Jump to content

Blood Sampling

Posted

Sometime last year, a friend of a friend who works in another NICU was trying to tell me about another way to draw blood. We were at a bar :) so I obviously don't remember much.

She was saying that you could poke a baby somewhere other then the heels or fingers/toes to get blood. These "areas" are rich in capillary beds and bleed really well.

Does anyone know what I am talking about?? Could you please elaborate?!?!

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

Um, no.

We never stick fingers or toes unless the baby has something rare like a blood clot in his leg.

We only stick the heels, or more preferably, get a venous stick.

I've been a NICU nurse for 3 years. I'm not that stupid :)

I found out what it was. It's called venous pooling. Basically if you stick the baby just below the anticub, you can collect blood by hitting a rich capillary bed. The girl said people had to be certified to do it and only did it when they needed a lot of blood. I guess there is a soft spot that if you stick deep can collect blood every time.

She worked at St. Joes in Phoenix if anyone cares!

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

Ouch. We do art sticks anytime we need a significant amount of blood. The docs here are pretty good about limiting the amount of blood draws ordered. We like to "keep the blood in the baby."

I didn't say you were stupid. I can't tell sometimes by the question who's a nurse, nursing student, HS student NICU wannabe, former NICU mom, aunt, sister, etc, lurker, troll, etc...:D

preemieRNkate, RN

Specializes in Level III NICU. Has 7 years experience.

Ouch. We do art sticks anytime we need a significant amount of blood. The docs here are pretty good about limiting the amount of blood draws ordered. We like to "keep the blood in the baby."

Ditto. And anytime the lab requistion says that they need 3 ml of blood or whatever to run a test, we call them and ask how much blood they really need.

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

Ouch is right....I'd not want to be sticking deep on any kid! We do art sticks when we need more than 1.5ml blood, in out and done. Didn't we have a thread about this a while back and no one could give us good info on it?

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

Yes! Now that you mention it, I believe we did!!!

RainDreamer, BSN, RN

Specializes in NICU. Has 16 years experience.

Yes, I started a thread a while ago on the venous pooling technique.

It's still fairly new and they're still doing research, as far as I know. On our unit, there are only certain nurses that have been trained to do it, that are able to do it. There are certain requirements too ....... you have to need at least 1.5 mls of blood or if the kid is a very hard stick.

It works great for us, but like I said there are only a handful of nurses that went through the training and are able to do it. I never could find any information about it, but I'm SO GLAD that someone else has heard about it!

Ya the girls that told me about it said similar things. They had certified people and only used it as a last resort if large amounts of blood were needed. I was just curious who else was doing it. There is definately no information on it.

On my unit we just get art sticks.

Thanks for the info!!

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi. Has 23 years experience.

Ouch is right. We get blood from the heel and if necessary from a venous stick. Be aware that there are guidelines about how much can/should be drawn on little ones in a 24 hour period. Need 4 cc's for one test and a bunch of other labs on our 2.1 kg HLHS patitent? You're gonna have to wait

RainDreamer, BSN, RN

Specializes in NICU. Has 16 years experience.

From the venous pool draws I've seen, it doesn't look any more painful than a heel/venous/arterial stick. They actually seem to sleep right through it because it's over really quick.

It keeps from using up veins and arteries. You can only access that "pool" on each arm once every 24 hours (I think 24, but don't quote me on that .... it might be up to 72). We never really need to access it more than that anyway though, our neos greatly limit the labs we draw to an absolute minimum.

But on a cardiac kid, those venous pool draws can be lifesavers at times while waiting for the a-line to be put in.

elizabells, BSN, RN

Specializes in NICU.

Ouch is right. We get blood from the heel and if necessary from a venous stick. Be aware that there are guidelines about how much can/should be drawn on little ones in a 24 hour period. Need 4 cc's for one test and a bunch of other labs on our 2.1 kg HLHS patitent? You're gonna have to wait

Wow, yet another thing my unit is way behind on... I have a poor wee primary (yes, another one) with fulminant MRSA and DIC, and I draw, let's see... CBC, Chem 20, ABG, coags... so... around 6ccs of blood, once a day, plus she gets Chem 10s and CBCs done at least one other time during the day. She's 1.4kg. I'm going to have to look into those guidelines. Usually we only draw that much off the ECMO kids, so it's not as much of an issue.

RainDreamer, BSN, RN

Specializes in NICU. Has 16 years experience.

Wow, yet another thing my unit is way behind on... I have a poor wee primary (yes, another one) with fulminant MRSA and DIC, and I draw, let's see... CBC, Chem 20, ABG, coags... so... around 6ccs of blood, once a day, plus she gets Chem 10s and CBCs done at least one other time during the day. She's 1.4kg. I'm going to have to look into those guidelines. Usually we only draw that much off the ECMO kids, so it's not as much of an issue.

6 mls a day?! :eek: Wow! I assume she has to be transfused pretty often.

elizabells, BSN, RN

Specializes in NICU.

6 mls a day?! :eek: Wow! I assume she has to be transfused pretty often.

Well, if you factor in the other CBCs, Chemistries and ABGs, I'd estimate more like 8ccs/day. And yeah, she gets PRBCs and platelets pretty much every day, and we were doing FFP and cryo for a while to get the DIC under control. After they had me give her Vitamin K (IM! For reasons unknown, as Neofax recommends IV for coagulopathy, and she's got like an inch of edema all over, so it was probably SC anyway) it got a little better. One of those kids with a crit goal of 35 and platelet goal of 50, you know?

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi. Has 23 years experience.

Well, if you factor in the other CBCs, Chemistries and ABGs, I'd estimate more like 8ccs/day. And yeah, she gets PRBCs and platelets pretty much every day, and we were doing FFP and cryo for a while to get the DIC under control. After they had me give her Vitamin K (IM! For reasons unknown, as Neofax recommends IV for coagulopathy, and she's got like an inch of edema all over, so it was probably SC anyway) it got a little better. One of those kids with a crit goal of 35 and platelet goal of 50, you know?

Yeah...check into those guidelines...that's a lot of blood to be taking.

mostly in our NICU we usually do arterial puncture or heel

littleneoRN

Specializes in NICU. Has 6 years experience.

Does anyone have a reference for the guidlines on on amount of blood-letting...um, I mean blood sampling volume per day? I have had concern about this before but haven't been able to find a solid reference.

what I know that blood draw it supose to be 3-5% from total blood volume some time except up to 10

% as maximmand total blood volume is 80 ml \ kg so I you have prem with 500gm blood draw is 2 ml

Guest
This topic is now closed to further replies.