[nurseiam]

We have a short gut baby that is over 90 days old, I think about 47 weeks. I was walking by her bed the other night when they were drawing her labs capillary. The nurse made a comment about hw difficult it was. The baby is only a bi-weekly lab. So my question is @ what age are heel sticks just not worth it? At this point would it not be better to just do a venous stick. Can you imagine what her heels must look like ater all this time? And also is there any articles to back this up?
Thanks!

[NicuGal]

Does she have a central line? We get an order to draw off the line when they are that old. We have done venous sticks on them too....we use EMLA cream.

[nurseiam]

She is on her second broviac after several Picc lines so there is an order for NO labs to b drawn from it. Do you use the EMLA in the NICU? I've used it on peds. I know that she is a ped patient but there are only a few of us that know this.......

[NicuGal]

Yes...we even use it on the heels, but we sometimes have to warm them as the EMLA can cause heelsticks to not bleed so well.

I hear you on how many lines some kids go thru...it is so sad!

Have they considered just doing one art stick for all the labs...that another thing we have done.

[nurseiam]

I think that it is more of getting others including new nurses to critically think about what they are about to do. They do a heel stick because that is the way it would be done for most other pts without a drawing line. I was just thinking at that age her heals must be callised and hard as a rock!! The poor thing! I would like something concrete to take in there and say"Hey lets not punish this baby......."

[VivaLasViejas]

Uhhhhh......excuse me, but how did this thread get titled "Geriatric patient" when it's about a sick infant?????

[NicuGal]

That is what they call long-termers...the geriatric neonate LOL

[janfrn]

I work PICU and I can tell you that practice differs greatly from facility to facility. In Winnipeg, we would draw from the line if possible ( and we had lots of CVCs we weren't permitted to draw from). If the kid was big enough or was an easy stick, we'd do a venipuncture. Failing that, the lab would come and do a capillary sample. They used heels for babes under two months, then moved on to fingers or toes. The fingerpoke method can be used on anyone. It isn't really any different from a heel stick, warming the digit being the key. I also like to put a little smear of Vaseline on the site before I poke, which helps put the blood into the microtainer and not running down their hand.

[VivaLasViejas]

Thanks, NicuGal! I learn something new every day on this BB

[cswain12000]

I have a friend who has twin daughters born at 23.4 weeks and they are now ten years old. They both weighed just over a pound at birth. The hospital they were at used finger/heel/toe sticks for labs unless the pt had an art line. At ten years old--they still have no feeling in their finger tips, and scars on their heels. I don't know of any way around some of this though when you have an old timer in the NICU. At my hospital we use a combination of venipuncture-(even on the tinies) and heel sticks. We will use art lines for as long as we can in the early days when we are doing numerous labs. We never use PICC lines, but we will use broviacs and UVC's. cindy