Any pointers regarding heal pokes?

[Love4Me]

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.

[Tiki_Torch]

I don't think a lot of people know this tip, but along with the swaddling, sucrose pacifier, raising the head of the bed, certainly warming the heel for 5 to 7 minutes, sticking in the appropriate place on the heel, and allowing the foot to fill with blood beween "squeezes" (watch for the skin to change from pale to pink--full of blood), you can also wipe the site again with an alcohol swab when the blood begins to stop flowing well. The clotting mechanisms begin as soon as the injury occurs so after about 2 minutes or less the blood will stop flowing well because clot formation is beginning; alcohol will break up the fibrin network at the site which makes the heelstick site bleed again. The blood will not flow as fast as it did with the initial stick, but you will certainly get another good round of drops to hopefully finish filling your tube. If you do use the alcohol trick, be sure to wipe the first drop with a gauze pad (like you do after you stick the heel) just in case the alcohol might cause a problem with the lab test (I don't know if it matters; being safe rather than sorry here). The alcohol trick is a really good one and one I love to share.

By the way, one of my pet peeves is to see medical people draw labs or fingerstick blood sugars and then place an alcohol wipe over the site. For crying out loud, I want a gauze pad placed on my arm or finger... I don't want the site to continue bleeding. :-D LOL.

[prmenrs, RN]

Only thing about the alcohol thing--it hurts. It does work, but it's a little cut, putting alcohol on it smarts.

[Tiki_Torch]

Prmenrs, as always you bring up a good point!

You are correct about the "smart" that alcohol on a cut can cause. This is another reason for quickly wiping the site with a gauze pad. The sucrose and swaddling are already on board. The quick, one swipe with an alcohol wipe is not a method to be applied every time a heelstick is performed, but in the case that a few more drops of blood are needed, my experience is that the alcohol smart is much, much less painful than another lance stick would be.

[Gompers, BSN, RN]

I usually just use a 2x2 gauze to wipe the heelstick site when the blood flow slows down - kind of rub the clot off and then it's flowing again, without the use of alcohol.

We're looking into ordering those saline wipes and wll be using those for heelsticks, does anyone else do that yet?