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Analysis

How to take a newborn blood spot sample

14 May, 2013

How to take a newborn blood spot sample

The UK Newborn Screening Programme Centre provides guidelines on performing the heel prick test to obtain a good quality newborn blood spot sample.
Midwives magazine: Issue 3 :: 2013

The UK Newborn Screening Programme Centre provides guidelines on performing the heel prick test to obtain a good quality newborn blood spot sample.


The UK National Screening Committee recommends that all babies up to one year of age are screened for phenylketonuria, congenital hypothyroidism, sickle cell disease, cystic fibrosis (babies can only be screened for cystic fibrosis up to 56 days of age) and medium-chain acyl-CoA dehydrogenase deficiency (UKNSPC, 2012a). The programme aims to achieve early detection, referral and treatment of any babies who are thought to be affected by one of these conditions.

Taking a good quality newborn blood spot sample is an important skill and a core competency for all practising midwives. However, not all samples received by the screening laboratories are adequate (UKNSPC, 2012b). In England in 2010-11, the overall rate of insufficient and unsuitable samples was above 3% (UKNSPC, 2012b). This equates to nearly 20,000 babies each year needing an avoidable repeat heel prick. There have also been reports of poor practice in newborn blood spot sampling (Ray et al, 2011; UKNSPC, 2012c).

The following step-by-step guide demonstrates how to take a good quality newborn blood spot sample. Information on blood spot screening for babies born prematurely, those cared for in hospital 

and older babies is available in Guidelines for newborn blood spot sampling (UKNSPC, 2012a). 


Preparation for the sample

► The routine blood spot sample is taken on day five, and in exceptional circumstances between days five and eight (day of birth is day 0)

► It is essential to offer parents an informed choice about screening for their baby and to gain consent

► Ensure that parents have a copy of the pre-screening leaflet at least 24 hours before sampling (UKNSPC, 2010). Explain the procedure to parents and record in the maternity record that screening has been discussed and recommended, the leaflet given and consent sought

► Explain to parents that the blood spot cards are stored by the laboratory for a minimum of five years after initial testing and may be used in several ways (UKNSPC, 2005); this is currently under review. Very occasionally, parents may be contacted to ask if they would like to take part in research linked to the screening programme. If parents do not wish to receive such invitations, the card should be clearly marked ‘No research contact’

► If the parents consent to screening, record ‘consent’ in the maternity record and personal child health record (PCHR) and proceed with sampling

► If the parents decline screening, for each condition declined record ‘decline’ and the reason (if stated) in the maternity record and PCHR. 


Blood spot card

► Check the card’s expiry date and place on a clean surface

► Complete the details at the time of sampling. Ideally, a bar-coded NHS number label should  be used (UKNSPC, 2013). Complete all other fields using legible handwriting. If a label is not available, ensure all fields are completed

► The baby’s NHS number on the card is mandatory in England

► Check with the parents that all the details are correct. 


Collecting the sample

► Recommend comfort measures, such as feeding the baby while the test is carried out, as this may help put them at ease 

► Clean the heel by washing thoroughly with tepid, plain water. Do not use alcohol or alcohol wipes. Allow the heel to dry completely

► Ensure the baby is comfortable and warm. Additional warming of the foot is not required

► Obtain the sample using an automated incision device designed for use on newborns. Avoid posterior curvature of the heel. Allow the heel to hang down to assist blood flow. Before activation, place the device against the heel in accordance with the manufacturer’s instruction

► The aim is to fill each circle on the card completely using a single drop of blood

► Wait for the blood to flow. Allow one spot of blood to drop onto each circle on the card:

- Do not allow the heel to make contact with the card

- Do not squeeze the foot

- Allow the blood to fill the circle by natural flow and seep through from front to back

- Do not layer the blood

- Do not compress the blood spots

► If the blood flow ceases, wipe the congealed blood away firmly with cotton wool or gauze. Gently ‘massage’ the foot, avoiding squeezing, and drop the blood onto the card. If the baby is not bleeding, perform a second puncture on a different area of the same foot or the other foot. A good sample can usually be obtained after a second attempt, but if this is not the case, another midwife or health professional should be asked to obtain the sample as soon as possible and discuss any training needs required

► When sample collection is complete, wipe excess blood from the heel and apply gentle pressure to the wound with cotton wool or gauze. Apply a hypoallergenic spot plaster if required.


After taking the sample

► Allow the blood spots to air-dry away from direct sunlight before placing in a glassine envelope

► Despatch the card on the same day by the agreed local method (for example, prepaid envelope). If this is not possible, despatch within 24 hours

► Record that the sample has been taken in the maternity record and PCHR where available. If the baby is in hospital, record the baby’s screening status on discharge/transfer notifications

► Inform parents that they will receive the results within six to eight weeks (sooner if the baby screens positive for a condition).


Blood spot sample 1

Blood spot sample 2

Blood spot sample 3






















Illustrations by Ben Hassler

















For more resources, see:

► Written, evidence-based guidelines that provide a consistent approach to blood spot sampling: newbornbloodspot.screening.nhs.uk/bloodspotsampling (UKNSPC, 2012a)

► A short film of the blood spot sampling procedure: newbornbloodspot.screening.nhs.uk/bloodspotfilm 

► An interactive, e-learning resource on the blood spot card: newbornbloodspot.screening.nhs.uk/interactive-card 

► For further information on what to do if parents decline, see: newbornbloodspot.screening.nhs.uk/consent



References

Ray R, Godwin Y, Shepherd A. (2011) Convective burn from use of hairdryer for heel warming prior to the heel prick test – a case report. BMC Pediatrics 11: 30.


UKNSPC. (2005) Code of Practice for the retention and storage of residual spots. See: www.newbornbloodspot.screening.nhs.uk/cms.php?folder=2547 (accessed 14 March 2013).


UKNSPC. (2010) Blood spot screening for your newborn baby. See:  www.newbornbloodspot.screening.nhs.uk/languages (accessed 14 March 2013).


UKNSPC. (2012a) Guidelines for newborn blood spot sampling. See:  www.newbornbloodspot.screening.nhs.uk/bloodspotsampling (accessed 14 March 2013).


UKNSPC. (2012b) Data collection and performance analysis report: newborn blood spot screening in the UK 2010-11. See:  www.newbornbloodspot.screening.nhs.uk/performance (accessed 14 March 2013).


UKNSPC. (2012c) Incidents and serious incidents reported to the UKNSPC between April and September 2011. See: www.newbornbloodspot.screening.nhs.uk/serious-incidents (accessed 14 March 2013).


UKNSPC. (2013) Bar-code project. See: www.newbornbloodspot.screening.nhs.uk/bar-code-project (accessed 14 March 2013).










































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