Heelstick vs venipuncture?


In my unit, in NJ, we do heelsticks for labs. But I wonder why we don't do venipunctures instead of gashing up their poor heels so much. I understand using the heels for small draws (blood sugar, blood gas). I guess we might end up losing all the veins for potential PIV sites, but it seems like it would cause much less pain...

Any thoughts? Does your NICU do heelsticks of venipunctures? Just curious to see what others think and any reasoning that might go with it as I am new to nursing and NICU.


409 Posts

Specializes in NICU.

We do heelsticks for our labs. If we have an excessive amount of labs to get, we will have the docs do an art stick for us. While I hate seeing their poor heels, I feel it's a whole lot better than the possibility of having to stick them multiple times for a lab trying to find a vein. Especially when we need to save veins for PIVs for blood and stuff.

iluvivt, BSN, RN

2,773 Posts

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

Yes we do heelsticks at our facility unless a lot of blood is needed. you are correct in your thinking...it can be incredibly difficult to locate and then successfully access a vein on a neonate and repeated venipunture can damage the vessels. Think venous preservation here and having a vein that is undamaged for peripheral IV therapy


146 Posts

Specializes in ICN. Has 24 years experience.

We do nearly all our own labs. We can stick the baby where ever we feel would get the most blood the quickest, and we rarely use heel sticks unless it is for a blood gas or blood sugar. Generally, I prefer to do an art stick (and yes, nurses can do them where I work) because I'm terrible at hitting a vein, but others do the back of the hand or the side of the foot for w venipuncture.


NicuGal, MSN, RN

2,743 Posts

Specializes in NICU, PICU, PACU. Has 30 years experience.

Heelsticks unless a large volume is needed then it is from an art stick. If it is a bigger kid with a central line we will use that. We rarely use veins.

Because you'll only be able to use a neonate's vein twice, tops, before you blow it. Then after a couple of days you'll be out of veins for labs, IVs, PICCs.

The key to doing heelsticks is using a proper sized lancet.We use Tenderfoots.I use the smallest one possible for my need. I will use a micro preemie lancet if I just need a drop of blood for an Accu Check. If it is a term kid and I need a CBC, I will use the largest size we have. The lancet should be held horizontally against the fattest part of the heel.. Be mindfull of where your "V" is. Do not stick the middle of a heel or outside of these shaded areas:


Your heels will be less, "torn up" and your pt will have less pain.


113 Posts

Heel sticks for labs unless we need a large amount or a CBC keeps clotting. Our RTs do our art sticks (and a doc if nobody can get it).

Remember some basics. Keep gravity in your favor! get the foot lower than the body, up that HOB some more. Inside of the foot gets more blood flow, bleeds better. Also, let me just add a little horror story. One baby's entire leg got all bruised up and battered from someone trying to force enough blood out of one heel stick for labs... family took pictures of said leg, etc. in case it didn't get better. Occasionally, you're going to have to stick the heel a second time - better do that, then cause damage.

Specializes in Level III NICU. Has 7 years experience.

We do heelsticks for our labs, unless a large volume of blood is needed. In those cases, we typically do art sticks. We (the nurses) do art sticks in my unit. If we only need a small amount of blood, but the docs want a central stick (to verify high K or Hct from a heelstick), we would do a venipuncture. Sometimes the key to not having to repeat labs is getting a good blood flow from the heel. We also try to be mindful of what labs are needed, and trying to do as much at once as possible. If the docs want a blood gas at midnight, and there are also morning labs ordered, we will ask them if it is okay to draw everything at midnight and hopefully only have to do one heelstick to get everything.


8 Posts

We rarely use heelsticks, except for CBG's and blood sugar. We have had some travel nurses and nurses come from other hospitals that want to know, why in the world we don't use heelsticks more. I really don't know. We do a lot of venous sticks for labs. I personally am trying to be better about using heel sticks, but as a unit we do 95% venous sticks. It looks to me like my hospital is in the minority, but then again we have old Dr's that apparently are old fashion.


234 Posts

I'm a new nurse so I've only worked in the NICU I'm currently at. We do venipuncture for the majority of our labs unless there's a central line. Heelsticks with the tiny lancets are mainly used for glucose testing. Sometimes they tell me it's ok to do a heelstick if it's just for a bilirubin test, but they prefer venipuncture for electrolytes because there's less chance of hemolysis causing false K+ levels.


142 Posts

Specializes in Neonatal nursing (paediatric trained).

We have the paediatric phlebotomist come do venepunctures every Tuesday morning on whoever needs them. Outside of that, the doctors or senior nurses will do venepunctures. If it's just a CBG, the doctors/senior nurses will do that via heel stick (we get our SBRs this way as well, as it comes out on the gas - if it's past a certain level, they try to get enough to send to the lab, as the gas machine becomes questionable after a certain level). If it's just a blood sugar or Gent level, it's a heelstick. And of course, we try to combine things - so, before one of my intensive babies is next due it's umpteenth blood sugar, I check to make sure the doctors aren't about to do some other bloods via venepuncture anyway.


188 Posts

Specializes in NICU. Has 11 years experience.

Our guidelines tell us to do the least invasive method that is appropriate for the lab we need to draw. On admission, we almost always do an arterial stick to get initial labs, and the nurses can do radial artery sticks. The MD or NP can do other arteries. For routine labs, we almost always do heelsticks. Once in a while, if we have to verify a K level or something like that, we will do a venous...but in the past two years, I think I have only done maybe three venous sticks total.

We do utilize a UAC for the first few days on our sicker/smaller kids to allow for more frequent lab draws. And once in a while, we will use a PAL both for BP monitoring and blood collection. But for the most part, we are a heelstick unit.

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