Having difficulty getting labs on newborns-need tips please!

Jokerhill · Apr 29, 2010

Look under the NICU forum there is some discussion there about this, including tips.

cokeforbreakfast · Apr 29, 2010

Have one of the lab employees give you a little demo next time they are around. There is definitely a trick to it, and proficiency comes with practice.

One common mistake is holding the foot too tightly throughout the entire collection process (this is easy to do because of all the stress and screaming:) It helps if the foot can refill with blood between squeezes. I hold around the ankle very loosely, squeeze the heel in a rolling motion, then release the entire foot with all but a couple fingers, then squeeze again. In addition, there are several different depth lancets; be sure you're using the appropriate size for the task and baby's safety. Also, the foot should be the lowest point (i.e. have the holder standing and you sit, or have the holder sit and you squat...though the latter is harder on your knees). Oh, and make sure the butt of the lancet is pressed tight up against the skin and you're not inadvertently jerking it away slightly at the last moment as a reflex.

It is so much easier to demonstrate than write! Good luck!

cokeforbreakfast · Apr 29, 2010

NICU Nurse has a fantastic post in this thread!

https://allnurses.com/nicu-nursing-forum/heel-sticks-49117.html

babyburperrn · Apr 29, 2010

Thanks for your replies! I will definitely try those practical tips. That sounds like a good technique for the squeezing of the foot. I definitely feel my stress level rise when the babies start screaming and I get really anxious just to get the whole thing over with! Thanks again!

Jokerhill · Apr 29, 2010

I worked in hematology for 14 years before going into nursing and now the NICU. If the specimen is good when you it leaves your unit it will be good to run forever. Clotting is a fast process not a slow one.

You have to be nice to the blood as you draw it you cant traumatize it breaking up cells, you can't traumatize the foot either as you do you release thrombin into the blood you are collecting (so don't squeeze to hard). Don't try to get every drop out every time if you completely empty the capillary it takes it longer to fill (think of a balloon when you first blow it up it is hard to fill but when it has some air in it already it gets easier same with the capillaries). Let blood flow back in after each squeeze relax and let the blood flow. Rubbing the area or cleaning it with alcohol causes platelet clumping, not good. Trauma to the baby in general causes vaso-constriction, so keeping them calm with sweat-ease helps. Keep the foot low let gravity work for you, and warm the heal first. The right size lancet helps as to shallow you don't get to the capillary bed, to deep you cut into muscle tissue releasing more thrombin, so know your product and use it wisely.

The longer it takes in the lab means someone was working harder to get you a result and finally had to give up as the cells were uncountable. The lab does not want to do the test over they already did most of the work but now have to repeat everything they already did, they don't get out of anything. They just get the opportunity to do more work by redoing the test now how many people want that. There are drawing techniques that help as pointed out but there is nothing the lab can do after the draw to make it better. The intensic and extrensic clotting cascades happen almost immediately not 20 min. later, not an hour later, if it did there would be a lot of bleeding going on in the OR and at accidents. It takes 1-9 min. for the cascade to complete and a clot to form but you don't even have to have a full clot to have a bad specimen you can have the begining of the clotting process start, causing fibrin strands to form in the specimen making it bad. So you could draw the baby in front of the analyzer and get a bad specimen, as I said before clotting happens fast not slow. There is no slow clotting process in a normal human. There are abnormal humans with low or missing clotting factors and anti-coagulated humans but this is not what we are talking about, because their specimens wont be having a clotting problem anyway.

redbeads · Apr 29, 2010

Please don't forget to use sweet-ease (sugar water specially prepared for babies undergoing traumatic procedures). If you don't have this, just use a bottle of 10%dextrose on a pacifier. This decreases stress for everyone involved, mom, dad, you, and baby. I often involve the dad in this process if he is willing....he can be the one who is giving the sweet-ease or pacifier, while you are doing the poking.