Bellieni CV, Johnston CC. Analgesia, nil or placebo to babies, in trials that test new analgesic treatments for procedural pain. Acta Paediatr. 2016; 105:(2)129-136

Blumenfeld T, Turi GK, Blanc WA. Recommended site and depth of newborn heel skin puncture based on anatomical measurements and histopathology. Lancet. 1979; 181:230-233

Bruck E. Procedures for the collection of diagnostic blood specimens by skin puncture, 3rd edn. Villanova, PA: National Committee for Clinical Laboratory Standards (NCCLS); 1991

Cavanagh C. Newborn blood spot sampling. Infant. 2009; 5:(3)168-171

Glenesk A, Shepherd A, Niven C, Mackenzie J. Blood spot testing: comparing techniques and automated devices. Br J Midwifery. 2006; 14:(2)96-99

Johnston C, Campbell-Yeo M, Disher T. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev. 2017; 2

Kazmierczak SC, Robertson AF, Briley KP. Comparison of hemolysis in blood samples collected using an automatic incision device and a manual lance. Arch Pediatr Adolesc Med. 2002; 156:(11)1072-1074

Meehan RM. Heelsticks in neonates for capillary blood sampling. Neonatal Netw. 1998; 17:(1)17-24

NHS. Health A–Z. Your pregnancy and baby guide. Newborn blood spot test. 2018. (accessed 3 December 2018)

NHS Clinical Evaluation Team. Clinical review: safety blood lancets (needle & blade). 2016. (accessed 3 December 2018)

Public Health England. Guidelines for newborn blood spot sampling. 2016. (accessed 3 December 2018)

Reynolds PR, Banerjee S, Meek JH. Alcohol burns in extremely low birthweight infants: still occurring. Arch Dis Child Fetal Neonatal Ed. 2005; 90:(1)

Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016; 7

Vertanen H, Fellman V, Brommels M, Viinikka L. An automatic incision device for obtaining blood samples from the heels of preterm infants causes less damage than a conventional manual lancet. Arch Dis Child Fetal Neonatal Ed. 2001; 84:(1)F53-5

World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy. 2010. (accessed 16 January 2019)

Yang KC, Su BH, Tsai FJ, Peng CT. The comparison between capillary blood sampling and arterial blood sampling in an NICU. Acta Paediatr Taiwan. 2002; 43:(3)124-126

A safety lancet for neonatal blood spot tests: a design that facilitates pain-free, atraumatic samples

24 January 2019
Volume 28 · Issue 2


Safety lancets are used to collect capillary blood samples to test if neonates have rare but serious congenital conditions, such as sickle cell disease, cystic fibrosis, congenital hypothyroidism and inherited metabolic diseases. Blood samples are taken from the heel, but the procedure can cause the neonate pain or discomfort, as well as a risk of local trauma to the nerves and blood vessels, bleeding, infection and scarring. This article explores the need for blood sampling in neonates, discusses the procedure and outlines the types of lancets available. It describes the Neoheel Safety Lancet (Smiths Medical), whose features are designed to avoid pain and trauma during the procedure. Three case studies are included to describe its use in clinical practice.

In neonates, blood samples obtained from an artery or vein are regarded as the ‘gold standard’ for laboratory specimens as they are perceived to reflect the body's true values. However, sampling from arteries and veins is not always feasible and the risks associated with indwelling catheters, such as thrombosis and infection, limit the duration for which they can be left in situ (Bruck, 1991). Furthermore, in hospitalised sick neonates, repeated venous sampling can limit the number of intravenous sites available for the administration of total parenteral nutrition or medications. Capillary blood sampling, therefore, remains the preferred method of obtaining small amounts of blood for laboratory analysis. Compared with venepuncture or arterial puncture, this procedure is easier and safer. Furthermore, the results of most laboratory tests of these samples have been found to be comparable to those from blood drawn from arterial catheters (Yang et al, 2002).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content