Newborn PKU: Heelstick vs Venipuncture?

Specialties Ob/Gyn

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Mimi2RN, ASN, RN

1,142 Posts

Specializes in NICU.

Interesting thread. We are told that we HAVE to do heelsticks for Newborn Screening, even if the baby has a UAC. Also we are supposed to wait a minimum of 24 hours, unless the mom is discharged sooner, which doesn't often happen. With our Level 2 babies, it's ordered for the morning after the baby is 48 hours old. I understand the optimal time is as close to 6 days of age as possible. We used to wait until then, but got dinged because sometimes they were missed and had to be done late.

I find it very strange that a baby had it done at one hour of age. That was a pretty worthless test, probably should have been repeated.

Mimi2RN, ASN, RN

1,142 Posts

Specializes in NICU.
We use the pampers. Wet with warm water, wrap up the foot and tape it. It works! It actually is better to warm both feet, I have found... but not many babies tolerate having their feet "bound" :)

Be careful using the warm Pampers. We had a baby with a second degree burn on it's foot (it blistered) when one was used in our nursery.

klone, MSN, RN

14,790 Posts

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I think it depends on the type of test the lab does. I've heard of newer screening where they actually look at the genetic marker, rather than the presence of amino acids in the blood. If the lab uses the genetic marker to screen for the disorders, it would be present immediately after birth, and not dependent upon the baby eating and a minimum waiting period.

Specializes in NICU.

I'm glad this thread is here, thank you for starting it!

I'm a new nursery nurse, so I'm still learning how to do both the heelsticks and the venipuncture. On day shift (which I worked while on orientation) it seemed like everyone did the venipunctures for the MBRs and the PKUs (we'd do both at one time so we'd only have to stick the babies one time). With the veinpunctures the babies usually slept right through it! They rarely cried at all. But I'm still learning and sometimes I couldn't even get in the vein ...... but I guess it just takes practice. But I hate having to ask other nurses to help me with it if I can't get it.

On the night shift (which is what I work now that I'm off orientation), a few of the nurses do heelsticks. The first time I did it, it was awful! The poor baby was squirming all around, crying so hard ...... definitely a lot more painful than the venipuncture. But no one told me I should warm the heel or anything .... I felt terrible. The next time I did a heelstick I had discovered the heel warmers they had ...... great thing! I put those on my babies and let the heels warm up real well. I used the tenderfoots too, very good. The blood flowed so good, it took no time at all.

I just wish I was better at getting the venipunctures. I like it so much better because it goes even faster and the babies aren't in pain from it. I guess I just need to keep practicing.

Oh and with the PKUs, we have to wait until at least 24 hours of age .... preferrably 72 hours, but most babies are discharged before that.

Specializes in NICU.

On the PKU form it says heel stick is the preferable method. Does anyone know why that is?

And if anyone has some good tips on how to be more successful with a venipuncture, I would love to hear them. I know it probably just takes a lot of practice. I'm able to get them sometimes, but it seems like the last few times I've worked I haven't been able to get any. I'd love to hear any advice or tips.

Specializes in NICU.

I did 2 heelsticks last night and I used the sweetease, to see if it'd help any. WOW, what a difference that made! Neither of the babies fussed AT ALL. I was just amazed at the difference. Now I don't feel so bad doing the heelsticks, as long as I give them the sweetease beforehand.

Specializes in postpartum,well baby nursery, L and D.

hi there. at our hospital most of the nurses do heel sticks for pku's. i've noticed the nicu or delivery nurses do venipunctures more i guess because they feel more comfortable with doing it. honestly, i think it has to do with how you do a heelstick...i usually warm up the heel first for a few minutes and give the baby some sugar..make sure the baby has been fed within the last 2 hrs and then i do it...and it usually works pretty good for me...and usually the baby wont cry and fuss alot...whereas sometimes i see a nicu nurse doing a venipuncture on a baby for a pku and the baby is screaming and appears to be in alot of pain and it takes just as long ..if not longer to do a venipuncture. so i like heelsticks better...

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