Tips for doing newborn screenings?

Posted

Hi, I am new to the post partum unit after having worked Med/Surg for 4 years and I'm seriously struggling with doing the heelprick newborn screenings. Night shift does almost all the screenings and I've tried to ask the other nurses for tips and tricks but almost everybody on nights are new grads and have not been much help when I ask them for their tips. They just say "IDK put a heel warmer on and just do it."

I use the heel warmers and incline the bassinet as one nurse suggested and I'm literally hit or miss with these tests. The other night I had one baby easily bleed enough to fill the circles but the next kid was so fussy, even with sweeties, and I could not get her to bleed enough. I know they say you are supposed to get each circle with one drop but no matter what I tried it wasn't happening.I feel like a complete failure even though this is really the only thing I'm struggling with. I live in California and we have 6 circles to fill. That difficult kiddo I got 2 circles and the rest were a nightmare to try to fill. I had to poke her again and still struggled.

Please, any tips you got I'd love to hear.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 16 years experience. 14,363 Posts

What I do (did, haven't done it in several years). 

Swaddle the baby tightly, everything except the foot you're going to use, keep that dangling out. In addition to the heel warmer, take a newborn diaper, run it under very warm water, and then wrap the diaper around the heel warmer. Keep it there for several minutes. Then I would actually pick up the baby, hold them in my left arm upright (similar to photo), and then squeeze the heel gently with my left hand, holding the paper in my right. Make sure you get a good slice. Let the blood form a fat drop before touching it to the paper. Milk the entire foot, and make sure you let go between milking to allow blood return, maximizing the size of the drop that forms. If the slice is clotting or closing, you can make a second slice. But I find making sure the heel has nice warm heat before hand, and then HOLDING the baby and allowing the foot to dangle and get the help of gravity, really helps.

 

Screen Shot 2022-11-18 at 5.13.25 AM.png
Nursegirrlll

Nursegirrlll

1 Post

Hey! What I used to do is definitely put a heel warmer on, and make sure the baby is sitting upright at like a 90 degree angle. Check the cap refill on the heel and where ever the refill is fastest is  where you should prick  them. I find that pricking lower on the heel gave me the best blood flow. Also, make sure you're not squeezing the foot because that can make it clot. But if you do need to squeeze though,  make sure you let a drop of blood fill up then you squeeze. I would say my biggest tip is letting the blood it fill up until you get a good drop, squeeze, then repeat and holding the baby upright. I never had to stick a baby more than once after doing all that. Hope that helps!

On 11/18/2022 at 3:18 AM, klone said:

What I do (did, haven't done it in several years). 

Swaddle the baby tightly, everything except the foot you're going to use, keep that dangling out. In addition to the heel warmer, take a newborn diaper, run it under very warm water, and then wrap the diaper around the heel warmer. Keep it there for several minutes. Then I would actually pick up the baby, hold them in my left arm upright (similar to photo), and then squeeze the heel gently with my left hand, holding the paper in my right. Make sure you get a good slice. Let the blood form a fat drop before touching it to the paper. Milk the entire foot, and make sure you let go between milking to allow blood return, maximizing the size of the drop that forms. If the slice is clotting or closing, you can make a second slice. But I find making sure the heel has nice warm heat before hand, and then HOLDING the baby and allowing the foot to dangle and get the help of gravity, really helps.

 

Screen Shot 2022-11-18 at 5.13.25 AM.png

Thank you so much! I'm going to try this tonight.

2 hours ago, Nursegirrlll said:

Hey! What I used to do is definitely put a heel warmer on, and make sure the baby is sitting upright at like a 90 degree angle. Check the cap refill on the heel and where ever the refill is fastest is  where you should prick  them. I find that pricking lower on the heel gave me the best blood flow. Also, make sure you're not squeezing the foot because that can make it clot. But if you do need to squeeze though,  make sure you let a drop of blood fill up then you squeeze. I would say my biggest tip is letting the blood it fill up until you get a good drop, squeeze, then repeat and holding the baby upright. I never had to stick a baby more than once after doing all that. Hope that helps!

Thank you for the tips!! I'm going to try tonight and hopefully have a better go at it than I've been. Appreciate the help!

It worked! Thanks to both of you! Baby needed a burp anyway so while he had the heel warmers warming him up, I held him up on my shoulder with his foot dangling down and burped him. I made sure to let a big drop form and gave his foot a squeeze and was easily able to fill my circles. 

 

I was so scared going in to do the screening but it went so well. He only cried when I had to weigh him after.