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heelstick or venous???

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what do you usually prefer to make use of when obtaining morning lab/bloodworks for babies? do you frequently use venous or heelstick? in my hospital, nurses prefer to use venous as compared to heelstick even if they will get only a small amount of blood for MBR.

do you do the same in your hospital? when is it best indicated to perform venous draws? in my previous hospital we do venous for blood CS and if massive labworks has to be done but not for MBR per se. pls. i need your opinion on this matter....thanks!

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baby&mommynurse

Specializes in OB. Has 10 years experience.

We always do heelsticks unless the lab indicates the need for venous, such as high hematocrits or if we're doing chromosomal studies.

babyandmommynurse,

thanks for your immediate reply, i do appreciate it very much...at least, now i know am not alone here.

Gompers, BSN, RN

Specializes in NICU.

If the baby doesn't have an arterial line, we almost always do heelsticks. We very rarely do venous sticks, only use them as a last resort when we can't get blood any other way. We find that it "ruins" that vein so it's one more you can't use if the kid needs an IV. We do arterial sticks if we need more blood than a heelstick can give us. We routinely do them on admission to get type and screens, blood cultures, and ABGs. After that, we'll do art sticks for coags, cultures, ABGs if the kid is really in respiratory trouble, and other tests that require lots of blood (i.e. chromosomes).

gompers,

i agree with all what you have said, i believe you are definitely right. the thing that bothers me is that in the past six weeks that i have worked with my preceptors (everyday i have different mentor) is that they always made me perform the venous work. may be my unit needs more info about this subject...being probably a level II NICU make it difficult for them to embrace changes...i mean, i came from a level III NICU, and everytime i would suggest or ask something the seasoned nurses will just reply to me that they have been doing those stuff for long time.

i am not sure if i can survive in my unit right now...the hospital is still starting to become a level III NICU and my unit lacks protocols or proper policy and procedures on subjects pertaining to NICU management or activities.

if there is anyone who can provide me a copy of certain policy & procedures in your institution, i would gratefully appreviate it...i would like to help my fellow NICU nurses in my hospital develop proper IPP.

thanks a lot!

yikes!

Sounds like your medical director and nurse manager need to get together and update your policy/procedure manual before you make the transition from II to III. Have they asked for a group to come together to work up a new P/P manual for your unit? Have ou asked to be part of this group? These kind of manuals usually have to be approved by hospital admin. and the process can be time consuming. Wish I could refer you to ours but it is not on-line and the book itself is 3 inches thick! Let me know specific policies you are looking for and I'll see what I can hunt down.

Heelsticks are so much better for the infant. What happens when you really need a vein? They will be all gone.

Don't worry. Your facility will not be able to go overnight from A Level II to a Level III. Most states require actual approval from the state licensing board, such as when changing levels in an Emergency Room. And that means written protocols in place, etc.

thanks for your support. i thought i could not ask help from anyone outside my unit. honestly, am having a difficulty shadowing my preceptors because everyday they assign me to a new one (and each of them has different levels of experience WBN,level I, levelII, LEVEL III). that's why each of them has their own ideas, style or techniques on how to do particular things.

for ex. the way one collects blood is different from the others. also, i have posted in another thread about the temp probe. some nurses clothed their babies even with the probe attached on them.

we don't have yet protocol on these subjects. even if we have, i think they are outdated and needs to be reviewed. so, if anyone could send me a copy of their IPP on thermoregulation, collection of blood, feeding infant, etc.. pls. do so, i would gratefully appreciate any help you could offer me to help my unit start a good level III. pls. send it to me at: blessedneonatalnurse2003-nursing@yahoo.com

i have been working in my unit for two months and some of the nurses commented "we are pretty laidback here, we just do as we please." i don't know how to react when someone told me this statement, the first thing i thought was she meant backwards )'coz am not familiar with some of the american or english terms). however, when i looked it up the dictionary i've found out she meant being lax, relax, or free. am asking help from most of the seasoned NICU nurses here on the board 'coz i don't want to risk my patients or babies when am already out of the orientation and dealing with my own babies i belive i must have a protocol to follow for mw not top commit any mistakes in the future.

seriously speaking am having a difficulty adjusting to my new level II turning level III unit by next year (as they claim). i don't have anything against my co-nurses, i don't mean i am better than them. it's just that some nurses just make me feel i am a bad nurse 'coz i do things in a different way. it's just that i felt it is very difficult to implement any changes in the unit since they don't like changes. may be they felt threatened to the newbies, i don't know really how to describe it. most of my fellow nurses there are seasoned nurses, some are LPNs turned ADNs or RNs., and some still look after their seniority or working on their MAs. they make me feel lost most esp. with one of our RP, i can feel that she doesn't like me and that she is trying to find faults in me. i once had approached her and had spoken to her if we have problems, then she told me because i do things in a different way than she expected me to do it. from then on, she never gave me admissions.

even if i came from a level III NICU it doesn't mean i am the best among the unit, i still have to adjust and adapt in the new area, i haven't found my comfort zone as of yet. what we do back from where i came from may be different from here 'coz that's the practice in another country and another hospital. i mean, my practice may be the one that is backwards so i still need to update myself. for her knowing that i have been in a level III, she expects too much from me. there's no way for her to help me adjust and learn the things their way.

speaking in general, i don't want to think that they have this kind of attitude "eating their youngs." i don't want to be bias to them, i just want to make my work and life easier. i hope to hear some good advice on how i can handle this mixed emotions.

i hope i didn't confuse all of you, apologies for my grammar and spelling.

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

We rarely do venous sticks...we do either heelstick or if we need a big amounto blood we do an art stick. We get new peds residents all the time that want to do venous sticks and we tell them...fine go ahead, but how good are you a neonatal IVs because when we have no sites because you stuck 10 veins trying to get 3 mls of blood we are going to be hunting you down.

Heelsticks, when done correctly, are so much easier then a venous stick!

Kaibigan-what country are you from?

baby&mommynurse

Specializes in OB. Has 10 years experience.

Kaibigan-what country are you from?

I believe she's from the Philippines, but is nursing in the US. Am I right, kaibigan?

Yes, I am from the Philippines. However, I have gained my NICU practice from the Middle East, in Saudi Arabia.

Nursing practice in KSA (Kingdom of Saudi Arabia) is basically based in UK.

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Whatever you seek for your future; whatever you hope for, aim high. Your dreams are the wings of your spirit, as long as you can dream, you can fly.

BittyBabyGrower, MSN, RN

Specializes in NICU, PICU, educator.

I have a friend that is in Saudi....I give you all credit for working there!

To answer Kaibigan's question, "heel stick or venous?"

Stick the heel, save the vein.

If no UAC or art line, use an art stick for blood culture, coag studies and when a volume greater than about 1.5cc are needed.

Kaibigan-

Sorry to hear you are having difficulty adjusting to your new hospital environment. The way you've described it, it sounds a little scary if the nurses are all doing their own thing and not following a unit protocol....scarier still if there's no protocol in place or not being enforced by the nurse manager. Surely there is an updated policy and procedure manual available to you in your unit. It is a JCAHO requirement. Perhaps it's time to sit down in private with your nurse manager and go over your concerns. They sound legitimate to me.

it is nice to receive helpful points of view from NICU nurses all over the globe.

best of all, thanks to sparkyRN for your advise and concern.

thanks to bittybabygrower, too!

your share of ideas is highly appreciated by me.

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