Medical Assistant Prep / Unit 20 MAS 495 review, 2 to 3 minutes
An Infant's Heel Puncture
The idea
This case is constructed for this course. It shows a heel puncture on a three-month-old baby, done with the parent's help and with a firm limit on the number of attempts.
In practice
The provider orders a capillary sample from a three-month-old baby. The medical assistant explains to the mother what will happen. She asks the mother to hold the baby securely and to talk to him, because comfort helps and stillness prevents injury. Because the baby is under six months old, she chooses the heel, on the outer edge of the bottom of the foot. She cleans the site and lets it dry completely. She makes a quick puncture with the lancet, wipes away the first drop, and collects the following drops in the order the laboratory specifies for skin punctures, hematology first. She does not squeeze the heel to speed things up. The first puncture produces too little blood, so she makes a second attempt, which fills the collection tube. She applies gauze, labels the tube in front of the mother, and comforts the baby. If the second attempt had also failed, she would have stopped and asked for a second opinion rather than trying a third time.
Where people slip
The firm limit on attempts protects the infant. Persistence feels helpful, but repeated punctures cause pain and distress and can injure a baby's heel. Knowing in advance when to stop, and who to ask for a second opinion, is part of doing the procedure well, and so is choosing the right site before the first puncture. Comforting the mother matters too, because a calm parent holds a baby more steadily than a frightened one.
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