Neonatal Blood Sampling Flashcards
What are capillary samples suitable/ not suitable for?
Suitable for most haematological and biochemical tests but not for:
- Blood gases
- Blood cultures
- Haemoglobin and PCV (packed cell vol.) in first 2 days of life
What are capillary samples most commonly used for?
- Blood glucose estimation by reagent sticks and machine
- Serum bilirubin measured by a bilirubinometer
- Blood spots for the neonatal screening card
What equipment is needed?
- Non-sterile gloves
- Sterile lancet with delivery system
- Cotton wool ball or gauze
- Screening card or sample tube or bottle
- Tape or spot plaster
Give steps 1-5 of the procedure
- Explain procedure to parent(s) and obtain informed consent
- Ensure card is filled in accurately or any samples are labelled correctly
- Recommend measures to comfort baby/ reduce pain
- Protect yourself and the furniture from blood
- Ensure the baby’s foot is clean and warm
Give steps 6-10 of the procedure
- If foot is visibly dirty, clean with water and ensure this completely dries
- If necessary, pre-warm the foot
- DO NOT USE HOT WATER
- Allow the limb to hang to increase blood flow
- Identify the correct area for puncture
Give steps 11-15 of the procedure
- Hold heel firmly with ankle flexed (heel should be red, not white)
- Use automated lancet (not more than 2.5mm depth) in correct area
- Wait up to 15 secs to allow blood flow
- Gently massage heel if necessary
- Blood should form large drops and one should fall into each circle of screening card, filling it front and back
Give steps 16-20 of the procedure
- If bleeding stops, perform a 2nd prick from a different part of the foot
- Allow circles to dry before placing in envelope
- Best to wipe away 1st drop to avoid contamination when testing blood sugar levels
- One large drop is required for blood glucose estimation
- Capillary tubes should automatically fill by capillary action - important that end of tube remains in contact with blood or air bubble will form = inaccurate results
What effect may excessive squeezing of the foot have?
May cause haemolysis and inaccurate results, especially in blood glucose and serum bilirubin estimations; it also causes pain and tissue damage
What should be done after the procedure?
- Immediate safe disposal of sharps
- After sample collection, apply pressure to puncture site with sterile gauze/ cotton wool
- If bleeding persists a small spot plaster can be applied - advise parents to remove it later
- Record procedure accurately
Name 4 possible complications of neonatal blood sampling
- Cellulitis
- Osteomyelitis
- Scarring
- Pain
Describe cellulitis
Infection of the soft tissue due to faulty aseptic technique
Describe osteomyelitis
Infection of the calcaneus bone due to sample being taken in the middle of the heel or too deep a puncture; this can necessitate amputation of heel or foot
Describe scarring
If multiple samples are requires, another technique should be used to prevent scarring
Describe how pain may be reduced
- Good technique
- Take sample while infant is feeding/ sucking or in a deep sleep
- Swaddling and skin to skin contact
- Topical pain relief cannot be used
Give some reasons that inaccurate results may be obtained
- Contamination by alcohol, soap etc
- Haemolysis
- Too little/ too much
- Leaving sample too long before analysis
- Blood glucose results can be inaccurate with good technique to in case of doubt, ask a doctor to send a venous sample
