncture device that is used for heelsticks.

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Phlebotomy
Discussion

Hemolysis can easily be caused by improper phlebotomy techniques. Hemolysis occurs when RBCs are broken up and hemoglobin is released into the plasma, causing it to become pink rather than its natural straw color. Hemolysis can occur by using too small a needle, pulling a syringe plunger too rapidly, expelling blood vigorously into a tube, or shaking a tube of blood too hard. Hemolysis can cause falsely increased potassium, magnesium, iron, and ammonia levels, and other aberrant lab results.In this case, Marcie did not properly wipe the site with gauze after cleaning it with alcohol, and alcohol contacting the blood could have caused RBCs to break up or hemolyze. Marcie also squeezed the baby's foot too hard, causing hemolysis.Relevant topics:Site selection and preparation, Heelstick: Puncture, Hemolysis, Causes of hemolysis

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Blood collection tubes: sizes

Adult tubes generally hold from 3 to 10 ml of blood. Pediatric tubes usually hold from 2 to 4 ml.Tubes for fingersticks or heelsticks generally hold one half ml or less.

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Heelstick - Neonatal Blood collection

Microlances (such as the Tenderfoot™ (ITC) or the QuikHeel™ (BD), shown here, are used to puncture the heel & collect capillary blood.These devices control the depth of incision, since going too deep into an infant's heel could injure the heel bone, and cause osteomyelitis (bone infection).

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Heelstick - Apply sterile gauze

After collection is completed, apply pressure to the puncture site with a sterile gauze pad until bleeding has stopped.Do not apply an adhesive bandage to an infant's foot since it may injure its delicate skin.

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Heelstick - Pediatric collection procedures: Introduction

Veins of small children and infants are too small for venipuncture;Safety Lancets are used to puncture the skin and collect capillary blood.Butterfly needles may be used to collect venous blood in older children.

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Heelstick - Site selection and preparation

Firmly grasp the infants foot. Do not use a tourniquet. The heel may be warmed with a cloth to help increase blood flow. Wipe the collection site with an alcohol prep pad, and allow the alcohol to dry. Wipe the site with sterile cotton or gauze, to be sure all the alcohol has been removed.

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Heelstick - Puncture

Puncture the left or right side (outskirt) of the heel, not the bottom of the foot.Wipe away the first drop of blood since it may contain excess tissue fluid or alcohol which could alter test results.

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Heelstick - specimen collection

Collect the blood into the appropriate tube.Do not: Squeeze the infant's foot too tightly and wipe with alcohol during the collection.These actions could result in hemolysis (breakdown of the red blood cells), invalidating the test results.

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