What's difficult in blood extraction of the babies is that their veins are still thin. You can not always use 3cc syringe to get the baby's blood from the arm. If possible, one should pull the plunger slowly so as to prevent the vein from collapsing. There should be an assistant to hold the baby's arm to secure the vein. Take note, the baby's veins are still movable and their skin tends to stretch.
THE SOLUTION...
To get blood samples for tests like CBC, Total and Direct Bilirubin for babies and the like, a passive blood collection technique called DRIPPING may be applied.
HOW TO DO DRIPPING
1. First and foremost, nursery rooms especially neonatal ICUs limit hand contacts to their babies. And for this reason, we should observe proper hand hygiene by washing our hands with soap and dry it thoroughly with a tissue/paper towel. Also, prepare the things you need. In our hospital, it is a policy to leave the warding trays outside the nursery rooms and bring only the things you only need.
2. It is an option whether you put gloves or not. As for me, I don't wear gloves until I have found the right vein for dripping.
4. One of the ways to obtain a successful extraction is the way you hold the baby's hand. In order for you to easily squeeze the hand as the blood drops, make a circle around the baby's hand.
5. Clean the site: inner to outer motion. In this manner you can see your chosen vein clearly. Let it dry.
4. Taut the baby's skin. Hold it firmly. A 23-gauge needle can be used. As you insert the sterile needle (bevel up), don't let air get into it. Shallow angle of insertion at first then insert deeper until blood coming from the vein of choice comes to the needle's hub.
5. SQUEEZING TECHNIQUES...
As soon as the blood drops, squeeze the baby's hand gently by letting your index finger massage the baby's hand downward. This is to facilitate the blood to drop in the microtainer tube that you're holding in your other hand. It is advised to observe a 3-second interval after squeezing to avoid needle dislodge and to allow more blood to drop in the tube.
6. In case you observe any clots in the hub, gently remove it by using an alcohol swab. This should be removed immediately or else the blood flow will stop. Also, when you notice the blood stops dropping, adjust the needle inward or outward. Do it gently.
7. After collecting the right amount of blood. Cap all the microtainers and remove the needle with a cotton ball immediately covering the puncture site. Apply pressure for 1 minute then put a plaster.
8. Dispose the sharps in the sharps container and make sure the baby's bed is clean before leaving.
Dripping might be time-consuming but I personally prefer doing it than the syringe method. I hope this helps...
Stay tuned for my Part 2 of neonatal phlebotomy tips!
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