March of Dimes
Collection of Screening Specimens
  Collection of Blood Specimen

The National Committee for Clinical Laboratory Standards (NCCLS) has produced a video Making a Difference Through Newborn Screening: Blood Collection on Filter Paper, demonstrating proper heel stick techniques (1). 

This Web site provides two resources regarding collection of blood specimens. You will need Adobe Acrobat Reader to view these resources. To download a free copy of Acrobat Reader, click here. These resources are provided courtesy of Schleicher & Schuell, Inc. and the New York State Department of Health.

Neonatal Screening: Blood Specimen Collection and Handling Procedure illustrates proper collection techniques.

Simple Spot Check illustrates examples of improper specimen collection.
Neonatal Screening: Blood Specimen Collection and Handling Procedure (PDF 84KB)
Simple Spot Check (PDF 40KB)


Equipment
  • Sterile lancet, with tip less than 2.4mm long. (Several collection devices made exclusively for heel stick specimens are now available. For information, contact the screening program in your state.)
  • Sterile 70% alcohol pads.
  • Sterile gauze pads.
  • Warm moist towel or compress.
  • Current filter paper blood collection form. (Outdated blood collection forms may affect test results.)
  • Sterile gloves.

Skin Puncture Site
The heel puncture should be made on the plantar (sole) surface of the foot. The safest area for heel puncture is medial to a line drawn posteriorly from the middle of the great toe to the heel, or lateral to a line drawn from between the fourth and fifth toe to the heel. Do not puncture on the posterior curvature of the heel, or on previous puncture sites (1).

Procedure
Since laboratory analysis of the specimen depends on an assumed amount of blood in the filter paper circle, it is imperative to carefully follow these procedures. Numerous studies have shown the variability occurring due to improper technique in specimen collection (2-5).

  1. Place infant’s leg in a position that will increase venous pressure.
  2. Warm the heel site to increase blood supply to the area by covering the puncture site for three to five minutes with a warm, moist towel which has been run under tap water at a temperature of not more than 42 degrees C.
  3. Cleanse the puncture site with a sterile alcohol pad. Wipe dry with a sterile gauze pad, as residual alcohol may cause hemolysis of the blood specimen resulting in an invalid specimen.
  4. With a lancet or specialty device, puncture the heel skin with one continuous, deliberate motion at a slight angle (a little less than 90 degrees). Wipe away the first drop of blood with a dry sterile gauze pad, as it is likely to contain tissue fluids that contaminate the specimen.
  5. Allow a second, large drop of blood to form.
  6. Lightly touch filter paper to this large drop of blood. Allow blood to soak through and completely fill the preprinted circle with a single application to this large blood drop. (To enhance blood flow, very gentle intermittent pressure may be applied to area surrounding puncture site.) Do not use capillary tubes. Do not touch the same circle to blood several times, as this causes a “layering effect.” Do not “milk” area surrounding puncture site. Milking may cause an admixture of tissue fluids with blood specimen, resulting in an invalid specimen. Apply blood to one side of filter paper only. (Either side may be chosen for this procedure.)
  7. Fill remaining circles in same manner as step 6, with successive drops of blood. If blood flow is diminished, repeat steps three through six with sterile equipment.
  8. Care of skin puncture site should be consistent with your institution’s procedures.

References
1. National Committee of Clinical Laboratory Standards. Making a difference through newborn screening: blood collection on filter paper [videocassette]. NCCLS publication LA4-A3-V. Villanova (PA); no date.

2. Mei JV, Alexander JR, Adam BW, Hannon WH. Use of filter paper for the collection and analysis of human whole blood specimens. J Nutr 2001;131(5):1631S-1636S.

3. Pappaioanou M, Kashamuka M, Behets F, Mbala S, Biyela K, Davachi F, et al. Accurate detection of maternal antibodies to HIV in newborn whole blood dried on filter paper. AIDS 1993;7(4):483-8.

4. Meites S, Glassco KM. Studies on the quality of specimens obtained by skin-puncture of children. 2. An analysis of blood collecting practices in a pediatric hospital. Clin Chem 1985;31(10):1669-72.

5. National Committee of Clinical Laboratory Standards. Blood collection on filter paper for neonatal screening program. Approved standard. 3d ed. NCCLS publication LA4-A3. Villanova (PA); no date.


The information contained in this section does not constitute the endorsement of any specific state policy or procedure by the March of Dimes. Content is based on the New York State Department of Health manual “Newborn Screening in New York State: A Guide for Health Professionals,” provided by the Newborn Screening Program, Wadsworth Center, New York State Department of Health. The material has been modified for a national audience, and additional information has been added by the March of Dimes. 		 
  © 2008 March of Dimes Birth Defects Foundation. All rights reserved. The March of Dimes is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to improve the health of babies by preventing birth defects and infant mortality.