Taking blood samples

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Hey everyone, 

Back when I worked in clinical research, we often had to take blood samples from children for certain trials. And long story short, it could be rather difficult ? 

Question: What are your personal techniques/tips/tricks for handling children when carrying out invasive procedures like venepuncture? Ways of keeping them calm and relaxed etc. so it all goes as smoothly as possible.

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Specializes in PICU, Pediatrics, Trauma.

It all depends on the age and how the parents handle it.  Rarely, but sometimes it’s best to ask the parent to leave the room.  Especially if they are very anxious.  They’re attitude effects the child big time.  Here’s a few basic principles I use.


For an infant, give them a pacifier or place them at the mom’s breast if breastfeeding.  Back in the day, we used to dip the pacifier in glucose water.  Apparently, that or breast milk was thought to be a natural pain killer.  

Warm the extremity and make sure you have help holding the pt in position.  Sometimes parents will want to hold the patient in position, but unless they are quite experienced with this, it’s not always a good idea as they often won’t hold strong enough, or they let go at the wrong time etc..Also, having a nurse help with holding is better because they can anticipate your next steps and it will go smoother.

For older children, explain ahead of time what you are doing, and use friendly terms as much as possible.  Have some sort of reward to give afterwards and let them know that they will get that once the procedure is done. A small toy, an ice cream, a book or whatever is appropriate in your setting.  Distraction can help, by having the parent hold a tablet or phone with the child’s favorite cartoon or song next to them to watch while you do the procedure.
 

Above all, keep yourself calm and speak in a reassuring voice.  Have everything you need ahead of time so there aren’t any interruptions.
 

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Best, most humane way for multiple blood draws is an arterial line...one stick and all the blood you want...

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Specializes in PICU, Pediatrics, Trauma.

Yes but, that would only be in an intensive care setting.  

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On 4/17/2022 at 8:29 AM, BeenThere2012 said:

Yes but, that would only be in an intensive care setting.  

So? Stepdown units can take a lines. My kid (1-6 yo)? Multiple (more than 2) sticks? Do it.

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Specializes in PICU, Pediatrics, Trauma.

I’m all for A-lines.  I thought the point of the post was to ask how to do these procedures in a less stressful manner for pediatric pts.  Not all have A-lines.

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Specializes in ER.

Burrito wrap, hold limb with hand as tourniquet, as a real tourniquet can be too tight easily, wait an extra second for flashback compared to an adult.

I tell the parents that I look for the best site, and I'm slow, so with all the looking they tend to settle anxiety wise, and that helps the child. It also helps me to go calm and slow. I put the needle under the skin, wait for that initial pulling away, and then go for the vein. Otherwise I go through. 

Always, always, do it from a chair. that has improved my success rate tremendously. And have your tape etc ready, don't take your hand or fingers off the site until it is taped.

I agree that the parents can not be used as holders. They will let go let go without warning

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Specializes in PICU, Pediatrics, Trauma.

Good technique!  Agreed!

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