Skin-puncture and blood-collecting technique for infants: update and problems.

Abstract

This is updated information on acceptable practice in skin puncture and blood collection in infants, as well as on the devices used, with the additional aim of emphasizing major problem areas and some tentative solutions. Consensus standards for skin puncture have little experimental support, and evade the hard fact that studies are needed to clarify optimum sites for puncture and depth and width of lancets, and to assess the effects of compression and skin resistance in the puncturing process. Preliminary data revealed that the puncturing depth of 2.4 mm recommended for the newborn is excessive. In four of 14 newborns at necropsy, the distance from posterior planar skin surface to underlying bone ranged between 2.0 and 2.2 mm. An experimental lancet, with a 1.8-mm tip length and a diameter of 0.79 mm yielded customary blood volumes from newborns in three of the four pediatric centers where it was tested. Lack of success with the lancet was attributed to inexperienced phlebotomists, not to the lancet's decreased size. Also reviewed are problems with common devices used, and the need for examining the "economy" of blood collection.

A Prospective Comparison of Transcutaneous and Serum Bilirubin Within Brief Time Intervals

“…3 Although TSB measurement via heel stick blood sampling is the most accurate way to determine the true serum bilirubin level, heel sticks are painful, stressful for the parents, time-consuming, and can lead to longterm consequences such as osteomyelitis, skin infections at the site of sampling, and calcium deposition at the heel-stick site. [4][5][6][7] Multiple investigators have found that TcB measurements correlate well with TSB levels. [8][9][10][11][12][13][14] Taylor et al looked retrospectively at 925 matched measurements of TcB (measured on various sites of newborns and with various instruments) and TSB measured within 2 hours of each other and found that the correlation between them was 0.78.…”

Capillary blood sampling: the pain of single‐use lancing devices

“…repeated use in one individual), have an adjustable penetration depth and cause minimal pain (McIntosh et al, 1994;Fruhstorfer and Lange, 1995). Their use in clinical routine is, however, not recommended owing to the risk of crossinfection (Meites, 1988;Polish et al, 1992). One possibility to improve lancet control and avoid the risk of cross-infection is the use of semiautomatic disposable lancing devices.…”

Cellular-resolution in vivo tomography in turbid tissue through digital aberration correction

“…This technical advance may enable noninvasive blood count, which will potentially address many challenges in diagnosis, management, and treatment of diseases. Neonatal blood sampling represents one type of clinical challenges where blood volume and accessible veins are limited for needle puncture, and capillary skin puncture may be associated with increased risk of infection, injury, pain, and maternal anxiety [31,32]. While, blood count monitoring during chemotherapy represents another type of challenges where the venipuncture-based blood test may lead to complications, and delays and/or dose reductions of subsequent courses of chemotherapy [33,34].…”