Labs

[emily0923]

Hi, I'm new to the NICU. I work in a Level 4 NICU. I have had a great orientation, but I am struggling with labs. I oriented and work strictly day shift so I missed out on a lot of lab opportunities during orientation. I'm looking for knowledge on when to do a heel stick vs. Venous vs. Art stick. As well as all the tips and tricks you have! 
 

Ps. we use EPIC, which is great about telling what container and how much blood I need to get. 

[NICU Guy, BSN, RN]

Anything over 3 microtainers (.6 mL each), I choose to get it through an arterial stick. Doctors/NPs do our art. sticks. Nurses do not do arterial sticks.

Some babies are good bleeders and getting a bunch of blood through a heel stick is easy, but most times after 1-2 vials, the blood slows down even with heel warmers. Getting the 3rd vial takes forever.

[NICU_Nurse_Casti, BSN, RN]

Its been a few months since your original post, so I am sure you have started to figure it out by now, but a majority of labs will be collected via heel stick.  Large quantities of blood would likely require a straight stick (venous/arterial).  Sometimes the provider will ask for a venous stick for a specific lab value if they suspect the heel stick is not accurate (like a potassium).  Blood cultures are straight sticks.  If we need labs, and our RT is planning on doing an arterial blood gas, we will ask them to get it for us to save sticks.  So, many different reasons and situations for the various types of blood draws in the NICU!  Hope this helps!