How Can We Make This Better for

EVERYONE?
What do they see when they look
at you?
Medical
Professionals &

Our Customers
Patients
Family
Physicians
Co-Workers
Health Care is Ever Changing
 Better Safety Devices
 Fewer needle stick injuries if used properly

 Better Smaller Volume Tubes

 Better incision devices

 Testing equipment that handles smaller volumes

 POC equipment
Butterfly is NOT a Dirty Word
 For infants, babies and toddlers it is the equipment of
choice.

 Allows for a bit more flexibility

 23 G Butterfly is recommended; and later on the 22 G

needle

 Maintain the integrity of the blood, do not use 25 G.

Noteworthy Changes
 Children < 12 months should be drawn from the heel

 MAXIMUM depth of incision 2.0 mm

 To avoid puncturing the calcaneus bone (heel)

 Pre-warming, 42 degrees C increases flow x7

 Commercial warmers or warm cloth/gauze
Things That Do NOT Change
 Proper ID of the Patient

 Never label the tubes prior to the draw

 Always use the Correct Order of Draw:

 Venipuncture- BC, Lt. Blue, Serum, Green,
Lavender & Gray
 Capillary – EDTA, Other additive specimens, Serum
 ANCHOR, ANCHOR, ANCHOR & MIX,MIX,MIX!!!!
CLSI: WHO?
 International- recognized worldwide

 Interdisciplinary

 Nonprofit

 Standards-developing

 Educational Organization
A LOT OF PEOPLE
Promotes the development
and use of voluntary
consensus standards and
guidelines within the health
care community.
Recommended Site
Recommended Finger Sites
How About Dorsal Hand Veins?
Proper Positioning is Critical!
Recruit a helper/holder
Use the parent or guardian if you trust them!

They are better used holding the legs and comforting as

well as securing the shoulder.
The co-worker is there to secure the ELBOW/arm
during venipuncture by pushing upward, gently,
to prevent the elbow joint from twisting.

Equipment: ready and close by. TIMING is CRUCIAL

Recommended Finger Sites
Or You Can Perform a Capillary
Puncture
 Wash hands, don gloves,  Massage finger from base
PPE to tip
 Check orders, gather  Clean with 70%
equipment, greet and ID isopropyl alcohol – allow
the patient to dry
 Choose one of the 2  Place device firmly on
middle fingers on either finger across the grain,
hand, nondominant 1st while applying pressure
 Choose largest lancet as release the trigger
Safety allows
Or You Can Perform a Capillary
Puncture
 As the 1st drop forms, relax the pressure which allows
the capillary to refill.

 Wipe away the 1st drop, apply a little pressure, begin

collecting into the microtainer tube.
 DO NOT scrape the skin while collecting.
Repositioning, and gravity may help

 Reverse the Order of Draw when applicable

Age Specific Considerations
0-6 Months -Totally trusting 6-12 Months –Fearful
 Talk slowly
 Keep Warm
 Make eye contact with infant
 Allow parent to hold during
heel puncture  Don’t rush

 Talk softly  Keep parents close for

reassurance.
Age Specific Considerations
 1- 3 yr. olds
 Self Centered
 Fearful
 Afraid of being hurt
 Very fast. They can grab,
roll, kick and flail their
arms. And they can be
very STRONG.
 The child can
understand simple
instructions. Do not
rush. They need to think
about what might be
happening. They like to
be asked to help. Parents
can help explain and
reassure. ( This can
backfire) Use lots of
praise.
Age Specific Considerations
 3-5 yr. olds – Very self  Be direct and use good
centered. Afraid of injury eye contact. Ask for their
& being held down. assistance to hold very
 Understand simple still. Praise them for
direct statements. their bravery. Keep
 Like to think of
parents close to help
themselves as brave, they comfort them
can be very STRONG.  BE HONEST
 4-5 yr. olds – Some are
capable of sitting for
venipuncture.
A Bit About Older Kids
 Teens have more of a tendency to faint.
 Watch For:
 Clammy skin
 Color change, i.e. Lips
 Eyes not focusing
 Arms stiffening
STOP the Venipuncture, call for help,
Remove tourniquet, needle etc. apply
Pressure.
Pediatric Blood
Volumes/Estimating Volumes
 Rough estimates based on AGE and WEIGHT
 Calculated by multiplying by weight in kilograms (kg)

 Divide the patient’s weight in pounds by 2 to convert

to kg and multiply the kilograms by 100 to get the
estimated blood volume
 1 lb. = 0.454 kg
 An average infants blood volume is 100mL per kg
Collecting a Newborn Screen
 Aka PKU (phenylketonuria)

 Done when the infant is 72 hours old

 No National Standard, so test may vary form State to
State
 Recommended site is the heel; warm the site, collect
into circles in a fluid motion. Avoid layering the blood
 Allow a 4 hour dry time, send to MDH
Some Final Thoughts
 Challenge yourself

 Never RUSH, take a deep breadth

 You must stay in control of the event!

 You are NOT there to harm, but to provide a valuable

service.
Acknowledgements
 PHLEBOTOMY HANDBOOK, Blood Collection
Essentials, 7th Edit., Diana Garza and Kathleen Becan-
McBride
 PHLEBOTOMY ESSENTIALS 4th Edit., Ruth E. McCall
and Cathee Tankersly
 Phlebotomy Today STAT, various publications
 Google Images
 CLSI H3-A6,6th Edit.,CLSI LA4-A5,5th Edit.,CLSI H4A5