Acceptable sites for capillary blood sampling

[wonderbee, BSN, RN]

Recently just started working with peds after years with adults. What are best practice sites for obtaining capillary samples for hemoglobin for children to 18 months? I know of the heel in newborns and very young infants. What about the big toe? I'm running into some flack about performing toe sticks on infants coming from my supervisor whose discipline is nutrition. I am new to my job and want to be sure of my facts. Finger sticking those tiny fingers doesn't seem like the best option.

[mizfradd, CNA]

I routinely stick finger or hallux in that age level for HgB as well as for lead testing. Why, (just wondering) does your supervisor have a problem with the toe stick?

[ChristineN, BSN, RN]

I've always done finger/toe sticks in little ones. Never did a heel stick, but I would probably be more prone to try if I needed more blood than I thought I would get from a finger.

[wonderbee, BSN, RN]

I routinely stick finger or hallux in that age level for HgB as well as for lead testing. Why, (just wondering) does your supervisor have a problem with the toe stick?

I think it's because my supervisor is not a nurse and if it's not "by the book" (the Hemocue book), she's worried that it is in violation of state protocols. I really need a nurse to be able to talk to with regard to practice issues. This is a new position and I don't think they realize that a non-nurse cannot supervise the practice aspect of my job. There are no other nurses in my department.

[BabyLady, BSN, RN]

I float down to Peds sometimes and I don't have very good luck with toe sticks, mainly because I can't get the flow of blood enough and heel sticks are much better so you don't get air in your CBG draw.

There are also more nerve endings in toes than heels, so it's a pain factor for me that I like to reduce, especially with chronically ill children.