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Is it safe to use the centre of the heel for obtaining capillary blood samples in neonates?
  1. Mona Noureldein,
  2. Harsha Gowda
  1. Neonatal Unit, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  1. Correspondence to Dr Mona Noureldein, Neonatal Unit, Luton and Dunstable University Hospital, Lewsey Road, Luton LU4 0DZ, UK; monafathe1979{at}

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A 25-week gestation preterm infant is admitted to the neonatal intensive care unit. She has been intubated and ventilated for 7 days, the umbilical artery catheter has been removed since her umbilical cord has fallen and she needs frequent blood gases. A senior nurse asked about the technique of capillary blood gas, and she wondered why don’t we use the centre of the heel?

Structured clinical question

In term and preterm neonates (patient), is lancing the centre of the heel (intervention) if compared with lateral and medial aspects for blood sampling, associated with bone or cartilage infection (outcome)?


Secondary sources


Primary sources

MEDLINE and PubMed; the following keywords were used: neonate, heel, calcaneus, calcaneum, osteomyelitis, distance and ultrasound. The results were limited to English language and over the period up to December 2017. The search retrieved 67 articles, of which 4 were relevant. Further indirect evidence was obtained from a review article retrieved in the search and references. 



Capillary heel prick blood sampling is by far the most common method of blood sampling in neonates. Unfortunately, it is painful, probably more painful than venipuncture if manual lances are used.1 …

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