Tourniquet with heel sticks?

[beautifulbyHisblood]

So last night I had to get labs from a 1 month old. We stuck his heel, but it didn't bleed well and clotted before we had enough blood (plus it looked like it was starting to hemolyze). So I stuck on a tourniquet to look for a vein to straight stick him, and blood started coming out of the heel stick site. We cleaned again and did another heel stick, and blood started pouring. I had enough blood within a couple minutes, and left the tourniquet on the whole time.

I had never seen anyone do that before, but his labs came back fine and laboratory never called. Is it okay to draw blood that way? I'm new so I'm just wondering... probably should've asked before I did it, but it turned out okay, right?!

[AP0525]

The way that I had always been taught to do it is put a heel warmer or some type of warm compress on the heel for a few minutes to bring blood to the capillaries. Then, do your heel stick.

You don't put a tourniquet on a diabetic's arm to do an Accucheck and it's the same type of thing.

[AP0525]

Ok, so I also just read that if used, a tourniquet should not be left on for more than one full minute. Also, it may cause hemolysis so it is not preferred.

[Jolie, BSN]

When drawing blood by heel stick, you want to warm the heel thoroughly first, then use a gentle "milking" motion to stroke the lower leg and heel, encouraging the flow of blood by drops, then allowing for capillary refill, then flow of blood by drops again, then capillary refill.....Don't expect a continuous flow of blood.

Using a tourniquet interrupts the process of capillary refill, and increases the chance of hemolysis, because you will almost completely occlude the superficial capillaries that you are attempting to draw blood from.

In my experience, if the heel is adequately warmed, and your technique of milking is correct, yet you still get inadequate blood flow, then you have probably not used a properly sized lancet. Month-old babies have a bit of sub-q pudge on their heels that needs to be penetrated. Make sure you are using a child-sized lancet, not a neonatal one.

[wooh, BSN, RN]

Agree, throw a warm pack on their heel beforehand and make sure you're using a lancet for heel sticks. The lancets for fingersticks don't "stick" enough.

[nola1202]

I also had this experience, and wondered about it. I guess there's the prefered method, and the unconventional that works that one time. Glad the labs ended up comming out fine.