2Differences in Paediatric Phlebotomy 1. Communication.2. Position of patient2. Distraction.4. Pain relief.5. Holding technique
3Communication Dealing with patient and parent Age appropriate language 0-6months : totally dependent , explain procedure to parent6-12months: fear of strangers / separation , smile talk gently to baby distract with toys1-3years : fear of injury,think only of themselves. Talk to child and parent simple commands to child need parent cooperation3-5years : fear of injury, enjoy pretending, role play ,singing Use pain relief6-12years: more involved aware of procedure, explain everything , try to get cooperation13- 17years : actively involved. Talk directly to teenager. Can be embarrassed to show fear especially boys watch for fainters!!!!Dealing with parent and child not one on oneAlways be friendly , look directly at patient
4Position of patient OPD: babies and toddlers on parents lap 5-8year olds may want to sit on chair alone with parent on chair beside them,but be aware that they may be better on parents lapOlder children may want to be on their own but must have parent outside ..Children over 16years do not need parents with them unless they have intellectual disabilityInpatients: small babies under 6months may have bloods done while in cot without phlebotomist needing assistanceOlder babies require two people to hold, parent may assist phlebotomist to hold and comfort babyFor older children have parent on opposite side of bed to reassure child and help
5Distraction Distraction can be a very valuable tool. Older babies and young children respond well to music, colourful toys and different noisesOlder children can be engaged by friendly chat and talking about what interests them soccer, music ,TV, phones,school.
6Pain reliefSucrose : used for small babies when inpatients as needs to be prescribed .Ametop: cream needs to be put on 45minutes before blood test.can add to anxietyCryogesic spray: used mostly , very quick very cold. Some children don't like it so always askBussy Bee: some parents bring this with them combination of cold and vibration distracts childSucrose is good for babies but only as inpatient must be prescribed Give plenty onto soother then do veinpuntureAmetop must come off after 45minutes as may cause rash and make vein harder to see. Works for up tp 4hrs after removalCryogesic spray good but very cold can sometimes make vein disappearBusy bees new works well
7Holding TechniqueDealing with babies and young patients requires Phlebotomist to be able to use one handed techniqueYoung children do not sit still and hold out their arm for blood tests so Phlebotomist must learn to be able to hold patient's arm and not let go and use butterfly and change bottles with other handParents are asked to hold child's hand that is not being used so that they don't try to take butterfly outBe aware that parent's concerns are for their child and may not hold as well as a colleague would.
8Anxious PatientsSome children can be very anxious and may not want blood test done at all. It is important to keep calm, talk gently to child and try ease their fears. It is also important to get parents on your side .If child is unmanageable and it is is unsafe to do the bloods the phlebotomist may stop and tell parents that they may have to leave as it is not safe to continueReferral to the physiology department may be offered if child cannot be persuaded to have bloods done.