Starting a new Ped's job

  1. Hello! I've worked in Peds before, HOWEVER, I'm getting ready to start a new job where I'll be doing alot of blood draws on infants. Any suggestions?? I'm freakin out a bit. I've done ONE blood draw on a 16 month old with NO success. Usually the doc I worked for only ordered blood draws on 4 years and up. *IF* we ordered on younger one's then they went to a Children's Hosptial Lab! ACK! I didn't do it! Anyway, now my new job is pretty much blood draws, immunizations, IV's, etc. I already told them what my limitations were but they hired me anyway! Don't get me wrong, I'm SUPER excited about working in Ped's again...and I'm excited about learning more! I'm just really nervous about the little one's and the blood draws. ANY tips would be GREATLY appreciated!
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  2. 8 Comments

  3. by   navynurse06
    Butterfly needles are your best friends when getting blood from the babies! And the AC is usually a good place. I say usually!
  4. by   GregCP, RN
    First impressions are crucial! If you walk into the pt's room, be sure to know everything about this pt- the parents will ask you questions, and if you dont know whts going on....the nurse-pt relationship is shot to hell. Parents are more protective of their childs well being, even more so than themselves...just keep that in mind.
  5. by   vamedic4
    Here's a link to something I posted awhile back....

    http://allnurses.com/forums/f95/peds...highlight=tips


    Also, when drawing blood on kiddos, remember that it's not always necessary to stick them with a needle. Heel/finger sticks can be just as accurate IF DONE PROPERLY.
    1. Clean the site thoroughly with alcohol and allow to air dry.
    2. Hold the heel/finger firmly.
    3. Hold the lancet FIRMLY against the extremity or finger you're sticking and parallel to the ridges of the fingers and toes.
    4. Lance the skin and let the blood drip to gravity. Wipe the first drop off with gauze.
    5. Hold the collection container (bullet or microtainer) up to the blood and allow to DRIP. DO NOT SCRAPE, THIS WILL LYSE THE CELLS. If you're only doing a digoxin level this won't matter, but if you're wanting, say, electrolytes...your K level's gonna be way off - because you've clotted the sample.
    It is okay to squeeze gently, or to "milk" gently.

    Once you've filled your container, be sure to invert it once to allow for mixing of the blood with whatever agent is inside the tube (sodium heparin/ EDTA, whatever.) Do NOT overshake, as this will also clot your sample.

    Do not fill past the fill line on any sample. The tubes and bullets are marked so that the precise amount of additive is able to keep the sample "usable" for the lab. Especially important for tests like PT/PTT/INR. Too much or too little blood in those tubes and you'll be sticking again.

    Don't think that you can't get 1cc out of a fingerstick, with many patients...you can.

    For the patients sake, know exactly how much you can draw per day. 1 ml per kg of body weight.

    Warm fingers and heels up prior to sticking...

    I'm sure there's more I'll think of at 1145 when I'm asleep, but the above may help you.

    vamedic4
    40 more minutes
  6. by   scribblerpnp
    I am an AC, scalp vein kind of girl. If they are already crying, the scalp veins stick out nicely. I would also use a thin rubberband as a tournequette around their head (in the same positition as if I were doing a head circumference). I would always have parents request finger or heel sticks, but to me they took longer then venipuncture, the kid cried more, sometimes it would be difficult to get enough blood, their finger would clot and you would have to do it twice or you would end up doing a venipuncture anyway, etc (Also, maybe I just sucked finger and heel sticks).

    Oh yeah, LOVE 24 guage butterflies for lab sticks
    Last edit by scribblerpnp on Oct 9, '06
  7. by   GregCP, RN
    Quote from scribblerrn
    I am an AC, scalp vein kind of girl. If they are already crying, the scalp veins stick out nicely. I would also use a thin rubberband as a tournequette around their head (in the same positition as if I were doing a head circumference). I would always have parents request finger or heel sticks, but to me they took longer then venipuncture, the kid cried more, sometimes it would be difficult to get enough blood, their finger would clot and you would have to do it twice or you would end up doing a venipuncture anyway, etc (Also, maybe I just sucked finger and heel sticks).

    Oh yeah, LOVE 24 guage butterflies for lab sticks
    Scalp veins should always be your last resort. IN terms of finger vs heel sticks, i always use heel- more meat to work with and less painful. Do this rather than a butterfly (depending on how much blood you need), because you can't gaurantee that you'll always get blood on your first stick...also, a heel stick is less traumatizing, because you dont necessarily have to restrain him, take mulitple attempts, and fish, like you would with a fly. Apply a warm pack 10 min prior to doing the stick, and the technique behind getting blood, is to allow time for the heel or finger to "refill" itself with blood- in other words, do not squeeze constantly. To prevent it from clotting, have a 2x2 bedside, and wipe off the site when the blood flow begins to slow down. But as a CRNP, with 6 years of expereince (uh huh....), you dont need me to tell you that.
    Last edit by GregCP, RN on Oct 10, '06
  8. by   scribblerpnp
    Quote from GregCP, RN
    But as a CRNP, with 6 years of expereince (uh huh....), you dont need me to tell you that.
    That's a bit of a snarky comment! 6 years of experience doesn't make me an expert on finger sticks, IV's, etc. As an RN, I worked on a unit where heel/finger sticks weren't common (as well as IV's) since the majority of pt's were critical/ chronic and had PICC's, broviacs, centrals, etc. We usually used this the majority of time for blood draws. And if blood draws were needed and we couldn't use the line, the amount of blood was much more than ANY nurse could get from a finger/heel stick. As a primary care PNP, I don't do blood draws anymore, since in the primary care office where I work, I have a nurse to do it for me. She also prefers venipuncture as well ( and she has been a peds nurse much longer than me in primary care and in hospital setting).

    I've read quite a few research articles in the past (2003-2004) on applying warm packs to heels prior to sticks (as well as helped a fellow grad student do such a study at a major children's hospital in the mid-west) and most of them (as well as my friend's study) published results that basically said warm packs do not have a significant effect on amount of blood received with a heel stick. The mid-west hospital I worked at (rated in top 10 of peds hospitals in the country) as normal practice didn't use warm packs. I sometimes would do it anyway since it didn't hurt anything to try, but for me, I didn't notice any change other than the VERY small waste of time it took to apply and remove the pack.
    Last edit by scribblerpnp on Oct 10, '06
  9. by   GregCP, RN
    ::revised::
    Last edit by GregCP, RN on Oct 18, '06 : Reason: revised
  10. by   GregCP, RN
    Quote from scribblerrn
    That's a bit of a snarky comment! 6 years of experience doesn't make me an expert on finger sticks, IV's, etc. As an RN, I worked on a unit where heel/finger sticks weren't common (as well as IV's) since the majority of pt's were critical/ chronic and had PICC's, broviacs, centrals, etc. We usually used this the majority of time for blood draws. And if blood draws were needed and we couldn't use the line, the amount of blood was much more than ANY nurse could get from a finger/heel stick. As a primary care PNP, I don't do blood draws anymore, since in the primary care office where I work, I have a nurse to do it for me. She also prefers venipuncture as well ( and she has been a peds nurse much longer than me in primary care and in hospital setting).

    I've read quite a few research articles in the past (2003-2004) on applying warm packs to heels prior to sticks (as well as helped a fellow grad student do such a study at a major children's hospital in the mid-west) and most of them (as well as my friend's study) published results that basically said warm packs do not have a significant effect on amount of blood received with a heel stick. The mid-west hospital I worked at (rated in top 10 of peds hospitals in the country) as normal practice didn't use warm packs. I sometimes would do it anyway since it didn't hurt anything to try, but for me, I didn't notice any change other than the VERY small waste of time it took to apply and remove the pack.
    So, in terms of what I've said above, the only thing that you would contraindicate would be the heel pack? Hmm...then it must have been pretty good advice.

    Even though your nurse prefers venipuncture before heel sticks, doesnt mean that it should be the standard. The reality is, you cannot gaurentee success to obtain a sample on a butterfly.....and just the sight of the needle..tourniquet...wraping a baby...is enough to traumatize any child. So if the lab permits a heelstick, then it should be your first choice. Now, I dont want to tell you what to do.....instead, just think about my rationale.

    Sorry for the snotty remark at the end....I took one look at your post and looked at your credentials...and I couldnt help but question the validity of it.
    Last edit by GregCP, RN on Oct 19, '06

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