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Phlebotomy Ch.12: Lecture 1 (Drawing for Pediatrics (prepare materials…
Phlebotomy Ch.12: Lecture 1
Pediatric Pts
physiological considerations
children have lower blood volume than adults and the amount taken must be monitored so as to not cause anemia or cardiac arrest
no more than 5% should be taken in a 24 hr period; 3% or less is prefered
no more than 10% should be removed in a month period unless medically necessary
dermal punctures require less blood and are prefered when small amounts of blood are needed
newborn's may require more blood due to a high ratio of RBC's to plasma than in adults
Psychological
children bring different experiences, fears, and levels of understanding to a blood draw
your job is to make it calm and as painless as possible so it is a positive for child and parent
cry/stress can increase WBC's and blood pH levels and give physician misleading data
immobilization technique
infants may be wrapped in blanket to control movement
diaper decks are useful and do not scare child
papoose boards may be used too
a good holder is essential
a vertical hold in which a parent or staff member assists
supine or lying down position
Drawing for Pediatrics
prepare materials ahead of time or out of view of child
for inpt's perform draw in tx room inside of child's room which is his/her "safe" area away from home
be friendly, patient, smile, and talk in a calm, soothing voice
explain procedure in terms that a child can understand
Do Not say that it will hurt but say it will be like a pinch
give child choices: bandage, sticker, which arm or finger
use smaller needles and smaller tubes
try to keep child distracted while drawing blood by talking or help from parent or co-worker
during draw let child know they are doing a good job and that you are almost done
always praise child after and give them a sort of a reward so that they end in a positive note
involve parents as long as they are positive
newborn ID bracelets will be on ankle along with mothers
Do Not ID infants by name on bassinet
small gauge needles and butterflies are useful for children and infants
follow policy with regard to use of topical anesthetics
Pediatric Dermal Puncture
heel is prefered for children under 1 yr
fingers can be used on older children
make sure to follow ID procedure
keep all equipment out of child's reach
heel warmers can also be used on fingers
make sure to remove all equipment at end of procedure and put bed rails up
Do Not use bandages that child could aspirate
Neonatal Bilirubin
a by-product of RBC destruction
the liver in newborns is not always developed enough to remove it from flood and jaundice can result
treat jaundice with "bili light" or UV light
Collect Precautions
bilirubin is light sensitive
turn off bili light during collection
use amber-colored tubes/shield tubes with foil to prevent exposure to lights
hemolysis can falsely lower results
collection times must be recorded accurately for track purposes
Neonatal Screening
use to detect inherited metabolic disorders that cause brain damage or death
includes: PKU, hypothyroidism, galactosemia, biotinidase deficiency and sickle cell anemia
heel collection directly into special filter paper is recommended procedure
Screening Tips
perform routine heel puncture
apply one large drop, fill each circle, without touching filter paper directly
apply to one side only, but make sure drop soaks through one side
air dry in a horizontal position
store at room temp. away from direct sunlight until delivered to lab
Dorsal Hand Vein Technique
used for larger amounts of venous blood no tourniquet required because you encircle the hand with your thumb and fingers
insert 23 gauge butterfly needle into dorsal hand vein and allow blood to drip into microcollection tubes or smaller syringe