After reading the post from Raindreamer, I just felt like this needed to be covered more.
1. You don't have to use the deepest device you can find!
The capilary bed is not very deep, and by going deeper you cut into muscle and connective tissue that has more thrombin (it is a clotting factor) in it to help heal deaper wounds so you don't bleed to death. So by going deeper you do not cut into anymore capilaries just muscle and tissue so no increase in blood is gained and you have released more clotting factor into your sample making it more likely to clot your sample and to stop bleeding.
You have also caused more scarring, and created a longer healing time to be needed. And if the site was not prepared correctly you may have introduced bacteria deeper inside.
2.If you need more blood make a longer cut (but not deeper).
By going longer you cut into more of the capilary bed getting more blood without getting the thrombin from the muscle and connective tissue.
3. Yes I said cut not puncture in number 2.
By making a cut not a punture you decrease the pain responce. Even BABIES FEEL PAIN! and a cut stimulates the pain responce differently than a punture. When the baby constricts its legs in responce to pain blood flow decreases due to just like it says vaso-constriction. When the leg muscles do not relax it puts direct pressure on the capilary and veinus systems. (Make a fist and you will see your veins get tighter and smaller on your handand when you relax they get larger, well it works just like that.)
So, I put here do what you can to reduce pain, sweetease or whatever you can do.
4. Did I say Pain in number 3.
Well dont squeeeeeeeze too hard or for to long. By being to tight it just hurts. But, by being to tight and to long it actually emptys the capilarys out compleatly. (Have you ever blown up a balloon? Well when you first start it is difficult to fill as it is empty. But when it is partially full it is easy to blow up, This is PEEP for those vent nurses out there.) Well the same thing goes for capilarys. So don't try to get every last drop from one squeeze leave it patially full and it will fill faster when you let go.
5. Yes I said let go in number4.
You have to let more blood in so dont just squeeze, squeeze, and squeeze some more relax and let the blood pool. But don't just let go of the foot as this will get blood all over your nice clean blankets.
6. Warm the foot!
I don't care which foot you warm or stick if you warm one blood flow will increase in both. (Check out any anatomy book to find out why).
7. Gravity is your friend, use it.
Do I need to say more?
8. Know the V and how to use it.
Where are your capilary beds located? Well the answer is on the sides of the heels in the fatty tissue, NOT over the bone! If it feels like bone don't stick it, You can cause ostiomelitis and the lose of a leg.
It is my recomendation that you use the inside of the heel for just a Dex. and the outside for blood draws when you need more volume as there are larger capilary beds there and will bleed better.
9. Combine all the blood draws together to minimize the number of sticks.
10. Be ready to finish, clean off the heel, and place a bandaid.
I am sure I left out somethings so please add as you see fit.
Feb 5, '07
good advice. i found lots of great advice here when i first started learning to do heelsticks, helped a lot.
another good thread regarding heelsticks: heel sticks?
Feb 5, '07
i really like this post, i worked in a pedi clinic where we do all the pku's for newborns and i watched nurses who would squeeze the poor baby's foot until it was blue! My best results were to have mom hold the baby like she were burping him/her and i never had a problem, most of the time the babies never flinched when i stuck them.
Feb 6, '07
Once we had a babe brought in by EMS (field delivery) that was slow to warm (per EMS). So they had done a heel stick right IN THE MIDDLE of this kid's foot! :angryfire Not on the heel, but in the middle of her PLANTAR SURFACE!
Feb 6, '07
All good info on heelsticks ya'll. I too had to learn from experience and it certainly does get easier with practice and knowlege of the proper method. I had some really good teachers even though they may have been a little bit backward in their technique as they didn't use any heel warming when I first came on. Change comes hard but they caught on quickly when the new heel warmers arrived and as new people came into our unit with experience elsewhere and knowlege of the benefits of heel warmers, things gradually started to change.
I would add that if you are in a place that doesn't provide heel warmers or if you are ever in need of one and it's not handy, I have found that a clean diaper wetted with warm (just right, not too hot) water will do just as well...simply hold it baby side up under running water and it will soak it up, then wrap the baby's foot and wait your usual 5-10 mins prior to sticking. It won't get your bed wet since the outside is water proof.
Jul 21, '07
I know this is an old post, but it came up on the bottom of a thread and I wanted to say thanks! I start in the NICU August 6 and I can't wait. I precepted there for 12 shifts and fell in love. So I'm here soaking up as much info as possible from all of you experienced NICU RNs
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