Blood Collection using Heel Lance Device (Neonates)



Canberra Hospital and Health ServicesClinical Procedure Blood Collection using Heel Lance Device (Neonates)Contents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc508030854 \h 1Purpose PAGEREF _Toc508030855 \h 2Scope PAGEREF _Toc508030856 \h 2Section 1 – Procedure PAGEREF _Toc508030857 \h 2Implementation PAGEREF _Toc508030858 \h 4Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc508030859 \h 4References PAGEREF _Toc508030860 \h 4Search Terms PAGEREF _Toc508030861 \h 4PurposeThe purpose of this procedure is to provide clinicians with best practice information on the safe and effective technique to collect a blood sample using the heel lance device Back to Table of ContentsScopeThis document pertains to staff in the Division of Women, Youth & Children who are working within their scope of practiceThis document applies to:Medical OfficersNurses and MidwivesStudent nurses, midwives and medical students working under direct supervisionThis document applies to neonates cared for in the Neonatal Intensive Care Unit (NICU), Special Care Nursery (SCN), Maternity and paediatrics. Back to Table of ContentsSection 1 – Procedure ContraindicationsThe heel lance technique cannot be performed on babies withOedematous feetInjured feet Infected feetAbnormalities that preclude putting pressure on the footEquipment:Alcohol Based Hand Rub (ABHR)Gloves Sterile cotton wool balls Heel warming equipmentHeel lance deviceBlood sample containers as required +/-Newborn Blood Spot Collection cardSucrose Pathology request formProcedure Attend hand hygiene by either washing or using ABHRProvide parents with information about the need for the collection of blood Obtain consent for the procedure from the parents and obtain signature if Newborn Screening Test (NBST)Assemble equipmentIdentify the infant as per Patient Identification and Procedure matching policyIf required pre warm the heel by applying a warm cloth/foot warmer for 3-5 minutesOffer breastfeed/Expressed Breastmilk (EBM) or give sucrose according to standing ordersFlex the foot between the thumb and fore fingerPlace heel lance device with the flat blade opening surface flush on the incision area as demonstrated in diagram (below) without exerting pressureDepress trigger and remove device disposing in a sharps containerAfter incising the heel wipe away the first drop of blood to discard cellular debris that can contaminate the sampleApply gentle pressure to allow large drops of blood to form for collectionRelease pressure to allow capillaries to refill and repeatNote:Avoid excessive heel squeezing to prevent unnecessary pain and sample compromise. Sample compromise can occur from fluid leakage, haemolysis and bruisingIf blood stops flowing wipe site with a gauze swab to remove clot, ensure time for capillary refill then reposition your hand and reapply pressureIf blood does not flow choose another site and repeat procedureAfter completing collection of blood sample apply pressure to the incision site with cotton wool Continue comfort measuresDiscard equipment appropriately and attend hand HygieneDocument procedure attended in clinical recordsLabel the sample and send it to pathologyNote:Avoid using adhesive dressings INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET INCLUDEPICTURE "" \* MERGEFORMATINET Safe incision areas are the sides of the heels on the plantar aspect of the foot. Research indicates that the plantar surface between those areas can be incised safely using a controlled-depth device if frequent sampling from the sides has rendered them unusable. Never incise the end of the heel (Advances in Neonatal Care 7(4) 175).Implementation This document will be implemented and communicated to staff through existing training programs, at in-services and orientation, emailed to staff and placed in work rooms. Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesHealth Directorate Nursing and Midwifery Continuing Competence PolicyConsent and TreatmentProceduresCHHS Healthcare Associated Infections Clinical ProcedureCHHS Patient Identification and Procedure Matching PolicyLegislationHealth Records (Privacy and Access) Act 1997Human Rights Act 2004Back to Table of ContentsReferencesFolk, L (2007) Guide to heel stick blood sampling in infants. Advances in Neonatal Care 7(4) 171-178Shah V, Taddio A. 2005 Neonatal capillary blood sampling. Neonatology [serial online]. July 2005. Available at: 6D672D2D-E340-4FD4-9B40-F0D64CEF118C.W5Doc. Vedder T, Nimavat J (2015) Heel sticks. MedscapeBack to Table of ContentsSearch Terms Heel prick, Heel lance, Heel stick, Blood collection, Blood spot, Neonatal screen testDisclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Policy Team ONLY to complete the following:Date AmendedSection AmendedDivisional ApprovalFinal Approval 14/03/2018Complete ReviewKaren Faichney, A/g ED WY&CCHHS Policy CommitteeThis document supersedes the following: Document NumberDocument NameCHHS12/087Department of Neonatology - Blood Collection using Heel Lance Device ................
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