Sharon M. GeaghanAn Interview With Sharon M. Geaghan, Medico

In the July issue of Patient Safety Focus, Dr. Geaghan described the risks associated with capillary claret sampling from a finger-stick puncture, a widely used method in bespeak-of-intendance glucose testing. Here she expands on that interview, focusing on the heel-stick sampling method, a simple procedure in which a baby's heel is pricked with a lancet and so a small-scale amount of the blood is collected in a narrow-approximate capillary glass tube or on a filter paper. Dr. Geaghan is professor of pathology and pediatrics at Stanford University School of Medicine in Palo Alto, Calif.

Nancy Sasavage, PhD, conducted this interview.

Please draw drawing blood by heel-stick sampling.

The heel-stick method for drawing capillary blood is the most common manner to draw newborns' claret. It is used to collect blood for newborn screening tests, usually before the baby leaves the infirmary. Heel sticks are the most ordinarily performed invasive procedure in neonatal intensive care units.

When is the heel-stick method used to draw claret from infants?

That is a frequently asked question. I similar to call up of this question in terms of developmental milestones. While fingers are the site of selection after infancy, heel sticks are advisable for most babies, including premature infants, neonates, and even babies 4 to 7 months old. The only caveat is that babies discover other parts of their bodies, such as their feet and toes, as they grow older.

A bandage placed on a baby's heel can pose a safety risk when the child is able to place its feet in its mouth. Past 8 to 12 months, babies are pulling themselves up, standing, and preparing to walk or walking; then heel sticks are not recommended at this developmental stage because the heels are bearing weight to varying degrees. Premies may not reach such milestones on the same schedule as full-term babies, so I recommend that parents be questioned about their kid'due south development before performing a heel stick.

What risks are item to heel sticks?

Improper heel-stick technique can harm the structures of the human foot, including the calcaneus bone and soft tissues. In fact, some reports take documented difficulties walking later in life. It is prophylactic to perform a heel stick if the puncture site is limited to the medial and lateral planter aspects of each heel pad, specifically medial to a visual line fatigued from the centre of the big toe extending posterior to the heel or lateral to a line drawn from between the 4th and fifth toes and extending posterior to the heel. Repeated punctures, bruising, or erythema limit the available area for punctures, specially in premature infants who may accept claret drawn multiple times or very tiny heels.

Immunizing a baby.

How can heel-stick rubber be assessed?

Due to the special technical requirements of this procedure, it is platonic to have experienced staff who perform heel sticks frequently. It is also important to have a program in place to maintain this special skill set. Periodic quality rounds to randomly inspect neonatal heels are a good thought to evaluate staff performance and accept corrective deportment when necessary.

Editor's Note

The Clinical and Laboratory Standards Plant (CLSI) recently released an updated edition of its standard NBS01-A6, "Blood Collection on Filter Paper for Newborn Screening Programs," which replaces standard LA04-A5. This important certificate, revised for the starting time time since 2007, contains a substantial amount of new information on the essentials of correctly collecting a loftier-quality specimen, handling the specimen after it has been collected, transporting it to the testing facility, and sorting the rest specimen that remains after laboratory testing. For additional information, visit the CLSI website.


Are at that place other safety risks associated with heel sticks?

Yes, in that location is also a take a chance of burning the infant'due south skin while warming its heel before the blood is drawn. Heel warming is used to increment claret period in the capillaries. If the heel is to exist warmed, using warm water submersion is risky unless you lot tightly control the temperature.

Chemic heat packs are unmarried-use, and offering a temperature-controlled, safer, but more expensive culling. Though heel warming is usually performed to increase blood menstruum, this protocol is actually based more on theoretical grounds than on any solid evidence that information technology works. Ii studies accept claimed that heel warming does not increase blood flow; nevertheless, the studies were not blinded (i, two). It is costly in terms of time and consumables, then a well-designed report to resolve this question would be welcome.

Are finger sticks on infants safe?

Yes, they can be performed with special prophylactic measures. Special lancets less than one.5-mm thick tin be used in one case heel sticks are no longer an pick and after 6 months of age. At that age, distance from the skin surface to os and cartilage in the middle finger is only 2.5 mm (3).

REFERENCES

  1. Barker DB, Willets B, Cappendijk VC, et al. Capillary claret sampling: Should the heel be warmed? Arch Dis Child Fetal Neonatal Ed. 1996;74:139–40.
  2. Janus M, Pinelli J. Comparing of blood sampling using an automated incision device with and without warming the heel. J Perinatol 2002;22:154–8.
  3. Reiner CB, Meites S, Hayes JR. Optimal sites and depths for skin puncture of infants and children as assessed from anatomical measurements. Clin Chem 1990;36:547–9.