Venepuncture Versus Heel Lance: Which Is Less Painful for Newborn Blood Sampling?

Venepuncture, the process of inserting a needle directly into a vein, may be less painful for full-term newborn babies than the standard heel lance method, according to a Cochrane review updated through July 2025. The analysis of eight studies involving 826 infants suggests venepuncture also reduces the likelihood of needing multiple skin punctures when no sugar-based pain relief is used.

Routine blood sampling is required in most countries for newborn screening tests and to manage conditions like low blood sugar (hypoglycemia) or jaundice. Because untreated pain in newborns can impact brain development and physical growth, clinicians often use sucrose solutions to mitigate distress. Pain is typically assessed through heart rate changes, crying, and facial expressions.

Comparing Venepuncture and Heel Lance Methods

Heel lance is the global hospital standard for collecting blood samples smaller than 1 mL. The procedure involves using an automatic device to make a puncture between 1 mm and 2 mm deep in the infant’s heel, followed by squeezing the area to collect blood. This method does not require specialized training for the practitioner.

Venepuncture requires a trained professional to puncture a vein directly. It is typically utilized when a sample of 1 mL or more is needed. According to the review, this technique can prevent the repeated skin punctures and associated risks, such as skin infections, that sometimes occur with heel lancing.

Impact of Sucrose on Pain and Procedure Success

The Cochrane review found that the effectiveness of these methods varies depending on whether a sweet-tasting solution is administered for pain relief.

• Without sugar solution: Data from six studies involving 488 babies indicates venepuncture probably causes less pain than heel lance. In six studies of 397 babies, venepuncture probably reduced the need for more than one puncture.
• With sugar solution: Three studies involving 170 babies suggest venepuncture may cause less pain. However, evidence from two studies of 110 babies left researchers uncertain about whether venepuncture reduces the need for repeat punctures when sugar is used.

Evidence Limitations and Study Scope

The review synthesized data from eight studies conducted in the UK, Spain, Nepal, Malaysia, Japan, and Sweden. Despite the findings, the authors rated their confidence in the evidence as ranging from moderate to very low.

Several factors contributed to this limited confidence. The review cited issues with how infants were assigned to groups and how results were reported. Additionally, the practitioners performing the procedures knew which method was being used for each baby, which may have influenced the pain assessments.

The report concludes that larger, better-designed studies with full reporting are necessary to definitively determine which blood sampling method is superior for newborn babies.