1. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.1 This product was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment & Training Administration. The information contained in this product was created by a grantee organization and does not necessarily reflect the official position of the U.S. Department of Labor. All references to non-governmental companies or organizations, their services, products, or resources are offered for informational purposes and should not be construed as an endorsement by the Department of Labor. This product is copyrighted by the institution that created it and is intended for individual organizational, non- commercial use only.

3. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Venipuncture on Children When performing venipuncture on children, there are two patients to be concerned with–the child and the parent. Speaking to both the child and the parent will offer reassurance. Skin puncture is often the best option for collecting blood from a child.

4. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.4 Skin Puncture Skin puncture sites available for under one year of age are the heel, the earlobe, or the great finger. Over one year of age, any finger except thumb can be used.

5. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Skin Puncture (cont.) Puncture site must be warm to increase blood flow up to seven times. Ideal temperature is 42° Celsius. Site should be cleaned with alcohol. After puncture, the first drop of blood must be wiped away to avoid contamination with interstitial (tissue) fluid. Blood should flow freely into the collection container.

6. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Skin Puncture Procedure Gently massage the finger to increase the blood flow.

7. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Skin Puncture Procedure (cont.) Clean the incision site and let air dry. Remove safety clip from puncture device. Do not touch blade slot end.

8. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Skin Puncture Procedure (cont.) Position the puncture device to cut across the fingerprint lines. Depress plunger.

9. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Skin Puncture Procedure (cont.) Remove the lancet. Gently wipe away the first drop of blood.

10. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Skin Puncture Procedure (cont.) Allow blood to flow into the container.

11. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Microcollection Order of Draw Blood gases Lavender top (EDTA) Green top (sodium heparin) Other additive microcontainers Red top (nonadditive) microcontainers

12. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Heelstick Collection Blood should be collected from the most medial or lateral portion of the plantar surface of the heel. Depth of puncture should be no greater than 2.0 mm. Excessive crying can result in elevated white blood cell counts.

13. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Heelstick Collection (cont.) Warm heel for three minutes with a heel warmer.

14. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Heelstick Collection (cont.) Remove the lancet device from the package. Device should be made for heelsticks

15. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Heelstick Collection (cont.) Position the heelstick lancet on the medial or lateral portion of the plantar surface Depress plunger. After triggering, remove the lancet and discard it in a sharps container.

16. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Heelstick Collection (cont.) Taking care not to make direct contact with the collection container, fill to the desired level.

17. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Anticoagulated Patient The patient on anticoagulant therapy will be susceptible to bleeding and hematomas. Contain the bleeding after venipuncture with gauze or cotton and an elastic bandage. Instruct the patient not to carry her purse or other heavy items with the venipuncture arm for at least an hour.

18. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.18 Any Patient A pressure bandage is a cotton ball over the site wrapped with an elastic tape. This will contain the bleeding on any patient.

19. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.19 The Resistant Patient It may take more time to convince the resistant patient that the collection is necessary. An aware patient may refuse The unaware patient can be drawn with valid physician orders

20. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.20 The Psychiatric Patient The psychiatric patient may not always understand what is being done.

21. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.21 The Obese Patient The obese patient’s veins are usually deeper and not as easy to feel. Fat globules will often mimic veins. Veins in the hand may be easier to access.

22. Copyright © 2005 Thomson Delmar Learning. ALL RIGHTS RESERVED.22 Patients with Damaged or Collapsing Veins Veins can be inaccessible because of burns, scars, or surgical procedures. Fingersticks or alternate veins must be used. Collapsing veins require the use of a syringe or small vacuum evacuated tubes.