ASSIGNMENT ON

CAPILLARY BLOOD
COLLECTION

Definition. A capillary sample is a blood sample collected by pricking the skin. Capillaries are

tiny blood vessels near the surface of the skin.
Keys Points

In newborns requiring repeated or frequent capillary blood collection venipuncture is

preferable as it causes less pain, takes less time and is associated with less maternal

anxiety

Equipment

 Tenderfoot automated lancet

 Alcohol swab/gauze swab if required
 Disposable gloves
 Correct specimen tube or newborn screening card
 Laboratory request form
 Cotton wool

Preparation of the newborn

 Methods to reduce pain for the newborn include

 Skin to skin contact with the mother – 10 to 15 minutes of skin to skin contact prior
 to the blood collection is an effective, easily implemented and safe method to
 reduce pain in the neonate
 Breastfeeding should be offered to alleviate procedural pain
 Swaddling/containment
 Administration of oral Sucrose

Procedure

 Maintain universal precautions

 Check newborn’s ID bands
 Position the heel; lower than the neonates body to facilitate blood flow
 Use the most medial or lateral portions of the plantar surface of the heel
 Cleanse the heel site if the foot appears unclean (eg faecal material). Allow site to
 dry completely before proceeding
 Hold the infants heel with a firm grip with the forefinger at the arch and the thumb
 well placed well below the puncture site at the ankle
 Press lancet into heel firmly
 Wipe away first blood of drop
 Wait for spontaneous free flow of blood
 Allow time for capillary refill of the heel and apply gentle pressure to the heel with
 the thumb, ease intermittently, if necessary to continue blood flow
 Wipe the heel and apply cotton wool over the puncture site holding until the
 bleeding stops
 Avoid the use of adhesive tape or bandaids as they cause pain on removal
 Document as required.
Puncture Site

Advantages of Capillary Blood Collection

 Only a very small amount of blood is needed, which reduces the potential for problems associated
with blood loss in delicate patients. ICU patients can lose up to 2% of their total blood volume
every day when venous blood sampling is done.

 Collection is simple and relatively painless. Finding a vein in an elderly person or a child can be
traumatic for both them and the lab tech.

 People can be taught to do capillary blood collections at home. Diabetics routinely check their
blood sugars this way using a finger-prick method with a lancet.

 Collection sites can be changed so that the risk of scarring and pain is lessened.

 Increasing adoption and implementation in labs and clinical research labs.

Disadvantages of Capillary Blood Collection

 Not all lab tests can be run on capillary samples.

 Capillary blood collection can sometimes rupture the blood cells, producing results that are
inaccurate.

 Problems with bleeding and infection can occur with any/either method of collection.

 Patients may feel faint after any type of blood drawing.

 Overuse of the same area for collection can cause scarring.

 Calcified nodules can develop at the site of collection, especially in infants. The nodules usually
resolve by themselves.
complications

Serious complications of the heel prick can include necrotising chondritis, calcaneal

osteomyelitis, and soft tissue damage.

BIBLIOGRAPHY: 

 Perry. Potter. Fundamentals of nursing. 3th. Mosby. 1985.

 Pricilla. Lemone; Lillis Carol; Taylor Carol; Fundamentals of nursing.5th Edition .

 Lippincott William and Wilkins. 2005.

Wilkinson.EB. Kozier.Fundamentals of nursing concepts and practical.5th edition. Addison

Wesley longman.1998
ASSIGNMENT ON
FEEDING TECHNIQUES
METHODS OF ARTIFICIAL FEEDING

1] Paladai feeding: Paladai is an open cup with long spout, used as a milk feeding cup for the infants.
The infant uses the tongue to lick the milk from the groove. The tongue action is same as used by the
infant while nursing from the breast.

Procedure:

 Put the baby on breast for non-nutritive sucking.

 Place the baby in upright posture with cotton napkin around the neck to mop the spillage.
 Take the required amount of expressed milk in the paladai.
 Fill the paladai spoon with milk, and place it at the lips of baby in the corner of the mouth and let
the milk flow into the baby's mouth without spill. Baby will actually swallow the milk.
 Repeat the process until the required amount has been fed. If the baby do not actively accept and
swallow the feed, try to arouse the baby with gentle stimulation.
 While estimating the intake deducts the amount the milk spilled.
 After feeding the utensils should be washed with soap and water. Boil for 10 minutes to sterilize
before next use.

Advantages:

 Simple and effective method to feed babies who are not able to suck directly at the breast.
 Reduces risk of infection.
 This method replaces the bottle feeding in nurseries. It is easy to follow and socially acceptable.

2) Cup feeding: Cup feeding is used mostly for premature infants and infants with cleft lip or palates,
until they are strong enough to start breastfeeding on their own. Cup feeding can be used on babies that
are past 32 weeks as they have not yet developed their suck, sallow and breathing reflexes. As a result
babies born before 32 weeks are fed through a gavage tube.

Advantages of cup feeding a baby

 Less regurgitation
 Less colic
 Better weight gain with infant cup feeding
 Easily learnt skill for an infant
  It provides more appropriate movement of mouth and jaw than when bottle feeding baby Less
time-consuming> It provides a way to feed baby that does not include an artificial nipple which
can cause problems with breastfeeding later.
 It can be used as one of the best alternative feeding methods for when mom is not available to
breastfeed.
 It lessens the need for a gavage tube after 32 weeks
 It provides baby with more social stimulation than bottle feeding
 It is less stressful for baby, as he will only need to deal with milk inside his mouth instead of a
nipple as well.
 Cup feeding can be done by the whole family
 Baby feeding cups are inexpensive and easy to use

Disadvantages of cup feeding babies

 It's one of those alternative feeding methods that can get really messy
 A cup feeding newborn might learn to prefer the cup over breastfeeding after a while It does not
cater for the baby's need to suck
 The danger of aspirating milk (having it 'go down the wrong way' into the lungs). This is why you
need to be alert while doing this as not to pour the milk down baby's throat.

How to cup feed baby

can use a medicine cup, but you do also get special baby feeding cups swaddle baby so that cup is not
knocked over Baby should be in an upright position

 Fill the cup half full with breast milk

 Rest the brim of the cup on baby's lower lip.
 Tip the cup so that the milk only touches baby's lips.
 Do not pour the milk into baby's mouth.
 Baby should lap or sip at the milk Stop to burp baby every few minutes Try cup feed baby when
he is alert.

3) Finger feeding: It is a breastfeeding alternative used for when baby refuses the breast or refuses to
latch on. Finger feeding is used to train baby on how to suck.

How to finger feed

 Wash your hands

 Baby's head needs to be supported and he should be facing you.
 You will need a lactation aid which is a feeding tube that is attached to a feeding bottle.
 The tube should be lined up on your index finger.
 Using your finger you can start to gently tickle baby's lips so that he can start to suck on your
finger
 Your finger should be placed with the soft part on baby's palate.
 If baby doesn't suck you might need to lift the feeding bottle as to allow the breast milk to run
down the tube.
 Remember that a finger feeding infant should not be finger fed to satisfy hunger but only used as
a way for baby to learn to suck.
4) Lactation aid "supplementing while breastfeeding": Lactation aids are used to supplement baby
while he is at the breast with a tube and bottle filled with your breast milk. The tube is inserted into baby's
mouth with your own nipple. The sucking helps stimulate mom's milk supply and is mostly used by
moms who have adopted a baby or who are trying to re-establish milk supply because of baby being
premature. Moms will be breastfeeding and pumping to get their breast milk supplies up.

How to use a lactation aid Baby should be latched onto the breast first and then the tube can be slipped
into baby's mouth. This can be done after baby has nursed on both breasts. Proper latching on will enable
baby to use the lactation aid easier.

 The tube can be taped to mom's breasts if it makes things easier for her.
 Mom might need to hold the tube in place while breastfeeding. The tube should be placed in the
corner of baby's mouth.
 Baby should not take longer than 20 minutes to finish 30ml as this could indicate that he is not
properly latched on.

Advantages lactation aids "supplemental nursing system"

 Babies are kept at the breast

 Mothers learn to breastfeed, even if they are mostly breastfeeding formula in the beginning
 Baby is less likely to reject the breast than if he was supplemented with a bottle or cup. Mom can
be breastfeeding and formula feeding baby at the same time without using a bottle.
 Moms breast are stimulated for increasing milk supply

Other alternative feeding methods

5) Spoon feeding - Allow baby to take the milk at his own pace by placing the spoon on the tip of baby's
lip.It is the best method of feeding.

 The bowl and spoon used should be cleaned with soap and water.
 Prepare the feed at the correct temperature.
 Remove the soiled linen and clean the baby.
 Place the baby in a comfortable position. i.e. propped up position in the cradle or on the lap or on
the cot with a pillow under the head. Warm feeds are fed by the spoon. Observe and prevent
aspiration and control the feed. Allow the food to be allowed before the next spoon is fed.
 Place the napkin around the neck to protect the child from spitting the feeds.
 Feed from the corner of the mouth.
 Burp the baby during and after the feeds.
 Clean the mouth with water. Soiled clothes should be changed.

6.Syringe feeding - Drop milk into baby's mouth while holding him upright. This can also be used to
supplement breastfeeding by placing the syringe in the corner of baby's mouth while breast feeding, this
will encourage baby to suck.

7.Bottle feeding: A special bottle sometimes called a "breastfeeding bottle" or known as a Haberman
Feeder can be used for infants with oral or facial abnormalities or for infants who have a delayed suck
reflex.
Principles:

 Bottle should be sterilized and covered with sterile cover. All utensils used to prepare the food
should be sterile.
 Baby should be held in a comfortable position while feeding.
 The hole of the teat should be of such size, so that 20-30 drops of milk may be sucked by the
baby/minute.
 At the end of each of feed, burp the baby.
 More than 20 minutes should not be spent for each feed.

Procedures:

 Sterile the bottle and the teat.

 Prepare the formula as per requirement; baby should be awake and hungry.
 Change the wet or soiled nappy, wash hands & check the amount & temperature of the feed.
 Sit in a comfortable position. Hold the baby.
 If any medication is there it should be given before feeds.
 If the baby is fed in the incubator or in a cradle it should be raised at the head end & body
should be turned to the right side so that food passes easily into the duodenum and prevent
regurgitation
 Let the teat touch the mouth corner and when baby opens the mouth, insert, it.
 Hold the bottle standing, so that the teat is completely filled.
 Burp the baby during & at the end of feeding.
 Hold the baby in sitting position on the lap. Place the baby on the right lateral position.

Disadvantages:

 Can't be maintained hygienically.

 Smell of rubber is not tolerated by the children. Child gets addicted to sucking from bottle.

8) Nasogastric tube feeding or Gavage feeding:

It is the ingestion of food substance through a tube passed into the stomach through the nose or the
mouth. Breast milk, formula, or liquid food is given through the tube directly into the stomach.

Indications:

 An NG tube may be needed if a baby or child is not able to eat enough food to get all the
nutrients needed. This can result when he or she :
 does not feel hungry, such as the child with cancer or liver disease
 A is not able to eat or drink by mouth, such as the child with a broken jaw tires when feeding or
eating, such as a premature baby is not able to chew and swallow well has a high need for
calories, such as the child with cystic fibrosis, heart disease, or lung disease is not able or not
willing to take in enough calories by mouth to support proper growth, such as "oral aversion"
 An NG tube may be needed if a baby or child needs a special formula to control their disease,
such as Glycogen Storage Disease or Crohns Disease.
 Purposes:

 To provide nutrition in a way that the child and family can accept
 To achieve and/or maintain ideal growth
 To provide the right amount of nutrients
 To provide the right amount of water
 To help control a control a disease or health problem

Equipments:

 Sterile catheter/feeding tube of15 inches for infant and 30 inches for older children
 Water soluble lubricant jelly
 Non allergic marker.
 Syringe and stethoscope
 Barrel of syringe 10-15 ml size
 The milk at room temperature.

Preparation for procedure:

 Explain the procedure to the patient & the family.

 Assemble all the articles.
 Position and restraints the child.
 Identify the site through which the tube should be inserted. In infants: through mouth and in older
children: through nose.
Measure the length of tube:
 Measure from the ear lobe to tip of the nose then just below the tip of the xiphoid process
ofsternum.
 Ear lobe to below the umbilicus.
 Insert the lubricated tube through the mouth or the nares till the mark.
 Child's head should be stabilized by nurses hand and it should be flex during insertion.
 

Check the position of the tube:

 Aspirate with the help of a syringe, note the content, color, and amount. Subtract that amount
from total quantity of the fluid.
 Instill air into stomach and check for air entry

DO NOT GIVE A FEEDING if you are not sure that the NG tube is in the stomach.

DO NOT GIVE A FEEDING if your child has problems breathing or speaking,has a distended
stomach, is crying, or complains of pain. There are four ways to feed a child by tube:

A."Top-up" feedings

Bolus feedings

Continuous feeding

Combination feeding
A."Top-up" feedings: These tube feedings are small volumes of formula (or breastmilk) and are often
given after feeding the child by mouth

B.Bolus feedings: child may need an entire mealtime feeding to be given by NG tube. This is called a
"bolus" feeding.

Bolus feedings are often given by gravity. The formula is placed in the baby bottle or feeding set and
hung above the child. Bolus feeds can also be given by pump or syringe.

C.Continuous feeding: This method of feeding is used to give fluids slowly over several hours or
overnight. It is usedwhen the child can only handle a small amount of formula at one time. Food pump is
used.

. D.Combination feeding: in this method above 2 methods combination is required at mealtime.

Removing the feeding tube (if ordered)

 Remove the tape.

 Pinch the tubing and pull the tube out in one quick motion.
 Hold, cuddle, and comfort your child. If the child is an infant, burp him or her.

9) Gastrostomy feeding:

A gastrostomy tube (G-tube) is a thin, hollow tube that is put through the skin into the stomach through a
small surgical opening (stoma).

Gastrostomy feeding is the administration of liquid nourishments through a tube directly into stomach
through the abdominal wall.

Purposes:

 To feed a child who is unable to feed orally

 To provide nourishment in child with congenital anomalies e.g. tracheoessophageal fistula. To
decompress the stomach.
Equipments:
 20-50 cc syrienge
 Sterile water
 Warm feeding formula Mackintosh and towel

Procedure:

 Place mackintosh and towel on child's abdomen

 Attach tubing to 10-50 cc syringe
 Hold child elevated
 Elevate syringe to 10-12 cms
 Aspirate gently
  Pour feed and allow flow with help of gravity
 Do not apply pressure
 Irrigate with clean water
 After feed the tube may: left unclamped to provide constant decompression
 Elevated and covered with gauge.
 Clamped-if patient is to be prepared for home care Record types, amount of feed, child's activity
 Keep the child in fowler's position or turned right
 The gastrostomy tube may be left opened and elevated to allow air to escape and decompress the
stomach.
 The tube should be secured in place and avoid excessive traction.
 Keep the area/ skin around gastrostomy clean and dry to prevent irritation and infection.

10) Gastrojejunostomy feeding:

A gastrojejunostomy is a surgical procedure in that the GJ tube is directly connects the stomach to the
jejunum & the second section of the small intestine, by a small tube.

The tube allows food, liquids, and medications to bypass the duodenum, the first section of the small
intestine. Indications:

children with stomach or duodenum blockages, often caused by stomach or pancreas cancer, and children
who cannot properly digest food.

In one common version of this procedure, one end of the tube is left in the patient's intestines, with the
other end outside of the abdomen, to be used for feeding and giving nutrients for as long as necessary;
this is often referred to as a GJ tube or feedingtube. Gastrostomy-Jejunostomy(GJ)A
gastrostomyjejunostomy tube is a lot like a Gtube except that there are 2 ports on a GJ tube Gastric port:
opens into the stomach Jejunal port: goes through the stomach

GJTube and into the small intestine

 The physician insert the nasojejunal tube through the nose into jejunum.
 Abdominal x-ray is taken to ensure placement of the tube. Place child always on the right side
with thigh and hips elevated.
 Give small feeds frequently.
 Do not aspirate the fluid
 Record as for other procedures.

Precautions:

 Check for abdominal distention by: measuring AG 2-3 hours daily. Palpate abdomen
 Observe for ripples in abdomen (flow of abdominal content as bubbling noise) Check stool for
bleeding, ph, and sugar to determine tolerance to feeds.
 Check for hematemesis
 Keep the child's head elevated after feed.