Blood Drawing From Peripheral Sites: Heel Stick and Finger Stick



Blood Drawing From Peripheral Sites: Heel Stick and Finger Stick









CHILD AND FAMILY ASSESSMENT AND PREPARATION



  • Assess child for signs of poor perfusion, local edema, infection at the site, and impaired blood coagulation. The presence of these findings can lead to inadequate sampling, blood specimen contamination, increased pain, and infection. Avoid edematous areas because the presence of the fluids can contaminate the blood specimen. The presence of ecchymosis or hemolyzed samples can give false results (e.g., elevated bilirubin or potassium levels). Rotate the sites of puncture to decrease these complications.


  • To decrease procedural pain, apply topical anesthetic (e.g., lidocaine, prilocaine), or mechanical device (e.g., Buzzy Pain Relief System) for finger stick before procedure, as time allows, and based on child’s preference. The research is conflicting, but most studies indicate that topical anesthetics are not effective for the pain of heel stick. Because a risk for methemoglobinemia exists, do not use lidocaine and prilocaine if the child is receiving methemoglobin-inducing agents (e.g., sulfonamides, acetaminophen).


  • Question the family about the existence of coagulation disorders in their family history and previous signs of a blood dyscrasia (e.g., the presence of unexpected ecchymotic spots or prolonged bleeding after blood testing or injury).


  • Administer vitamin K per newborn routine before heel stick to increase clotting and prevent prolonged bleeding.


  • Verify healthcare prescriber’s order for laboratory tests.


  • Explain procedure to child, as appropriate, and family caregivers.


  • Prepare the child, as appropriate, to cognitive and developmental level (see Chapter 2). Provide therapeutic play as indicated, or involve a child life specialist, to allow the child to work through fears, help with the procedure (e.g., hold Band-Aid), and master control of the situation.


  • Encourage a family member to remain with the child during the procedure. Discuss with the family member comfort measures and holding techniques (e.g., swaddling, skin-to-skin contact, breastfeeding, use of sucrose pacifiers, sweet tasting solutions) and distraction techniques (e.g., audiovisual) that they can use with their child. Select measures to employ and initiate use of these measures prior to beginning the procedure (see Chapter 7).


Jul 9, 2020 | Posted by in NURSING | Comments Off on Blood Drawing From Peripheral Sites: Heel Stick and Finger Stick
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