Neonatal blood sugar checks

  1. I had issues the other night trying to get blood out of a tiny twin preemies' heels to do q2hr blood sugar checks. I could barely get a drop and I felt terrible squeezing their little legs. I am not an OB nurse, but was floated there so I am not an expert on this and was wondering if you guys had any input. I warmed their heels first and it helped some. I didn't use alcohol because I was told it would alter the result. And I didn't wipe away the first drop because I was afraid I couldn't get another. Any thoughts?
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  2. 8 Comments

  3. by   SmilingBluEyes
    I always run very warm water in the sink and then warm the heel with that. Those heel warmers are USELESS and an expense, to boot.

    Another suggestion is to have mom/dad hold the newborn, comforting him, and let the heel dangle down toward the floor as you let the blood droplet grow. Gravity is definately your friend here!

    You absolutely SHOULD use alcohol to clean the foot. But what I do is, after cleaning, I allow a few seconds for the alcohol to dry. Then, I let the first blood droplet get really big, drop off onto a cotton ball, and use the NEXT droplet that forms for my test. This won't alter your result that way.....

    If you use warm water, let it run over the heel for at least 1-2 minutes and dangle that foot; you should have no problem getting plenty of blood for PKU tests, and lab draws, as well as blood sugar checks. This will really eliminate the need to repeatedly squeeze the foot to get blood, which at least, in a CBC can cause a problem with hemolysis. It also really upsets the baby!

    Good luck. Try these simple things and see if they work for you. They never fail for me~!
    Last edit by SmilingBluEyes on Jan 26, '07
  4. by   33-weeker
    I don't have trouble getting single drops of blood for bedside glucoses - how small were the babies?

    I don't squeeze their 'legs', I encircle their heel with my fingers and thumb and squeeze in a circular motion. The trick is in the squeezing - and in the pricking - are you pressing the lancet guide close enough against the skin when you press the button?

    Obviously gravity and warmth (and thus dilation of the vessels) help, too.
  5. by   strn96
    I've found that if you take a washcloth, fold it in fourths to make a long strip, and run it under warm water and then wrap it around the baby's heel it works really well. A lot better than heel warmers!
  6. by   ElvishDNP
    Quote from strn96
    I've found that if you take a washcloth, fold it in fourths to make a long strip, and run it under warm water and then wrap it around the baby's heel it works really well. A lot better than heel warmers!
    Probably a lot cheaper too. I will use that in the future. Thanks!!
  7. by   matchstickxx
    In the NICU we do use the heel warmers. I put the heelwarmer on the baby and then do an assessment on the baby. By the time my assessment is completed, the heel should be warm enough. (about3 minutes) Press the lancet firmly against the foot as you activate it.
    If you do use the warm wet washcloth technique, be sure your washcloth does not get cold before you start the heelstick. I have seen many nurses get sidetracked and by the time they get back to the baby, the foot is cold again.
    Last edit by matchstickxx on Feb 4, '07
  8. by   AnnieOaklyRN
    This is probably a stupid question, but...

    Do you guys use special lancets for heal sticks or do you just use the teh adult ones for the older babies??
  9. by   EricJRN
    There are lancets that come in newborn and premature sizes.
  10. by   twinkletoes53
    Quote from Sweetooth EMT-P, RN
    This is probably a stupid question, but...

    Do you guys use special lancets for heal sticks or do you just use the teh adult ones for the older babies??
    We use lancets that are designed for use in newborns. They are automatic puncture devices which limit the depth of the puncture to 1 millimeter (mm.) in term babies. We use a shorter lancet to draw blood from preemies.

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