Newborn PKU: Heelstick vs Venipuncture?

Specialties Ob/Gyn

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I was just wondering how many of you are still doing heelsticks or venipuncture for newborn pkus.

I hear that venipunture is the way to go now since it's less painfull and supossedley faster. I have done both and don't mind either way. At my current work very few nurses are actually doing venipunture, but the push is toward venipunture. When I was doing my senior precetorship at a different hospital all we did were venipuncture unless we couldn't get it after 2 attempts then we went to a heelstick.

Also what size needle are you using? Whats the minimum size that can be used? Are you using pipettes or letting it flow? Are you using regular needles/with hub or breaking off the saftey devise?

I just thought this would make an interesting thread. I didn't see anything similar to this posted yet but ft it has sorry.

~Kim

Specializes in Maternal - Child Health.
Oh nothing like a little guilt right off the bat to a new mommy! At one hour the test is useless! I have always declined in the hospital (we usually leave with in 12 hours) and have the test done by 3 days of age.

My advice: Keep the little one in an upright baby carrier (baby bjorn, etc.) and the blood sample is obtained much easier. In the end the best sample was when I kept my daughter in the carrier, foot exposed, and the sample was taken.

T

Please don't put words in my mouth. I am not trying to guilt a new mother, but rather pass along accurate information on this test. A PKU done at 1 hour of age IS useless, and completely unnecessary, unless the baby was leaving the hospital at this time. If this baby actually had PKU, it is highly unlikely that it would have been detected based on a test done at 1 hour of age. What a waste of time, money, and discomfort!

Your advice on keeping baby upright prior to (and perhaps while) drawing heelstick blood is very good. Let gravity work with you. It pains me to read of babies with purple feet from squeezing. This is totally unnecessary and counter-productive, as squeezing causes hemolysis, not to mention pain and bruising. There is another thread on drawing heelstick blood, but 3 basic steps are: 1. Warm the extremity first. 2. Select an appropriate size lancet. Tenderfoot brand is one of the best choice, and has sizes appropriate for preemies and full term infants. 3. Gently MILK the extremity from the knee down to the heel. This results in good blood flow, without squeezing.

Finally, venous blood is perfectly fine for a PKU, as long as it is drawn using non-heparinized equipment.

Again, StuNurseUP, I am sorry for your experience. It would not be unreasonable for you to contact the hospital and request an explanation of how your child's PKU was drawn, and why it was done so soon after birth.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I hate heel sticks---imagine stepping on a HUGE piece of glass in your heel and that is how it feels for them. How sensitive is YOUR heel? If like mine, this would be a major owie. Now you know how that poor baby feels. And not only that, now you are gonna SQUEEZE that foot to get the blood flowing? (like so many of us do)

Most of the time, however, heel-sticking is how we do PKU/testing where I am, too. I have been known to do venipuncture on babies cause it is MUCH less traumatic and much faster to get those stupid spots filled, but also found, unless you really prepare the parents, they get upset. Something about seeing a bandage on the hand, versus the foot, I guess that upsets them....

Fergus' suggestions of warming the heel and using a diversion are great. If you are going to do a heelstick, you have no business sticking a cold and unprepared heel. I run very warm water in the sink in our nursery over the heel for about 5 minutes---this does two things. First, you warm and dilate those vessels, obviously. Those stupid so-called heel warmers are a waste of money and time. Warm water does it much better..... Also, gravity brings a very nice blood supply to the foot. Doing these things virtually makes it unnecessary to "milk" the foot at all---and we all know squeezing the heel is as traumatic to them as anything else---those babies hate it.

But if you are allowed to and the baby is not likely to need IV access later, IV stick for PKU is the way to go! I have had babies sleep through the procedure, doing it this way. Rarely can say that about sticking that poor heel. Plus, you get good practice for venipuncture this way!

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Specializes in ER.
Please don't put words in my mouth. I am not trying to guilt a new mother, but rather pass along accurate information on this test. A PKU done at 1 hour of age IS useless, and completely unnecessary, unless the baby was leaving the hospital at this time. If this baby actually had PKU, it is highly unlikely that it would have been detected based on a test done at 1 hour of age. What a waste of time, money, and discomfort!

Your advice on keeping baby upright prior to (and perhaps while) drawing heelstick blood is very good. Let gravity work with you. It pains me to read of babies with purple feet from squeezing. This is totally unnecessary and counter-productive, as squeezing causes hemolysis, not to mention pain and bruising. There is another thread on drawing heelstick blood, but 3 basic steps are: 1. Warm the extremity first. 2. Select an appropriate size lancet. Tenderfoot brand is one of the best choice, and has sizes appropriate for preemies and full term infants. 3. Gently MILK the extremity from the knee down to the heel. This results in good blood flow, without squeezing.

Finally, venous blood is perfectly fine for a PKU, as long as it is drawn using non-heparinized equipment.

Again, StuNurseUP, I am sorry for your experience. It would not be unreasonable for you to contact the hospital and request an explanation of how your child's PKU was drawn, and why it was done so soon after birth.

Oh, I didn't mean that you were making her feel guilty!!! I ment the fact that she felt pressured to have the test done at one hour, instead of waiting, as if the second choice were somehow neglectful. Sorry, if my post was misunderstood:)

T

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I know this is a little off the subject, but I am a new mom who was horrified at the heelstick! My little girl was just 1 hour old and they tried twice to stick her and squeezed the bejeebers out of her foot for 45 minutes! Was it really necessary? They told me I legally couldn't say no to the test. Why?

Is there really not a better way?

I'm sorry about your experience but I also don't believe that it was a pku since you must have food (breastmilk or formula) in them before the test is done, but maybe some other type of test (maybe a NICU nurse would know about.) I haven't seen other types but your probably in a different state maybe they have some other type of test.

Do you remember seening them warm the baby's foot? If it was a lab tech draw they don't often do babies draws at our hospitals and when they do (usually only for a float nurse who doens't know how) they make a mess and baby is screaming. We try to offer to do it for other nurses if they feel uncomfortable. And the gravity idea does work the best. We warm the foot but running hot water in a diaper or putting a hot wet washcloth in a zip lock bag then putting it on the foot.

Again sorry for your bad experience.

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We do heelsticks or rather the lab does them and we wait 12 hours. If we waited 24, the moms/babes would be home already.

steph

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I am sure it was a Pku test. As soon as my daughter was born, before any testing was done they wrapped her up in a blanket and I breastfed her for about 40 minutes. then they washed her and wieghed her and the lab tech took some blood work b/c I had strep B. The nurse told her to do the Pku "Since she was already there." I really wish I would have known about this test beforehand. I would have postponed it till she was at least a day old. It was pretty traumatic for us both. Thankyou for all of the information you guys are giving me. I appreciate it.

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Specializes in CV Surgery Step-down.
I know this is a little off the subject, but I am a new mom who was horrified at the heelstick! My little girl was just 1 hour old and they tried twice to stick her and squeezed the bejeebers out of her foot for 45 minutes! Was it really necessary? They told me I legally couldn't say no to the test. Why?

Is there really not a better way?

Oh, this is bringing back some bad memories. My son had to be retested (his newborn screen came back w/ low TSH and T4?) at 4 weeks. The tech/phlebotomist was great. Two weeks later we went back again--different girl. She brings out these huge vials (I ask where the small glass pipettes that they used the last time were, and I got a "huh?") and attempts to FILL THREE of them. My son is screaming bloody murder, and this is going on for over 20 minutes to both heels. My mom heard him in the waiting room and she was crying. I was crying, too, and tried so hard NOT to clock the lady in the head. Finally, I told her to stop. She bruised the crap out of his ankles, and I brought him straight upstairs to his peds office. They called the lab and reported her--she was brought in to fill in from another office. Wasn't in nursing school then. I know a bit more now...

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I am so sorry for you and your child, that is a heartbreaking experience.

I am glad that lab-tech got reported! She obviousley didn't know what she was doing.:o

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Specializes in NICU, L&D, OB, Home Health, Management.

I just got an update from our state lab and for the PKU (at least in MI) there is no longer any need for feeding at all. The important thing - according to them is to wait 24 hours because some of the tests (we now do 27) are inaccurate before that. The only time they want one done early is if the baby is going to receive a blood transfusion or TPN.

In terms of the lab tech from hell - 20 minutes and large tubes - we had a phlebe much like that a couple of weeks ago. Came into our nursery to get blood on a baby we were transferring and wanted 7cc of blood!! The doc had a fit, nurse instituted chain of command, and eventually drew micro tubes for lab. New plebe is no longer working here!!

Linda

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Specializes in NICU.
Fergus' suggestions of warming the heel and using a diversion are great. If you are going to do a heelstick, you have no business sticking a cold and unprepared heel. I run very warm water in the sink in our nursery over the heel for about 5 minutes---this does two things. First, you warm and dilate those vessels, obviously. Those stupid so-called heel warmers are a waste of money and time. Warm water does it much better..... Also, gravity brings a very nice blood supply to the foot. Doing these things virtually makes it unnecessary to "milk" the foot at all---and we all know squeezing the heel is as traumatic to them as anything else---those babies hate it.

I agree - warm water does work better than heel warmers. Of course, in the NICU I can't take very many of the babies to the sink to run water over their heels, but that does sound like the perfect way to do it! I do what we always did before we had the fancy heelwarmers - soak a washcloth in very warm water and wrap the baby's whole foot and ankle with it, then use a diaper to hold it on and keep the heat in. I don't know if it's because the whole foot is being warmed, not just the heel, or if it's the warm, moist heat - but this works so well.

If I was doing a PKU on a healthy newborn with no need for IV access, I agree that venipuncture sounds like the less traumatic way to go.

Quick question: we run heparinized saline (2units/ml) through our UAC and peripheral arterial lines. If we need to do a PKU on one of these babies, we draw back our waste blood and take the sample from these lines. I've never heard that heparin can alter the results. Should we change our practice? What are you all doing if you have arterial access already and are drawing a PKU?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I like the warm, moist washcloths, too, for babies we can't carry to the sink! I do this for our special care babies in the warmers.

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I like the warm, moist washcloths, too, for babies we can't carry to the sink! I do this for our special care babies in the warmers.

We use the pampers. Wet with warm water, wrap up the foot and tape it. It works! It actually is better to warm both feet, I have found... but not many babies tolerate having their feet "bound" :)

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