Phlebotomy: Selecting a Puncture Site on an Infant

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Posted on 29th April 2011 by admin in Uncategorized

The guidelines for selecting a puncture or incision site for adults and older children over the age of 1 year is different from the guidelines you would use to determine a capillary puncture site on an infant. For adults and children, the best location for capillary punctures is the palmar surface of the distal or end segment of the middle or ring finger of the nondominant hand. As a phlebotomist how you select a puncture site for infants is important and the heel is the most recommended site for collection of capillary blood specimens.

Although the heel is the most recommended location there are still precautions you should take when using this location for capillary collection. It is important that the puncture is performed in an area of the heel that will not cause a risk of puncturing the bone. If an infant’s bone is punctured a very painful bone inflammation called osteomyelitis can result. This is caused from the inflammation of the bone marrow and any adjacent none. Osteochondritis is another type of inflammation that affects the bone and cartilage because of infection in the puncture area. Infections can be spread from additional punctures that occur in the same area.

The heel bone of small or premature infants is not far below the surface on the bottom of the heel. The depth of the heel bone has been found to be as shallow as 2.0 mm below the skin surface in very young infants. If a puncture is deeper than this at the back of the heel, bone damage can result.

To avoid puncturing bone the best place for heel puncture are located on the sides of the heel. A puncture on either side will usually have less risk to bone, nerve, tendon and cartilage. Do not puncture directly behind the heel.

Here is a list of capillary puncture precautions for infants:

-Do not puncture the earlobes.

-Do not puncture deeper than 2.0 mm.

-Do not puncture a previous puncture site.

-Do not puncture anywhere other than the recommended puncture sites.

-Do not puncture the posterior curvature of the heel.

-Do not puncture the arch of the foot.

-Do not puncture an area that is bruised.

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