A B C D E F G H I J K L M N O P Q R S T U V W X Y Z #

Heel Stick Specimen Collection (Newborn Metabolic Screening or Microtainer samples)

Test Code
ZHEEL


Instructions
DEFINITIONS
Heel stick: term assigned to the procurement of laboratory blood samples through skin puncture through the most medial or lateral portions of the plantar surface of the heel. 
 
This collection technique is reserved for infants, which less than 3 cc of blood is needed or venipuncture has been requested by the Pediatrician. (Venipuncture on infants younger than one year of age must be performed by an in-house Pediatrician or ED physician.)
 
Note:Only an automated heel incision device (Tenderfoot lancet) will be used for this procedure. This device is designed to make a standard incision of 1.0 mm in depth and 2.5 mm in length.
 
Do not perform punctures on the posterior curvature of the foot. Skin punctures in this area may result in injury to the nerves, tendons, and cartilage.
 
Do not puncture through previous sites that may be infected.
 
Heel-warmer: a 4X4 square pack (latex free), supplemental heat source for increased capillary circulation. Includes latex-free tape for affixing to the newborn's heel.
 
 
EQUIPMENT LIST
  1. Disposable sterile lancet (Tenderfoot® lancet)
  2. Sterile gauze squares
  3. Alcohol swabs
  4. Latex free gloves
  5. Collection containers, as required by test
  6. Microcollection containers (Red, Amber, SST, Green plasma tubes, and EDTA microvettes)
  7. Newborn Screen card
  8. Biohazard sharps container
  9. Heel-warmer
 
PREPARATORY PHASE
  1. Review physician’s order.
  2. Confirm the patient has a signed informed consent.
  3. Verify the patient’s identity according to policy.
  4. Assemble equipment.
  5. Wash your hands. Dry with paper towel.
  6. Use appropriate isolation precautions.
 
STEPS
 
1. Squeeze heel-warmer to break inner pouch to mix and activate the contents to produce heat. Apply heel-warmer to appropriate site on the baby’s foot for 3-4 minutes.
 		 KEY POINTS
 
1. Heel-warmer does not exceed 40°C (104°F).
 
 
2. Examine the foot and determine the puncture site. Wipe the puncture site in concentric circles using a 70% isopropyl alcohol wipe and allow to air dry.
 		 2. Concentric circles decrease possible contamination of clean skin with surface bacteria for adjoining skin. Allowing the alcohol to dry will decrease the pain to the patient upon puncture.
 
3. Position the Tenderfoot® lancet device on the skin surface and depress the puncture activation switch on the device.
 		 3. The device has a spring loaded mechanism to perform the skin puncture.
 
4. Wipe away the first drop of blood with sterile gauze.
 		 4. This removes any residual alcohol that could contaminate the specimen.
 
5. Collect the required specimen by touching the opening of the Microtainer® against the large drop of blood and allowing the blood to flow naturally into the Microtainer®.
 		 5. Note: do not scrape or scoop blood off of the heel, as this will collect other contaminants such as surface clots, dead skin, and tissue thromboplastin even if the site appears clean.
 
6. Collect the Newborn Screen card samples by touching the circle on the blotting pad to the blood drop and filling the circled area. Repeat the process until all of the blotting circles have been filled.
 		 6. Partial filled blotting circles can result in some tests not being performed.
 
7. Upon completion of the collection process, wipe off the heel with sterile gauze, apply pressure, and apply a sterile spot band-aid.
 		 7. This will aid the skin closure after the collection and minimize the chance of any infection to the puncture site.
 
8. Label all samples, at the patient’s bedside, with the patient’s labels (HIS/LIS), collection time, and tech code or initials.
 		 8. Patient safety requirement that all samples are properly identified.
 
9. Remove all equipment and trash from the infant’s vicinity. Dispose of the Tenderfoot® lancet device in a sharps container.
 		 9. Used collection materials pose a risk to patient safety.
 
10. Document the completed collection in the patient’s chart, in accordance with the hospital policy.
 		 10. Completed collection documentation helps prevent repeat collection of samples.
 
 Instructions for Newborn Metabolic Screening:
Apply a patient label to the Newborn Screen form.  Complete all information requested on the form.  See Newborn Metabolic Screening (code NMS) for more details for completion of the form and submission to the lab. 

  
Instructions for EDTA Microvettes:
a. Collect blood with the assembled End-to-End capillary, holding microvette in horizontal or slightly inclined position.
b. Collection is complete when the End-to-End capillary is completely filled with blood.
c. Hold the tube upright to allow blood to flow from capillary into microvette.
d. Turn the cap to remove and discard the preassembled capillary as one unit.
e. Remove the cap from the base and seal the microvette ('click' position)
f. Mix sample by inverting 7-8 times.




The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.