Fingerstick or heelstick?

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We have a policy that we perform heel sticks on infants <1yr old unless the infant is walking.  This policy has always created a "grey" area on what do with children <1yr but walking.  We are using a 1.8mm depth lancet currently for finger sticks and I am concerned if staff use this on a finger of a walking 6-12mo old infant, there is a potential to hit a bone. Before I approach the lab medical director with recommendations for this grey area, I wanted to reach out to see if anyone else has a policy or practice they are using at their location that has been successful.  If so, would you be willing to share with me?

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We also use heel sticks until the age of 12 months. Our policy mentions about using the appropriate size lancet for the site. There is more concern about hitting a bone in the finger, not the heel in our policy. There is also reference to using finger puncture if the child is ambulating.

Here is a summary for WHO guidelines: Capillary sampling - WHO Guidelines on Drawing Blood - NCBI Bookshelf (nih.gov)
Additionally, CLSI document GP42—Collection of Capillary Blood Specimens, 7th Edition can detail recommended lancet size/locations for pediatrics.  

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Laura Ball
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