1. Introduction to Paediatric Phlebotomy

2. Differences in Paediatric Phlebotomy
1. Communication.
2. Position of patient
2. Distraction.
4. Pain relief.
5. Holding technique

3. Communication Dealing with patient and parent Age appropriate language
0-6months : totally dependent , explain procedure to parent
6-12months: fear of strangers / separation , smile talk gently to baby distract with toys
1-3years : fear of injury,think only of themselves. Talk to child and parent simple commands to child need parent cooperation
3-5years : fear of injury, enjoy pretending, role play ,singing Use pain relief
6-12years: more involved aware of procedure, explain everything , try to get cooperation
13- 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 one
Always be friendly , look directly at patient

4. Position 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 lap
Older 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 disability
Inpatients: small babies under 6months may have bloods done while in cot without phlebotomist needing assistance
Older babies require two people to hold, parent may assist phlebotomist to hold and comfort baby
For older children have parent on opposite side of bed to reassure child and help

5. Distraction Distraction can be a very valuable tool.
Older babies and young children respond well to music, colourful toys and different noises
Older children can be engaged by friendly chat and talking about what interests them soccer, music ,TV, phones,school.

6. Pain relief
Sucrose : 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 anxiety
Cryogesic spray: used mostly , very quick very cold. Some children don't like it so always ask
Bussy Bee: some parents bring this with them combination of cold and vibration distracts child
Sucrose is good for babies but only as inpatient must be prescribed Give plenty onto soother then do veinpunture
Ametop must come off after 45minutes as may cause rash and make vein harder to see. Works for up tp 4hrs after removal
Cryogesic spray good but very cold can sometimes make vein disappear
Busy bees new works well

7. Holding Technique
Dealing with babies and young patients requires Phlebotomist to be able to use one handed technique
Young 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 hand
Parents are asked to hold child's hand that is not being used so that they don't try to take butterfly out
Be aware that parent's concerns are for their child and may not hold as well as a colleague would.

8. Anxious Patients
Some 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 continue
Referral to the physiology department may be offered if child cannot be persuaded to have bloods done.