Phlebotomists collecting blood from children and neonates must be well trained and practiced in phlebotomy or venepuncture techniques for these groups of patients. A uniform and safe sampling technique is crucial to reduce pain and psychological trauma to the patient.
Practical guidance- paediatric and neonatal blood sampling
Patient identification
For paediatric and neonatal patients, it is important to ensure that patients are correctly identified before taking blood. Check the name, date of birth and hospital or file number written on the lab form to correctly identity the patient. Also need to check for the typing and entry errors while registering patients on computerized systems.
Selection- site and procedure
The selection of site and procedure-venous site, finger-prick or heel-prick (also referred to as capillary sampling or skin puncture) will depend on the volume of blood needed for the procedure and the type of laboratory test to be performed.
Venepuncture can be a method of choice for blood sampling in term neonates as it is believed to cause less pain than heel-pricks; however, it requires the expertise of an experienced and trained phlebotomist. At times, a capillary blood specimen from a finger-prick or a heel-prick is appropriate method for blood sampling. The blood from a capillary specimen is similar to an arterial specimen in oxygen content and is suitable for only a limited number of tests because of its greater probability of contamination with skin flora and lesser total volume.
Finger and heel-prick
Whether to select a finger-prick or a heel-prick will depend on the age and weight of the child. Patient immobilization is crucial to the safety of the paediatric and neonatal patient undergoing phlebotomy, and to the success of the procedure. A helper is essential for properly immobilizing the patient for venepuncture or finger-prick in a child or neonatal case.
Venepuncture- Equipment and supplies for paediatric patients-Key points
A winged steel needle, preferably 23 or 25 gauge, with a butterfly can be used.
Remember that the common butterfly needles are 1/2 to 3/4 inches long and come in a range of gauges, with 21 and 22 gauge the most frequently used for adults. The smaller gauge- 23 or 25 can be used preferentially with pediatric patients.
A butterfly can be used with either a syringe or an evacuated tube with an adaptor.
Remember that a butterfly can provide easier access and movement, but movement of the attached syringe may make it difficult to draw blood.
Avoid very small gauges of needle as they may be associated with an increased risk of haemolysis.
A syringe can be used with a barrel volume of 1–5 ml, depending on collection needs.
When using an evacuated tube, choose one that collects a small volume (1 ml or 5 ml) and has a low vacuum which can help avoid collapse of the vein and may decrease haemolysis.
Use safety equipment with needle covers or features to minimize blood exposure.
Auto-disable (AD) syringes only designed for injection are not appropriate for phlebotomy.
Patient Preparation
Immobilize the child- It is vital to the successful and safe phlebotomy practice to immobilize the child. Ask whether the parent of a child would like to help by holding the child. If the parent wishes to help, provide full instructions on how and where to hold the child; if the parent prefers not to help, ask for assistance from another phlebotomist or staff.
If required, take the following steps to improve the ease of venepuncture process.
Keep the child warm, which may increase the rate of blood
Warm the area of puncture with warm cloths to help dilate the blood vessels.
Use a transilluminator or pocket pen light to display the dorsal hand veins and the veins of the antecubital fossa.
Let the parent or caregiver hold the infant, leaving only the extremity of the site of venepuncture exposed.
Ask the parent to rhythmically tighten and release the child's wrist, to ensure that there is an adequate flow of blood.
Drawing blood-Key points
Follow the procedures related to hand hygiene and asepsis
Patient identification and positioning
Skin antisepsis (due to limited safety data, CHG is not recommended for use in children <2 months of age).
Once the infant or child is immobilized, puncture the skin 3–5 mm distal to the vein which allows good access without pushing the vein away.
Draw blood slowly and steadily.
References:
You can also read:
https://www.springfieldcollege.ca/post/platelet-rich-plasma-prp-application-medical-aesthetic-fields
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