Phlebotomy 101: How to get blood from babies? Part 1

 Neonatal Phlebotomy is one of the challenging things a phlebotomist could encounter in nursery rooms and neonatal ICUs. Though dangerous, I prefer getting blood samples from babies than pediatric patients.

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.

3. VEIN ASSESSMENT: To choose the right vein for dripping, gently press the baby's dorsal hand with your index finger just like when Nurses are going to insert an IV needle. Take your time in finding the vein of your choice.
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!

A CRY OF EVERY PHLEBOTOMISTS

If you think that being a phlebotomist or a warding medtech is easy, think twice.

"Here comes the NURSE...", as people sometimes call us when getting a blood sample, but at the back of our minds, how we would love to tell them that we are medtechs. But that's how they see us and to make things easy, we remain silent.

At just a simple look, a patient might ask: "Are you an intern?" but then we just ignore the insult and laughed at the thought to stay confident and prove to them they're wrong.  As the Coldplay song goes, 'Nobody said it was easy'. Sometimes, they have no idea how nervous for us just palpating the small veins of a cancer patient, obese patients and even babies when pressured to do it JUST ONCE (either thru syringe, vacutainer or butterfly method).

Well, the issue in here is...they just don't have the idea how it feels like to be degraded by someone emotionally, professionally and even physically just because you failed to extract. Here's also the thing, the SOs or the significant others cursing us for being so incompetent and pointing their fingers like we owe them a big deal. Even calling the attention of other people just to humiliate or compare us to other phlebotomists as well. REALLY! These situations do happen just to compensate that one mistake we did! They were not in the position when some of us phlebotomists want to disappear in an instant just because of shame, and the dignity that was taken out from us.

Yes, we encounter these scenarios everyday not mentioning the health hazards we face! They don't have an idea how frustrated we are trying to get blood as we swim the needle through and through. Even a simple 'Tsk, Tsk' is an alarm that we need to pull it out because it's hopeless and the patient complained already. Worse, we get discouraged that at the end of the struggle, the blood is still hemolyzed, clotted and needs re-extraction.

Yes, our job is to inflict pain to patients by using needles. Yes, we do accept our mistakes (even the hematoma on your skin, we're really sorry) because humans as we are, we fail. We're just asking you to give some understanding and a little of your respect to be considerate enough. We're also health professionals who took our time and dedication of studying and even passing the licensure exam. If we fail, I think there's a formal or a right way that you could vent your frustration, not to shout or curse us in public. Take note, this job is just a portion of being a medical technologist. Don't judge us as a whole.

But in the lighter note, we commend those people who regard us phlebotomists as vital in the laboratory. We really do appreciate those people who reply in our sincere 'Thank you' after every extraction.

This is a shoutout for those people who don't know us yet.  You just don't know...AS PHLEBOTOMISTS, WE CARE. To all the phlebotomists and warding medtechs out there, don't just say 'I'm just a phlebotomist.', Be proud of it because the patient's laboratory results depend on you. Blood collection is where it all started. We are the key players of the patient's diagnosis.

LONG LIVE TO THE SO-CALLED BLOOD SUCKERS IN THE LABORATORY!