PKU test help

Don't feel bad! It definitely can be a bit tricky. I've learned a few tips though that have really helped me! One, slap two heel warmers on that kiddo, overlapping a bit (one right over heel, one a bit above.) If you leave them on for a solid 5 mins, it really helps increase circulation. Two, if in the bassinet or being held, elevate the heart above the heel. Either put the plastic cot up to the little lip, or have the person holding sit them upright. Three, get a good grip so that you can manipulate the foot angle easily. Give on good squeeze on the whole foot, not just the heel, and tip it down towards the paper. Since you can't touch the foot to the sheet, you want to let the blood form a nice juicy drop so you can just barely touch the blood drop to the circle. Four, give a nice release time in between drops to allow the circulation to return. I've squeezed and squeezed before and had poor luck, whereas when you let the capillaries really refill, it makes obtaining the next drops easier. I don't know if you ever send labs, but these same techniques apply there too. Hope this helps!

Thank you! I've tried all that you mentioned EXCEPT to stop squeezing! Duh! That would make sense.

"I had two babies that needed PKU tests done the other night".

The tests are not easy RNMee, and the skill will come. BrandNewBabyNurse gave some excellent tips which I will share when I precept. I'm so glad you asked the question, because many nurses are frustrated with this procedure.

Remember, you are not drawing a PKU test. You are drawing a Newborn Screen, which includes the PKU. PKU, while commonly used, is an old term. All of the tests are very important and vary by state. Unfavorable results from any of the tests will have devastating consequences if not treated. This information will not help you draw the blood, but just a little extra for educational purposes.

I do what Elvish does with regard to swaddling the baby except the one foot. I will also hold the baby in one arm, which allows gravity to really help. It took me a few years to get proficient at it, but once I got the technique down, I could do amazing perfect circles every time.

I agree that warming the heel well is critical. Babies have better blood flow when well hydrated, but since we often have to draw on one day old's, that isn't always the case. Maximizing perfusion to the foot will help-- elevate the head of the crib and make sure the heel is well warmed. Swaddle the baby with one heel out and lay baby on his or her side. I like to heel stick the superior (upper) edge of the heel and give one nice squeeze of the foot (keep a good grip so the baby doesn't kick and the blood spills) until you have a perfectly round large drop of blood pooled on top of the heel. Then I take my filter paper and lay it on top of the blood circle and let it saturate the paper from behind. (The printed circles are facing up so I can see the circle filling up and can adjust the angle of the paper as needed as it is filling up with capillary action). This technique is a little trickier to master because you need to lay the paper on the blood in the right spot, and it can take a while to perfect, but it works like a charm and you can get your circles filled fully quickly and easily without serum rings (because you don't need multiple drops of blood usually). Always let go of the foot and let it refill will blood fully and wipe off your puncture site with gauze between circles so that you always get a nice large round drop of blood resting on top of the baby's heel each time. This technique also reduces heel bruising because you aren't squeezing so hard-- just one nice squeeze of the heel.

It takes practice, but you'll get it in no time!

Hi. Warm the baby's foot with a warmer and hold him for a couple of minutes (Gravity is your friend). When doing the PKU even a foot dangle of an inch will help.

Thank you! Last night was actually a little better:)

I hate doing PKU's. I've been bargaining and doing another nurses hearing screen if she'll do my PKU. í ½í¸‚

PKU s are not my favorite either, however as seasoned mom baby nurse I can give you a few pointers

Heel warmers

swaddle the baby with the foot out

put the crib at an incline with the head elevated

do it under the heat lamp

hold the heel in the grip for several minutes BEFORE you lancet it

make sure it is nice and red and warm

do NOT touch the heel to the pku slip, it will cause a clot at the bleeding site

when you are gripping the heel, you milk it out, not squeeze it...

if the baby is crying give it a pacifier or sweetease...screaming babies don't bleed because screaming causes vasoconstriction

You will master the grip in time, and when you do, it will be second nature...

hope that helps