Newborn Screening Blood Sample Collection Procedure

1. Complete the required information on the specimen collection form, using a ballpoint pen. To prevent specimen contamination do not touch the filter paper circle area.

2. Gloves must be worn for specimen collection per OSHA guidelines. Filter paper must not come in contact with gloved hands, formulas, antiseptic solutions, lotions, or other materials at any stage of the collection process. These materials may be absorbed into the filter paper and adversely affect the specimen and diagnosis.

3. Select the puncture site on the heel. The shaded areas on the following diagram indicate the preferred puncture sites. The least hazardous sites for heel puncture are medial to a line drawn posteriorly from the middle of the big toe to the heel or lateral to a line drawn posteriorly from between the fourth and fifth toes to the heel.

4. Warming the skin-puncture site may increase blood flow to the site. A chemical heel-warmer pack or a warm, moist towel at a temperature no higher than 42° C may be used on the site for 3 minutes. Keep foot in dependent position to increase blood flow.

5. Cleanse site with 70% isopropyl alcohol and allow to air dry. Vigorous rubbing during this step may stimulate blood flow to the area.

6. Puncture the skin with one continuous motion using a sterile lancet with < 2.5 mm tip. Longer tips may cause excessive tissue damage.

7. Wipe away first drop of blood with dry, sterile gauze and discard, since it may be contaminated by disinfectant or tissue fluid.

8. Allow the second drop to form by spontaneous free flow of blood.

9. Touch the filter paper form to the drop of blood, as close to the center of the circle as possible. While observing from the opposite side, allow the blood spot to enlarge until the circle is reasonably filled (2/3 filled).

A. Apply blood to one side only of filter paper. It does not matter if the blood is applied front-to-back or back-to-front on the filter paper. However, the blood must soak through from side to side.

B. It is not necessary to fill the entire circle, but attempt to fill at least 2/3 of the circle with one drop only.

C. It is permissible for the blood to go outside the circle, but do not allow blood to overlap on blood in an adjacent circle.

D. Do not apply the heel to the filter paper more than once to avoid an overlap of blood.

E. The use of capillary tubes or syringes is not recommended due to scratching the filter paper or over saturation of the filter paper. If syringes or capillary tubes are used, however, allow only one drop of blood to drop onto the filter paper, avoiding touching or scratching the paper. Do not over saturate the paper by applying more than one drop of blood per circle.

F. Additional blood may be collected on unused areas of the filter paper if there is inadequate filling of the circles, but 4-5 drops much be of sufficient size.

10. Check that written information on collection form is accurate and complete. Do not forget to fill in "date and time of collection."

11. Dry specimen for 3 hours and send to VU lab (central receiving) in a plastic specimen bag.  Do not fold form.

12. Complete a State Newborn Screen Report Form, review, have peer review with signature, have medical receptionist scan this form into StarPanel, and file in the patient chart.

13. For first specimens, give the parents the lavender-colored pamphlet (English) "Your Baby and Newborn Screening" or peach-colored pamphlet (Spanish) "Su Bebé y Exámenes en el Recién Nacido". Inform parents that the State Screen was done.