11/13/24, 7\:26 PM Guide | Paediatric venepuncture

Paediatric venepuncture

Table of contents

Preparation

If intravenous access is likely to be required, it is preferable to insert a cannula and take blood samples at the same time (to
avoid performing a second procedure). However, vascular access devices should not be left in situ if they are not required to
minimise infection risk.
Children should be o™ ™ ™
, EMLA or LMX-4 ).
Check the minimum age the product is licensed for and the minimum and maximum durations the anaesthetic should be left
on the skin, as this di
Apply a blob of cream over the vein and cover it with a clear
prevent the child from removing the cream.
Older children can be o1
them what it feels like
It is reasonable to show
Babies can be given oral sucrose to minimise pain. The majority of evidence of e
may be an analgesic e2
It can also help if they are held by a parent.
Once the topical anaesthetic has been applied for the recommended time, and you are ready to perform venepuncture, take
the child to a treatment room away from their bedspace if possible. This aims to keep the child’s bed space as a safe space
which they do not associate with traumatic procedures.

Gather equipment

Collect all equipment needed for the procedure and place it within reach on a tray or trolley, ensuring that all the items are
clearly visible.
The equipment you need will di
Clean procedure tray
Non-sterile gloves and apron
Tourniquet (if appropriate)
Vapocoolant spray (‘cold spray’), if required
Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
Blood sampling device (e.g. butter
Blood specimen bottles
Sharps container
Gauze or cotton wool
Sterile plaster
Laboratory forms, labels and transportation bag
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Gather equipment
Ask a play specialist to accompany you to distract and reassure the child.
In older children, a tourniquet can be used. In younger children, a colleague should act as the tourniquet by holding around
the arm and squeezing. This will also help minimise movement from the child.
In babies, you should be able to hold the limb tightly enough to act as a tourniquet, but an assistant can help if required.

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the child and parent/caregiver, including your name and role.
Con
Brie
For example, with younger children\:
" I n e e d t o t a k e s o m e o f y o u r b l o o d t o l o o k a t t o h e l p
"
Older children, or children who have previously had blood taken, may have a better understanding of what is going to happen
and so the explanation should be tailored to this. For example\:
" I’ m g o i n g t o t a k e a b l o o d s a m p l e u s i n g a s m a l l n e e d l e / c a n n u l a ,
s o w e c a n t r y t o
"
Managing fear
Some children become particularly frightened when you approach them with a tray of unfamiliar objects. It can help to
ask,
"
w o u l d y o u l i k e m e t o t a l k a b o u t w h a t w e a r e go i n g t o d o
d o e s ?"
.
They may decide they don’t want to see anything, so you should ensure the parent knows what will happen. However,
most are much less frightened once they know what the equipment does.
Gain consent (from the parent(s) and the child, if appropriate) to proceed with venepuncture.
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Check if the patient has any allergies (e.g. latex).

Expose the site

Remove any local anaesthetic cream with a paper towel or gauze, if used.
Identify and expose the site. Make sure you take your time looking for a vein you feel most likely to be successful in taking
blood from.
When choosing a vein\:
Do not take blood from an arm with IV
Avoid areas of skin damage or bruises.
In children, veins are less likely to be palpable and ‘spongy’ compared to adults, and you may have to aim for those you can
see, rather than feel.

Preparation

1. Don gloves (gloves don't need to be worn for cleaning the site, but they should always be donned prior to performing
venepuncture itself).
2. Clean the site with an alcohol swab for 30 seconds and then allow to dry completely for 30 seconds\:
You should start cleaning from the centre of the venepuncture site and work outwards to cover an area of 5cm or more.
DO NOT touch the cleaned site afterwards at any point, otherwise, the cleaning procedure will need to be repeated prior to
venepuncture.

General venepuncture procedure

1. Prepare the needle device you are using (see below for di
2. Make sure everyone is ready to start, including the parent, play specialist, and the person holding the child's arm.
3. Apply the tourniquet/squeeze.
4. Anchor the vein with your non-dominant hand from below by gently pulling on the skin distal to the insertion site. If someone
is acting as your tourniquet, they can provide slight upward traction on the skin.
5. If you are using vapocoolant spray, ask your assistant to spray from a distance of 15-20cm from the skin, in either 2-3 short
bursts or for a couple of seconds. The skin should turn slightly white (avoid ‘frosting’ the skin as this can be painful).
6. Insert the needle with the bevel facing upwards within 15 seconds of applying the vapocoolant spray. In children, the entry
angle is less than in adult venepuncture and can sometimes be almost parallel to the skin.
7. If you have entered the vein, blood should start dripping or you should see
8. Collect blood samples, then remove the tourniquet
9. Withdraw the needle and then apply gentle pressure to the site with some gauze or cotton wool.
10. Apply a dressing to the patient's arm (e.g. cotton wool, gauze, plaster).
11. Let go of the child’s limb and congratulate them for being brave! Many children will respond well to rewards, such as
stickers, after a painful procedure.
Number of attempts
Children can quickly become distressed with repeated attempts to take blood. As a general rule of thumb, a single
practitioner should have no more than two attempts before seeking senior support.
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Venepuncture devices

There are several methods to collect blood from a child, using various di
methods are using a cannula or a butter
Paedatric venepuncture devices. From left to right\: cannula,
There is no single ‘best’ method, di
preferences over time.

Cannula

of child.
Intravenous cannulation is a common method of collecting blood from children, and any sized cannula can be used in any size
The procedure for paediatric cannulation should be followed. However, the cannula is removed after blood has been
collected (if ongoing IV access is not required).
Blood can either be allowed to drip out of the end of the cannula, collected with a blunt
blood culture, or collected with a small syringe.

Butter

This technique is similar to venepuncture using a butter
Follow the initial steps described above\: identify a site, use an appropriate anaesthetic, clean and appropriately position the
patient.
1. Attach a small syringe to the end of the butter
and you are less likely to collapse the vein.
2. Insert the needle into the skin with the bevel upwards. Veins in children are more super
entry is less (sometimes almost parallel with the skin).
3. Observe for
4. Gently pull back on the syringe to aspirate blood. If larger volumes are needed, the syringe can be changed during the
procedure.
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5. Once you have obtained the appropriate volume of blood, remove the tourniquet, then remove the needle and apply
pressure.

Flag needle

These needles are not typically encountered in adult medicine but can be found on paediatric wards. The needle is a small
metal tube with a plastic handle attached, which looks like a
Follow the initial steps described above\: identify a site, use an appropriate anaesthetic, clean and appropriately position the
patient.
1. Insert the needle into the skin with the bevel upwards. Veins in children are more super
entry is less (sometimes almost parallel with the skin).
2. Once you have entered the vein, blood should immediately start dripping out of the back of the needle. This happens
rapidly, so make sure you have the blood bottles ready.
3. Allow the blood to drip from the
4. Once you have obtained the samples you require, release the tourniquet, then remove the needle and apply pressure.
This method is not suitable for collecting sterile samples required for blood cultures.

Paediatric blood bottles

For most patients, samples will be collected into speci
sized'
, blood can be collected into standard-sized bottles, as you would in an adult.
The bottles have the same colour coding as full-sized bottles. However, check local guidelines where there is any
uncertainty.
Generally, most paediatric-sized blood bottles will need 0.25 - 1ml of blood, depending on the type of bottle and tests
required. A couple of exceptions to this rule\:
Coagulation pro
, but this needs
ESR\: in most laboratories, this requires a standard-sized 'purple bottle' as approximately 2ml of blood is required.

Paediatric blood cultures

When taking a paediatric blood culture, only one bottle is generally used. This is a speci
but it creates an aerobic environment for the culture.
There is no clear guidance on the optimum amount of blood to put into a blood culture bottle, and manufacturer advice
di
years (i.e. 5ml for a 5-year-old). Blood cultures with insu

To complete the procedure...

Explain to the patient and parent that the procedure is now complete.
Document the patient's details on the blood sample bottles at the bedside (using either pre-printed or handwritten labels).
Dispose of PPE appropriately and wash your hands.
Send the blood samples to the lab for analysis in an appropriate plastic leak-proof bag with the completed laboratory request
form.

Reviewer

Dr Matt Fox

References

https\://app.geekymedics.com/osce-guides/clinical-procedures/paediatric-venepuncture/ 5/611/13/24, 7\:26 PM Guide | Paediatric venepuncture
1. GriLINK]
RJ et al. V a p o c o o l a n t s ( c o l d s p r a y ) f o r p a i n t r e a t m e n t d u r i n g i n t r a v e n o u s c a n n u l a t i o n . Published 2016. Available from\:
2. Thyr M et al. O r a l g l u c o s e a s a n a n a l g e s i c t o r e d u c e i n f a n t d i s t r e s s f o l l o w i n g i m m u n i z a t i o n a t t h e a g e o f 3 , 5 a n d 1 2 m o n t h s .
Published January 2007. Available from\: [LINK]
3. Royal Children’s Hospital Melbourne. I n t r a v e n o u s a c c e s s - p e r i p h e r a l . Updated in September 2019. Available from\: [LINK]
4. World Health Organisation. W H O g u i d e l i n e s o n d r a w i n g b l o o d \: b e s t p r a c t i c e s i n p h l e b o t o m y . Published 2010. Available from\:
[LINK]
Source\: geekymedics.com
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