• H Vertanen, V Fellman, M Brommels, and L Viinikka.
• Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland. helena.vertanen@hus.fi
• Arch. Dis. Child. Fetal Neonatal Ed. 2001 Jan 1;84(1):F53-5.

ObjectivesTo evaluate in a randomised blind study the effect on puncture site lesions of two different incision devices used to obtain blood samples from preterm infants by repeated heel sticks.SettingThe neonatal intensive care unit at the Hospital for Children and Adolescents and Laboratory, Helsinki University Central Hospital.PatientsA total of 100 preterm infants (birth weight below 2500 g) not previously subjected to heel stick sampling.InterventionsThe infants were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. The same type of lancet was used for any given baby throughout the study (2-21 days).Main Outcome MeasuresThe damage caused by sampling was evaluated using four criteria: bruising of the heel, inflammation of the heel, bruising of either the ankle or the leg, and skin healing at the puncture site. The evaluation was based on photographs presenting typical categories of each outcome.ResultsTo obtain a sufficient volume of blood, on average 2.6 times more punctures were needed when the conventional manual lancet was used than when the automatic incision device was used. Heels punctured with the lancet had more bruising (100% v 84%) and more signs of inflammation (79% v 53%), and there was more bruising of the ankle or leg (92% v 53%) than when the automatic incision device was used. Skin healed equally rapidly in the two groups.ConclusionThe use of an automatic incision device for collecting repeated skin puncture samples from preterm infants is less traumatic than the use of a conventional manual lancet.

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