Any pointers regarding heal pokes?

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Specializes in NICU.

I am a student nurse in a level 4 NICU. We do the blood collections for most of our babies labs. More often than not they blood is collected from a heel poke. I have a hard time getting my kids to bleed very good. When I have asked the nurse about it, she just told me "poke him again".

I don't want to cause these lil ones any more pain than necessary. So I was hoping that I could get some advice on how to better collect blood via a heel stick.

Thanks.

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Specializes in NICU, Infection Control.

Warm the foot. Either use a commercial heel warmer or wet a diaper w/warm water, but check the temp of the diaper--just use a regular thermometer, you don't want it more than ~ 101 or so. Give it about 5 mins.

After the alcohol, put a very thin film of something like neosporin, A&D, on the selected site. This makes the blood bead up instead of running all over the foot and you--anywhere but where you want it.

You can also ask another nurse or your instructor or the CNS for advice. Ask if you can watch them do a heel stick.

Hang in there and Good Luck!

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I am a student nurse in a level 4 NICU. We do the blood collections for most of our babies labs. More often than not they blood is collected from a heel poke. I have a hard time getting my kids to bleed very good. When I have asked the nurse about it, she just told me "poke him again".

I don't want to cause these lil ones any more pain than necessary. So I was hoping that I could get some advice on how to better collect blood via a heel stick.

Thanks.

The "art" to it is the milking of the heel... getting the blood to flow.... I had a very hard time with this at first, too, so dont worry. I had a hard time grasping the concept of "milking" rather than "squeezing " the heel....it took me a long time..keep practicing... and ditto to everything prmnrs said, you have to warm it good to have a chance.... I remember thinking it was impossible for me to fill those big ( it seemed then) tubes for labs.. it didnt matter how many times I watched, I just had the hardest time with it!!!!! Just practice. You'll get it.....good luck... and good for you.... I only wish my school had a clinical component in a NICU!!!!

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Specializes in Infection Preventionist/ Occ Health.

Good advice so far..

Warming the heel is the best thing you can do to make sure you have a successful stick. I recommend warming both heels so that you can use the other if need be. Also, make sure that you are sticking them in the right place. If you don't get the fleshy part of the heel, there will not be as many capillaries close to the surface, and it will not work as well.

If it makes you feel any better, a lot of people have trouble with this.

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Specializes in NICU, Infection Control.

Also, never use the very back of the heel--that is where the Achilles' tendon attaches, and it could interfere w/walking; and don't use the bottom--same reason.

As you're "milking", remember to let go every so often so more blood can get to the foot. If you're running your thumb along the surface of the skin, you'll get more extracellular fluid in the specimen, and it'll come back hemolyzed, so don't do that. You should be [gently] dorsiflexing the foot and squeezing the ball and arch and calf, then letting go. Sometimes, the baby cries more from that part than from the actual puncture. And some term babies can really give you a fight!

Term babies are harder to get blood from than premies-their circulation to their extremities is not that great, and you may feel like you're chasing them all over the bed. Swaddle them tight, leaving the desired foot out of the wrap, consider a pacifier and sweet-ease. You can also put them on their tummies for the duration of the proceedure. If they fall asleep while you're getting the Newborn Screening Test, consider yourself a PRO!

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Specializes in ER, NICU, NSY and some other stuff.

Does the unit have a video for you to watch?

Also watch teh technique of some of the more experienced folks. You might evn be able to get someone from the lab to instruct you.

You should also have a diagram of the correct anatomical locations for puncture sites. The lancet boxes usually have one.

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Specializes in NICU.

Thank you for all of the feedback. Tonight I watched a nurse warm the baby's heel prior to poking (just like you all suggested). I had a different nurse come and watch me while I collected blood for labs. She thinks that it is my "milking" technique. She showed me how to hold the foot (the dorsiflexion and squeezing). I wasn't putting enough muscle into it.

I haven't had another chance to try since she showed me, but I am sure I will very soon.

Once again thank you VERY much.

P.S. My school doesn't have any clinical in the NICU. I got hired into Children's as a Student Nurse (and I love it!) :heartbeat

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Specializes in NICU.

This is an old thread, but it may still hold some nuggets of wisdom. ;)

https://allnurses.com/forums/showthread.php?t=49117&highlight=heelstick+technique

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Specializes in NICU.

Thank you for the link to the previous thread. It had lots of great advice also. I hate to admit it but I too am one who doesn't take advantage of gravity. But I am gonna try next time :)

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Specializes in NICU.

I just wanted to thank everyone again for the pointers. Tonight I drew up TPN labs on 2 babies. We have to collect 3 containers for each baby. And it was a huge success with each baby. When I got to the last container on my baby the kid wasn't bleeding as well. So I rubbed the heel with an alcohol pad and then wiped away the first drop. Still wasn't bleeding great. But then I remembered: use gravity. So after I dropped that lil heel down, the blood started to flow.

It feels great to be successful in even the little things.

THANKS AGAIN!!!!

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Specializes in NICU.

I was so happy last night when I was able to assist a nurse with her heel stick. She had already stuck the babies heel not once but twice and was getting ready to move on to the other heel (she had another tube to fill). I gloved up and jumped right in and used my good (and learned here) technique for squeezing right along with gravity. Not only did we fill up that tube quickly, but the baby was saved from another poke. It feels good getting confident with my abilities

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I was so happy last night when I was able to assist a nurse with her heel stick. She had already stuck the babies heel not once but twice and was getting ready to move on to the other heel (she had another tube to fill). I gloved up and jumped right in and used my good (and learned here) technique for squeezing right along with gravity. Not only did we fill up that tube quickly, but the baby was saved from another poke. It feels good getting confident with my abilities

I learned this from an experienced nurse and then found the same info in an article which had the details of why it works.

After warming the heel you want to use, remove the warmer and place it on the opposite leg. You will get great blood flow!

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