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Reducing Neonatal Pain during Routine Heel Lance Procedures

Morrow, Carla DNP, CNM, RN; Hidinger, Andrea MSN, RNC, IBCLC; Wilkinson-Faulk, Debbie PhD, RN, CPNP

MCN: The American Journal of Maternal/Child Nursing: November-December 2010 - Volume 35 - Issue 6 - p 346–354
doi: 10.1097/NMC.0b013e3181f4fc53

Purpose To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group.

Design and Methods A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Infants in the experimental group (n = 22) were swaddled and held in an upright position during routine heel lance procedures while neonates in the control group (n = 20) remained in a standard care position. Pain was measured with the Neonatal Inventory Pain Scale (NIPS) at two points in time for each group (just before the heel lance procedure and at the completion of the heel lance). Total collection time was measured using a stopwatch accurate to 1/100th of a second. Specimen quality was measured based on the number of rejected specimens for each group. Descriptive statistics and t tests were used to analyze the data.

Results The mean NIPS score for neonates who were swaddled and held during the procedure (experimental group) was significantly lower (M = 1.3, SD = .9) than the score for infants in the standard position (control group) (M = 2.7, SD = 1.3), t (40) = -4.48, p < .001. Although the total collection time was lower for infants who were swaddled (2 minutes and 17 seconds, SD = 59) versus (2 minutes and 47 seconds, SD = 85) for controls, this was not a statistically significant difference (p = .45).

Clinical Implications Swaddling combined with positioning neonates upright during routine heel lance procedures offers nurses a nonpharmacologic method of neonatal pain reduction for heel sticks. This technique can be easily implemented on any unit independent of facility protocols. Furthermore, the technique is not associated with any cost or policy development, making it more likely that nurses can use it in practice.

What is the best method of reducing neonatal pain during heel lancing? These nurses launched a randomized control trial of different methods to find out.

Carla Morrow is a Certified Nurse-Midwife, Texas Health Harris Methodist Hospital Cleburne, Cleburne, TX. She can be reached via e-mail at

Andrea Hidinger is a Perinatal Clinical Specialist, Texas Health Harris Methodist Hurst-Euless-Bedford, Bedford, TX.

Debbie Wilkinson-Faulk is a Pediatric Nurse Practitioner, John Peter Smith Hospital, Fort Worth, TX.

The authors have disclosed that there are no financial relationships related to this article.

For 37 additional continuing nursing education articles on neonatal topics, go to

© 2010 Lippincott Williams & Wilkins, Inc.