Transcript Blood sample collection in children Do’s and Don'ts Dr Swati Bhave Preparation of Pediatric Patients • Find out – Is it the first time.

Blood sample collection in children
Do’s and Don'ts
Dr Swati Bhave
Preparation of Pediatric Patients
• Find out –
Is it the first time for the child?
Find out about past experience. How
did the child react ? How did the
parents react ?
• Explain –
To parent and child about procedure (if
possible with dolls or puppets)
Explain need of second attempt if
required
Parental co-operation
• Assess - Parental ability to
participate or assist you
• Decide - Whether parent should
be present or not
• If present - Decide how will they
assist : physical restrain,
distraction, emotional support ,
explanation
How to relieve Anxiety & Fear
• Collect blood away from other patients in a special room.
Never in the hospital bed. This is a comfort zone
• Area should be child friendly. Uniforms should be colourful
• Keep equipment out of site
• Ask child’s preference of hand
• Allow child to select comfort object
• Stop procedure if child combative
• Try later or another person
Minimizing PAIN
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Topical anesthetic like AMETOP, EMLA
Cost, time ( 10-60min)
More than one site tried, allergy
Sucrose or pacifier
Selection of Site
• Very important to get adequate volume
• Will be decided by
– Age of the child: heel or finger stick, IV
– Whether arterial or venous blood required
– Equipment available eg neonate capillary
tubes, vacutainers, routine needle & syringe
etc
Infants and Neonates
HEEL stick puncture
• Lateral plantar bottom surface
• 3 - 5 min Pre-Warming > blood flow (arterializes)
• Pediatric lancet New born 2.5mm L /1mm D, Preterm
o.75 mm L / 0 .85 mm D
• Depth of major BV is 0.03 mm to 1.6 mm from skin to
calcaneous
• > 2.4 mm depth injury: Osteomyelitis
Infants and Neonates
HEEL stick puncture
• Do not use anteromedial area or posterior curve of C
• Do not use alcohol swabs to stop bleeding : stinging;
Use sterile gauze for pressure
• Do not use adhesive tapes :maceration and bruising of
skin
• Do not squeeze or milk excessively : hemolysis or dilutes
blood with tissue and interstitial fluid : erroneous results
• Discard first drop
• Complications cellulitis, abscess, scarring, tissue loss,
calcified nodules
Older child : > one yr age finger prick
• Damaged veins, arm in cast or bandaged
• Do not use if edema, infection, <
circulation
• Skin to BV depth 1.5 -2.4 mm
• Should not go >2.4 mm deep
• Pediatric lancet sizes 1.75/1.25/0.85 mm
Intravenous blood collection
• Site selection
• Tourniquet not excessively tight
• Special precautions when
– Heparin lock or
– IV line collection
What is required from the sample
• Does the test require : whole blood , serum or
plasma.
• How much is the volume required : 2, 4, 5, ml
etc. Pre-term 10 ml may be 5 % of total volume
• What are the special bulbs or ready made tubes
required : e.g. fluoride bulb for sugar, chemistry
bulb for urea , EDTA for hematology etc
In What to collect blood ?
BULB
FUNCTION
USED FOR
CBC,Reticulocytes,
Chelates Ca preserves
EDTA
ESR,G6PD, Hb
cellular elements
electrophoresis
Trisodium Converts Ca into
PT, APTT, TT
citrate
non-ionized form
Fibrinogen etc
Enzyme poison.
Inhibits Glycolysis
Flouride
Glucose
In RBC (Glucose
destroyed at 5%/hr)
ORDER of drawing
• This is important - so that additives in one
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tube will not contaminate specimen in
subsequent tubes
Blood culture
Non Additive tube
Coagulation tube
Non Additive tube
• If using syringes minimize clotting by filling
additive tubes before non additive
When & How to get Serum & Plasma
• Serum sample
– blood collected without
any anti-coagulant and
centrifuged
– clear supernatant fluid
devoid of any fibrin
products
• Plain bulb
– Most enzymes,
– Biochemical LFT,KFT,
– S Electro.
– Serological :Widal, VDRL
• Plasma sample
– blood collected & mixed
with anticoagulant and
centrifuged
– clear supernatant fluid with
thrombosis inhibited. Most
satisfactory sample. No
changes occur in blood
• Heparinized bulb
– PH, NH4, RBC levels,
Plasma cortisol,
testosterone,
globin,cholinesterase
For Special Testing
• PCR, Genetic, ammonia, blood gases, drug, antibiotic
& hormone levels etc.
• Before collection of sample ascertain that you know
everything about the sample collection
• Confirm from lab how much volume, what bulb,
procedure, timing etc
• Recollection of blood is distressing for everyone:
Child-parent- doctor & adds to cost
HEMOLYSIS OF SAMPLES
• Contact with water
• Excessive heat or cold
• Rigorous mechanical injury to RBS (
thin gauge )
• Prolonged storage
• Hemolyzed samples will give erroneous
results
PREVENTION OF HEMOLYSIS
• Equipment used to collect : absolutely
dry
• Minimum constriction of limb
• Use correct gauge
• Collect slowly and steadily
• Remove needle and put immediately
into the bulb
• Easier if collection in Vacutainer
Important steps before collection
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Identification of the patient
Labeling correctly: very very important
Re-checking which test is required
Keeping ready all the necessary equipment :
drawing of blood and bulbs for collection
• Clean up the area before and after collection
Following safety precautions
• Do no harm to your patient
– Ensure use of safe and sterile equipment
• Do no harm to yourself
– Follow universal precautions
– Avoid needle stick injuries and splashing of blood
into your eyes, skin or mucous membrane
• Do no harm to the community
– Ensure that you have safely and correctly
disposed all equipment so that no other person
can get exposure
Transport & Storage of samples
• Ideally the sample should be collected in
the laboratory and immediately into the
processing
• If it cannot be sent immediately one should
follow instructions carefully for
Storage
• where should it be kept ? : room temp, cold
storage-what temp
Transport
• What are the precautions during transport
Summary
• Blood collection in children is a
traumatic and invasive procedure
• All efforts should be made to
reduce the discomfort
• Care should be taken to avoid
need for repeat puncture