Neonate heel pricks for screening

[dawnbee]

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

[Hardknox]

The mother/baby or nursery nurse draws the blood on all babes. It's been that way for 28 years. After all the babes we've tested we would be much more of an expert than a phlebotomist. And the tests are done on a more timely basis.

[SmilingBluEyes]

Where I work, the lab does no sticks on babies except very difficult venous ones. We do all PKU's. It does save time, if you ask me; and it's not that hard.

Just make sure everyone knows where the proper place to stick is (never right in the middle of the foot) and warm the heel VERY well prior to sticking, so you do'nt have to squeeze so much to get the sufficient amount of blood for all those dots. Also cluster care is a good idea. For example, if you are doing a heel stick for sugars or some other reason, draw a PKU at that point, too, if the timing is right; save that kiddo the distress of a stick.

OF COURSE RN's are QUALIFIED. Like you said, if you can start an IV (quite the invasive procedure), you can draw PKU. Just make sure everyone understands, the paperwork must be completed flawlessly (those slips that you send in to the state). NO BLANKS and NO incompletes or faulty info, this is critical. And like I said, make sure everyone knows where you do and do NOT stick (to prevent nerve damage). It's not rocket science, and every RN who cares for newborns should know how to do heel sticks, anyhow. Hope this helps. Good luck w/your policy writing.

[palesarah]

Deb's post sums it all up pretty well so I won't repeat, just wanted to weigh in that yes, all PKUs are done by RNs where I work. We use oral sucrose for pain relief.

[Fiona59]

PKU's were done after discharge (24hour stays) at home by the visiting health nurse. Paperwork went home with mum and baby. Never heard of any problems with the system.

[SmilingBluEyes]

I like THAT, fiona, better! That would really be ideal, but unlikely to happen around here.

[frekinbrechin]

In the hospital where I work, the nursery nurse and/or tech draws the blood for the PKU screening. This way the PKU's get done at the appropropriate time.

[BittyBabyGrower, MSN, RN]

No lab people here...we do our own.

[Lawnurse]

the lab did ours - however, once one got lost (or something) and I had to do it....OMG, it took 30 minutes, 2 sticks, and the help of another nurse and I was apologizing to the poor baby the whole time.

I'm sure it doesn't take very long to get good at it - but I sure was terrible the first time.

[birthingcenter]

I work in a small rural hospital as a Perinatal Nurse. It has always been the hospital policy to call a lab tech in to draw blood for PKU screening before discharge. Several of us would prefer to do the heel pricks ourselves, as it would save time if we could test the babes rather than wait for lab to come around after our moms get a discharge order. Management is all for it, as are the lab people, however, before we can write a policy, we need to do some research about whether it is common practice in other hospitals for RNs to perform this task. My feeling is that if I am qualified to start an IV in a scalp vein, I can probably handle a heel prick, and I can make it easier on the babe by using EMLA and hot packs before even attempting the procedure. Who does screening in your hospital?

I also work in a small rural hospital and we have always had the nursery nurse collect the PKUs. As a general rule that lab will come and get BILIs and CBCs etc however do to the timing concern, we choose for the nurses to collect PKUs

[babyktchr, BSN, RN]

Many moons ago...the repeat PKU was done in the outpatient lab. An appointment had to be made..yada yada. Then someone thought...hey..we can capture the revenue from this...and TADA....we now do the repeats. We also do the first screening too. I try not to let the lab draw on any baby...seems they don't have too much experience sticking the wee ones.

[USA987, MSN, RN, NP]

We also do our own after 24 hrs. of age. BUT it is the discharging RN's responsibility to look it up in the computer and ensure that the lab has received if. If you send a baby home without the PKU being done it's a mandatory DAY OFF WITHOUT pay!!