bilirubin lab draw site on newborns

  1. 0
    Hi, I just recently (2 months) started work at a very small rural hospital.
    There are 2 family practice guys running the show for the ob dept.
    The lab draws the bilirubins via vein puncture on these newborns. Said it's required per the Doctors ,that the results are more accurate than a heel stick. Iv'e never heard of this before and feel the attempts per lab and the need for nurses to hold infant down during this procedure that sometimes takes up to 30 mins is not really a necessary treatment.
    Also many of these babys are being placed under photo therapy with bilirubin levels around 10 at 2-5 days of life. Can anyone give me some concrete evidence to the right practice modalitys for these 2 concerns?
    Iv'e been working L+D the last 15 years so may not be up on the latest.
    thanks, llc333
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  3. 7 Comments so far...

  4. 1
    A venipuncture will be more accurate for a hct, but a bili can and should be a heelstick. I agree with you, that seems pretty barbaric!

    There are several great articles out on bilirubin levels in 35 weeks and above, do a medscape search. There is a chart we go by!
    danissa likes this.
  5. 1
    We always do heel sticks...

    BTW Don't know if you know this or not but when lab is drawing the blood on those bitty bilibabies - make sure that the bili lights are OFF. if the blood is exposed to the lights, you can get a false low reading.
    danissa likes this.
  6. 1
    I"m a lurker and a Phlebotomist!! ALWAYS a Bili test is done by a heelstick in my experience....I can't even imagine trying to venipuncture a NEWBORN, that is insane and mean!!!!! Also agree with a pp: make sure that the bili lights are OFF. if the blood is exposed to the lights, you can get a false low reading.
    danissa likes this.
  7. 0
    Quote from llc333
    ........ and feel the attempts per lab and the need for nurses to hold infant down during this procedure that sometimes takes up to 30 mins is not really a necessary treatment.
    thanks, llc333


    Oh holey Moley! Holding an infant down for 30 mins of torture............Think I will vomit now..thats barbaric!!!! All for an SBR, when a heel prick, by an experienced Nurse would have been done and sent and tested at the lab, in that time, with available results..(well , results on a good day!_), however, as you gain experience in the neonatal field, you will not put up with such ineptitude. You will learn that to DIY is preferable in a lot of cases, such as obtaining bloods from your baby in a less painful way. NICU Nurses are not there for the purpose of " holding the baby down!" we are there for the BABIES!

    (this is in no way aimed at the OP BTW!) JMHO!!!!!
  8. 0
    We always do heelsticks for bili levels.
  9. 0
    We do heel sticks for a SBR on my NNU. If we need a level quickly or were only able to get a small amount of blood, we may do a quick test on the gas machine that's on the unit. However, if the gas machine shows a high reading or we are able to get a decent sized sample, we always send it off to the lab, as their results are more accurate. Still, it's always capillary sampling, never venepuncture.

    I also used to be a phlebotomist before training as a nurse - and it was the same: always a heel stick.
  10. 0
    I've noticed a trend, during my short time in peds clinicals, for some staff to not take into consideration the comfort of my babies.

    For instance, I was quite angry just yesterday at the RT chick who felt she had to have mom hold her 2yo baby down for 10 minutes while she (RT chick) held the mask over the face of the baby, with him screaming and kicking the whole time, terrified.

    When I asked why she wasn't doing it intermittently the way the previous RT dude did it, her response was "WELL, *I* do it THIS way". It damn near got her cussed out. My clinical instructor probably saved me from getting into trouble by making me go on break.

    It really surprised me how quickly the patients became "my babies". Enough to make me willing to fight over their care.

    Maybe I'll eventually calm down and be more easy to get along with. But for now, they need to be good to my babies.


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