Pediatric Procedures PLAB 1323/1023 74
Pediatric Procedures PLAB 1323/1023 74
Pediatric Procedures PLAB 1323/1023 74
Pediatric Procedures
A. Introduction
3. Very challenging patients due to size and emotional response to blood collection.
1. Every person is unique, but each will go through various stages of development.
a. Special consideration needs to be given to certain age groups, since not all of our
patients are young or middle-aged.
b. Children and older adults have different needs than young adults.
c. By learning about how people in different stages of development respond to others
and their surrounding environment, we can better formulate and implement their
care.
2. The following are general guidelines to aid you in dealing with patients based on age:
a. Infancy the period between birth and 1 year. They need to be provided with a
protective environment, ensure warmth, cuddles and hugs, and protect them from
skin abrasions.
b. Pediatric - the period between 1 and 12 years. They need to have unfamiliar objects
explained, should not be left unattended, and may need to be immobilized if
necessary. Distraction techniques can also be used.
c. Adolescent - the period between 12 and 18 year. They need to be included in
explanations of procedures, provided privacy, and may need pregnancy addressed.
d. Adult - the period between 18 and 65 years. They require explanations of
procedures, want to ask questions, and be addressed with respect.
e. Older Adult - 65 years and over. Things to consider include mobility, visual acuity,
skin protection, and orientation.
3. Healthcare workers can use this information to help them provide the best care for each
individual patient.
4. Study the chart in your textbook which illustrates age-specific care considerations which
incorporate knowledge of child development, their fears and concerns, and possible
parental involvement and tips for the phlebotomist.
1. Important to develop good interpersonal skills and routine during pediatric blood
collection.
a. During the introduction be warm, friendly, calm and confident.
b. Correctly identify the patient.
c. Ask about previous blood drawing experiences the child has had.
d. Develop a plan based your impression of the child’s and parent’s cooperation (or
lack of cooperation), involve the child if possible.
e. Explain and demonstrate the procedure.
f. Establish guidelines.
g. Be honest when asked about the amount of discomfort.
h. Encourage parental involvement.
3. It is best for the child psychologically if the procedure can be performed in a treatment
room away from the child’s bed or play area, especially if the room is shared by another child.
b. Important to restrain the arm during venipuncture to prevent injury to the child.
1) Have the parent hold the child on their lap with one arm around the child’s
waist the other hand under and clasping the child’s elbow.
2) Have the child lay down, the parent leans over the child restraining the near
arm with their body while holding the extended arm securely.
3) For small children do not allow full weight of adult to be put on child.
7. Combative children
a. At times the child may kick and thrash about even while restrained.
b. Do not use excessive force to restrain the child, this may result in injury.
c. Notify the nurse or physician.
8. Pain alleviation
a. If many venipunctures are anticipated during a hospital stay a topical anesthetic
EMLA (eutectic mixture of local anesthetics) may be applied to intact skin.
b. Combination of lidocaine and prilocaine which has minimal side effects.
c. The anesthetic affect occurs after 60 minutes and lasts 2 to 3 hours.
d. Disadvantages are cost, waiting 60 minutes, and advanced knowledge of vein to use.
e. Visit the EMLA web site for additional information: http://www.emla-us.com/
1. For pediatric and neonatal patients documentation of amounts drawn are critical.
2. Micro-capillary skin puncture is the procedure of choice when only a small amount of
blood is needed.
a. Collect hematology specimens first, then chemistry, then blood bank.
b. Sites include the heel or finger.
4. Warming the site is critical to increase blood flow to the area, commercial heel warmers or
warm wash cloth may be used.
5. Complications of heelstick
a. Cellulitis
b. Osteomyelitis of the calcaneus bone
c. Abscess formation
d. Tissue loss
e. Scarring of the heel
F. Newborn Screening
1. Venipuncture
a. Routine
b. Dorsal vein hand procedure
c. Other sites may be used, equipment of choice is the butterfly.
4. Blood may be withdrawn from IV lines but also requires additional specialized training.
5. Careful monitoring of the number of times and amount of blood withdrawn is required. A
volume of 10 mLs on a premature infant may be 10% of their total blood volume.
7. Central venous catheters can be used for blood collection but require special training.