Newborn PKU: Heelstick vs Venipuncture?

  1. 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
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  2. 30 Comments

  3. by   JaneyW
    I would love to hear from those doing venipuncture. I HATE doing heelsticks. It is torture for the baby and for me! I am mostly in L&D, but on the days I do PP, I feel like I would pay someone else to do bloodwork for me. We do heelsticks for CBCs and CRPs. I think I am going to start doing venipuncture. I did a heelstick last weekend and it was AWFUL.
  4. by   fergus51
    I work NICU and will not waste a vein on a premie for the PKU. I will do it on term babies where IV access is not such a concern, but honestly I don't see a big difference. I've been doing heelsticks for so long that I'm pretty good at them and the babies don't fuss much at all as long as they have their sweetease and their pacifier.

    We use 24 gauge safety butterfly needles (the same ones we use for blood cultures) with a 3 cc syringe attached to pull back.
  5. by   labman
    Hi everyone

    I know we do heel stick for PKU on babies. I think trying to hit the vein is way to hard on such a little baby. I still hate doing them with a passion. I just can't do them. Well I would love to hear from a place where they do them venipuncture.

    KENT
  6. by   Krojas21
    For venipuncture:
    In my senior preceptorship we would use a regular need with hub (23-25G, I think) enter the vein in the back of the hand by bending their wrist and our own had was the tournoquet. We used glass pipettes in the hub then blotted the circles on the pku test paper.

    Where I work now the nurses that do do venipunture just use a safety needle (I think 23 G) (but they break off the safety part because it gets in the way) and lets the blood flow out of the hub and catch it on the test paper.

    If you use a butterfly needle and syringe, do you have to draw back very slowly so as to not collapse the vein or injure the area? I haven't done blood draws besides a bili and that was a heelstick. Thanks for any info.
  7. by   fergus51
    Quote from Krojas21
    For venipuncture:

    If you use a butterfly needle and syringe, do you have to draw back very slowly so as to not collapse the vein or injure the area? I haven't done blood draws besides a bili and that was a heelstick. Thanks for any info.
    Fairly slowly, but not excessively so on term babies. I've never had a vein on a term kid collapse from that. Their veins are comparitively big to me since I deal more with premies and we use these safety needles on premies as well (all our babies get a blood culture drawn on admission and those are the needles we are required to use in order to avoid contaminating the sample). The IV with pipette method is just a lot more work IMO.
  8. by   StuNurseUP
    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?
  9. by   Jolie
    Oh boy, where did you have your baby?

    First of all, a PKU is next to useless at one hour of age, and should have been repeated if it was indeed done so early. Babies need to ingest and metabolize protein in order for the PKU to be accurate. For this reason, they are usually done as near to discharge as possible. After 24 hours of age, at least.

    By any chance, might it have been a blood glucose that was being drawn at that time?

    Secondly, a parent has the right to refuse any procedure. If a parent wishes to decline a state-mandated test such as a PKU, s/he may be required to fill out an AMA form, but without a court-order, no test or treatment can be imposed upon your baby against your will.

    Lastly, heelsticks, like any procedure, are perfected with practice and experience. I can draw heelstick blood better than most of my colleagues because I've had 11 years of practice on infants ranging from 500g to 5 kilos. Any nurse or lab tech who had difficulty doing this on your baby should have immediately stopped and found someone else to complete the test.

    I'm sorry you had such an experience.
  10. by   StuNurseUP
    I am sure it was a pku test...It was done on those green cards with 5 dots to fill with blood. The lab tech couldn't get it done and so I said that I wanted them to wait bacause my little girl's foot was dark purple from all of the squeezing. But the nurse said " no she was going to try". Next time I will request one of you NICU nurses.
  11. by   jrring1019
    Quote from Krojas21
    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
    I have always done heelstick. Someone told me once that the plastic in the syringe can affect the test...anyone ever hear of this? I also would cause more trauma to a baby fishing for a vein. I have always thought the heelstick was cruel and unusual punishment, but there are techniques to make it a little easier.
  12. by   crjnursewarrior
    I have no experience to shed on this subject, as I am not a NICU or OB nurse, however, I found this thread interesting. My daughter was born with Tetralogy of Fallot and stayed in the NICU for 5 days after birth. She had to have daily H&H drawn and the nurses there did heel sticks. They seemed very adept at it and my daughter barely cried most of the time. So, I am sure there are many experienced NICU nurses out there like the ones that took care of my daughter that are excellent at doing the heel sticks without that much difficulty. My daughter weighed 9lbs. 1oz. when she was born, and in the NICU!! She looked like a giant in there! She was in the bed/crib(whatever that thing is called in the NICU--sorry, my nursing expertise is corrections!) next to a baby born at 6 months gestation. It was amazing and unreal to see her there in comparison to him. Anyhow, my hat is off to all you NICU nurses...either way--heel stick or VP--you are amazing for performing such a feat. :flowersfo :bowingpur
  13. by   hospitalstaph
    Quote from StuNurseUP
    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 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. Our last had 4 screens as she "failed" the galactosemia screen. Each tech had a different way of positioning my little one for the heel stick. One told me that she wanted her to lay on a table and cry so that she could get more blood! In the end the best sample was when I kept my daughter in the carrier, foot exposed, and the sample was taken.

    I was also pretty irritated that the person that checked us in at the lab commented that I left the hospital too early and that I should have stayed later and taken advantage of the free daycare (I mean really, what an idiot this guy was)

    T
  14. by   Jolie
    Quote from L&Dsomeday
    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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