advice for heel sticks on big babies

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Specializes in NICU.

I have such a hard time with getting heel sticks on babies usually about 6 months or older. They kick me and I feel like no matter how many heel warmers I put on their foot, I usually can only get about 1 full microtainer of blood before it dries up. I heard that babies can get heel sticks anywhere from 1 year old or until they can walk. Any advice for handling labs on these big babies would be appreciated. :nurse:

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Specializes in ICU, Home Health, Camp, Travel, L&D.

If I've got to get more than one microtainer, I consider venipuncture (shop around, see what the kiddo's got, etc).

Swaddle or held by one of my partners in crime with foot in dependent position after heel warmer, which I hold in place with cling or a sock, if I'm doing the heel stick.

Also, use a little petroleum jelly, then wipe excess, then heel stick. Causes the blood to "bead up" well & you don't have the accident victim look if your kiddo is the squirmy type.

Don't use the vulcan death grip on the foot. Squeeze/release or dorsi-plantar flex "pump" foot.

HTH--that's my hitlist.

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Specializes in NICU.

Thanks Tablefor9 for your responses. I have done venipuncture before, but i have had a hard time too with getting enough blood from the site and the chubby big kids are a bit difficult for me to find veins on. When you do venipuncture, do you use a butterfly or iv catheter?

The big ones always want to kick their heel warmers off so I make a heel warmer boot looking thing. I use three of them - 1 around the ankle, one around the foot, and one in the front to cover the rest and then use tape to hold it all together.

I think I am guilty of the vulcan death grip because I'm trying so hard to keep their foot steady so the blood is going in the tube instead of on me or anywhere else!

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Specializes in ICU, Home Health, Camp, Travel, L&D.

Butterfly, usually. Just depends, b/c if I think I may have to do the IV, anyway, I may just go on and saline lock the kiddo.

I also use the "phone a friend" option--get a partner in crime that's holding the kiddo to stabilize the extremity in question.

One nurse we recently hired pops a 24 ga in and as the blood pools in the cathlon hub, withdraws with a syringe/sterile needle. Worked great the couple of times I saw her do it, just takes lots of hands or a papoose board.

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Specializes in Maternal - Child Health.

It's also important to note that not all lancets are created equally. Be sure you are using one intended for larger babies. You lab probably stocks them, but the NICU may not, since big chubby kiddos are rare there :)

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Specializes in NICU.

In my NICU, we only have 2 different size lancets: premie and newborn. Jolie, you have a lancet size for bigger babies than the newborn size?

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Specializes in NICU, PICU, PACU.

But, if the kid is there and has NO PICC line and will be NPO and getting IV abx, don't use up veins for venipunctures. We threaten our residents when they start to do that.

Warm the heel and put it in a dependent position, that will help. Also, make sure you are using a lancet that is not for preemies (we have two different sizes).

Our lab doesn't want us to use vaseline on their heels, they say it can mess up certain results and you certainly don't want that on your PKU paper.

Remember to use the squeeze release method...don't keep a hard grip on the leg/foot, all you do is impede the blood flow..that is why after you do a stick on a kid like that, come back in a half an hour and it looks like Freddy or Jason have been in your bed lol

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