Heelstick vs venipuncture?

[gudiarani]

In my unit, in NJ, we do heelsticks for labs. But I wonder why we don't do venipunctures instead of gashing up their poor heels so much. I understand using the heels for small draws (blood sugar, blood gas). I guess we might end up losing all the veins for potential PIV sites, but it seems like it would cause much less pain...

Any thoughts? Does your NICU do heelsticks of venipunctures? Just curious to see what others think and any reasoning that might go with it as I am new to nursing and NICU.

[Galore]

I had no idea that my unit is in the minority for using venipuncture almost exclusively. I'm also having a really hard time picturing the doctors having to draw most of the labs, maybe they would not order so many if that were the case where I worked :)

[Jolie, BSN]

In my experience, those who have problems with heel sticks were not properly taught or have fallen into bad habits. By warming the heel, using an appropriate lancet, milking the lower leg (not just squeezing the heel) and using gravity to assist, it is possible to get sufficient amounts of blood for almost any venous blood test without traumatizing the heel/foot or hemolyzing the sample. I also believe that one of the biggest problems with heel sticks is the use of those God-awful dot band-aids that seem to be left on forever and macerate the baby' skin. If everyone would simply wrap the heel with gauze and tape over the gauze (not the baby's skin), the condition of the heels would improve greatly.

I realize that there are circumstances that justify arterial sticks (need for an ABG and/or a large amount of blood in an urgent situation) but I don't believe that it is a good idea to use art sticks for routine labs. While rare, there is the possibility of causing arterial clotting or spasm, leading to necrosis. IMO, that risk just doesn't seem justified for a routine lab.

[texas2007, BSN, RN]

We usually get our labs with heelsticks. Sometimes the older chronic kids will get a lot of scar tissue and won't bleed so they'll be art or venous. It's really up to the nurse to decide how she wants to get labs, unless its a repeat K+ or something. We rarely draw from the central lines unless a parent throws a fit and gets the Dr. to write an order for it.

[NeoNurseTX, RN]

If there's any type of art line, we use that first. Large amts of blood are usually art sticks and I'm fairly decent at getting enough blood on venous sticks. A lab or two in a microtainer can be done by heelstick. Our transport nurses can draw from CVLs but staff nurses cannot.