Pediatric Venipuncture

PEDIATRIC VENIPUNCTURE
 Pediatric venipuncture requires the expertise and skill of an

experienced phlebotomist.
 If a child is under age 2, venipuncture should be limited to

superficial veins of the antecubital fossa and forearm, and never
deep, hard-to find veins
 An infant or young child has a small blood volume and every effort
must be made to collect the minimum amount of blood required for
testing. Large amounts of blood removed at once or even small
quantities on a regular basis can cause anemia.Removing 10% of blood
volume at one time can lead to shock and cardiac arrest.
 Excellent interpersonal skills are needed to deal with distraught

parents and with crying, screaming, and scared children, ideally,
only experienced phlebotomist should draw blood from children;
however, the only way to gain exprience is through practice.Through
experience, one learns what works in different situations.Frequently,
smaller-gauge (23-gauge or 25-gauge) needles are employed.
 Attempt to interact with the pediatric patient, realizing that both

the patient and the parent (if present) may have anxiety about the
procedure and be unfamiliar with the new settings.Acknowledge the
parent and the child, Be friendly, courteous, and responsive. Allow
enough time for the procedure.
IMMOBILIZING A CHILD
 An infant can be wrapped in a blanket. Physical restraint may be

needed for toddlers and young children
 A toddler can be restrained while sitting on a parent’s lap. The

parent uses one arm to support and steady the venipuncture arm and
places the other arm around the child and the child’s other arm.
 If the child is in a bed, a parent or helper leans over the child

from the opposite side of the bed, reaching one arm around the child
to support the venipunctiure arm and the other the child to secure
the child’s other arm.
 Older children do not usually need restraint, but a parent or someone

else should help steady the arm
Specimens from children yonger than age 1
1. Venipunctures should not be performed on children younger than 6

months of age unless there are specific testing requirements
necessitating a venipuncture.
2. Venipunctures on infants between 6 and 12 months of age should be

done if the child is of at least average weight for age and the quantity
of blood and/or the assays require a venipuncture.
3. If an extensive number of tests are ordered on a small child, an

experienced phlebotomist should perform the procedure.
CAPPILARY SPECIMEN COLLECTION
- Drops of blood for testing can be obtained by puncturing the capillary

bed of the skin with a lancet or other sharp device. Capillary specimen
collection (also called dermal or skin puncture) is especially useful in
pediatrics where removal of larger quantities of blood can have serious
consequences. Collection sites include the fingers of adults and
children over the age of 2 and the heels of infants.
 Skin punctures often are performed in:
 Newborns; in pediatrics patients younger than 1 year
 In adults who are severely burned and whose veins are being reserved
for therapeutic purposes
 In elderly patients with fragile veins, When peripheral circulation

is poor, however, accurate results may not be obrained with specimens
acquired by skin puncture.
CAPILLARY BLOOD
-is actually a mixture of venous blood, arterial blood, and tissue

fluid.
-When the puncture site is warmed, the specimen more closely resembles
arterial blood(PROPER TECNIQUE)
-White blood cell counts in specimens obtained by skin puncture may be

15% to 20% higher than the counts in venous specimens
-Clinically significantly higher glucose values are found in specimens

obtained by skin puncture compared with those obtained by venipuncture.
MATERIAL USED:
A. Alcohol; gauze and bandages
-CLS recommends using 70% isopropyl alcohol to clean capillary

puncture sites. Gauze or gauze-type pads are used to wipe away the first
blood drop to eliminate alcohol residue and excess tissue fluid and to
hold site pressure after specimen collection.
B. Lancets
-are sterile, disposable, sharp instruments used for capillary

puncture.
C. Warming devices
-Warming the site increases blood flow up to seven times and is

especially important when performing heel sticks. A towel or diaper
dampened with warm water can be used; however, water temperature must
not exceed 42°C or it could scald the patient.
D. Microcollection tubes
-Microcollection tubes (microtubes) are special small plastic tubes

often referred to as “bullets”. Markings for minimum fill levels
typically measured in microliters (uL).
E. Microhematocrit tubes
- Microhematocrit tubes are narrow-bone capillary tubes primarily

used for manual hematocrit (Hct) determinations. They come coated with
heparin for collecting directly from a capillary puncture or “plain” to
be used when filling with blood from an EDTA tube.
F. Sealants
-sealants are clay like substances used to seal one end of

microhematocrit tubes. For safety reasons, manually pushing the tube
into the sealant is no longer recommend.
G. Glass slides for specific test orders
-is used when blood smears are being requested.

COLLECTION SITES
 The fingertip (usually of the third or fourth finger), heel, and big
toe are appropriate sites for the collection of small quantities of
blood. The earlobe may be used as a site of last report in adults, Do
not puncture the skin through previous sites, which may be infected.
 IMPORTANT NOTES:
 In infants, fingers should not be punctured.
 The site of choice in infants is the literal (outside) or medial

(inside) surface of the plantar side (bottom) of the heel, although
there have been some problems with puncturing the posterior tibial
artery when the medial surface is used.
PROCEDURE:
1. Obtain and examine the requisition form.
2. Assemble equipment and supplies.
3. Greet the patient (and parents)
4. Verify that any dietary restrictions have been met (e.g ,, fasting),
and check for any sensitivity to latex.
5. Position the patient and the parents or designated holder as

necessary.
6. Put on gloves.
7. Organize equipment and supplies.
8. Select the puncture site,
9. Warm the puncture site. Warming increases the blood flow sevenfold.
Use a commercial heel warmer or warm washcloth (40 °C to 42°) for 2 to 5
minutes.
10. Cleanse the puncture site with 70% isopropyl alcohol using
concentric circles, working from the inside to outside. Allow skin to
air dry.
11. Perform the puncture. Puncture depth should not exceed 2 mm.
12. Wipe away the first drop of blood. This removes any residual
alcohol and any tissue fluid contamination.
13. Make blood smears if requested.
14. Collect the specimens and mix as needed. If an insufficient sample

has been obtained because the blood flow has stopped, repeat the
puncture at a different site all new equipment.
15. Elevate the puncture apply pressure until bleeding has stopped.
16. Label the specimens with required information.
NOTE: Compare the labelled tube with the identification bracelet for
inpatients; have outpatients verify that the information on the labelled
tube is correct, whenever possible.
17. Handle the specimen appropriately.
18. Thank the patient and parents
19. Dispose of all puncture equipment and bio hazardous materials.
20. Complete paperwork and indicate “skin puncture collection”
21. Deliver the properly labelled specimens to the laboratory
Order of collection of specimens
a. Slides, unless from sample in the EDTA microcollection tube
b. EDTA microcollection tube
c. Other microcollection tubes with anticoagulants (I,e,, green or gray)
d. Serum microcollection tubes
Tests using Capillary puncture specimens
A. Microhematocrit
B. Neonatal Bilirubin Collection
C. Neonatal screening
D. Blood typing
A. Microhematocrit
-the hematocrict is the volume of packed RBCs that occupies a given

volume of whole blood. This is often referred to as the packed cell
volume (PCV) . It is reported either as a percentage (e.g,, 36%) or in
liters per liter (0.36 L/L).
B. Neonatal Bilirubin Collection
-Proper collection of infant bilirubin specimen is crucial to accuracy

of test results. Specimens must be collected carefully to avoid
hemolysis, which can falsely decrease results, and as close as possible
to the requested time so any rate of increase in bilirubin levels can be
accurately determined. Light breaks down bilirubin nad also falsely
decreases results. To minimize light exposure, UV lights must be turned
off and specimens collected as quickly as possible in amber microtubes.
Protection from light is also required during transportation and
handling.
C. Neonatal screening/ new-born screening
-Blood samples for new-born screening tests are typically collected by

heel puncture and placed within printed circles on special filter paper
that is part of the requisition. New-borns are screened for genetic
disorders
D. Blood typing
- Test used to determine the ABD-Rh antigens present on patient’s RBCs.
CAUSE OF HEMOLYSIS
• Alcohol contamination
• Excessive squeezing
• Scrapping of blood during collection
Cause of Hemolysis
 Alcohol contamination
 Excessive squeezing
 Scrapping of blood during collection
NOTES NI GIANA:
0-2 Months – cannot go capillary puncture
 Iatrogenic Anemia
 Test under new born screening
1. Phenykelonuria
2. Hypothyroidism
3. Homocystinuria
4. Sickle Cell Anemia
5. Maple Syrup Urine Disease/ Maple Sugar Urine Disease
6. Galactosemia
Capillary puncture – mixture
Venipuncture – venous blood
Advantages of Capillary Puncture
1. Only small amount of blood is needed

2. Easy to perform.
3. POCT
Obese – for chem test, okay for capillary puncture.

Blood gas –Green topped – to avoid introduction of room air
Lavended – Smear
Green – OFT,HLA
Over milking = Dilution
Hematorit Tubes
Blue – Non heparinized
Red – Heparinized
Hematocrit –
Local Immediate Accumulation – accumulation of granulocytes causes slide

elevation of WBC
I’ll make it because He carries me.
-Medtech 2022

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PEDIATRIC VENIPUNCTURE

 Pediatric venipuncture requires the expertise and skill of an

 If a child is under age 2, venipuncture should be limited to

 Excellent interpersonal skills are needed to deal with distraught

 Attempt to interact with the pediatric patient, realizing that both

 An infant can be wrapped in a blanket. Physical restraint may be

 A toddler can be restrained while sitting on a parent’s lap. The

 If the child is in a bed, a parent or helper leans over the child

 Older children do not usually need restraint, but a parent or someone

1. Venipunctures should not be performed on children younger than 6

2. Venipunctures on infants between 6 and 12 months of age should be

3. If an extensive number of tests are ordered on a small child, an

CAPPILARY SPECIMEN COLLECTION

- Drops of blood for testing can be obtained by puncturing the capillary

 Skin punctures often are performed in:

 Newborns; in pediatrics patients younger than 1 year

 In elderly patients with fragile veins, When peripheral circulation

-is actually a mixture of venous blood, arterial blood, and tissue

-White blood cell counts in specimens obtained by skin puncture may be

-Clinically significantly higher glucose values are found in specimens

A. Alcohol; gauze and bandages

-CLS recommends using 70% isopropyl alcohol to clean capillary

-are sterile, disposable, sharp instruments used for capillary

-Warming the site increases blood flow up to seven times and is

-Microcollection tubes (microtubes) are special small plastic tubes

- Microhematocrit tubes are narrow-bone capillary tubes primarily

-sealants are clay like substances used to seal one end of

G. Glass slides for specific test orders

-is used when blood smears are being requested.

 In infants, fingers should not be punctured.

 The site of choice in infants is the literal (outside) or medial

1. Obtain and examine the requisition form.

2. Assemble equipment and supplies.

3. Greet the patient (and parents)

5. Position the patient and the parents or designated holder as

7. Organize equipment and supplies.

8. Select the puncture site,

13. Make blood smears if requested.

14. Collect the specimens and mix as needed. If an insufficient sample

17. Handle the specimen appropriately.

18. Thank the patient and parents

19. Dispose of all puncture equipment and bio hazardous materials.

20. Complete paperwork and indicate “skin puncture collection”

21. Deliver the properly labelled specimens to the laboratory

Order of collection of specimens

a. Slides, unless from sample in the EDTA microcollection tube

b. EDTA microcollection tube

c. Other microcollection tubes with anticoagulants (I,e,, green or gray)

d. Serum microcollection tubes

Tests using Capillary puncture specimens

B. Neonatal Bilirubin Collection

-the hematocrict is the volume of packed RBCs that occupies a given

B. Neonatal Bilirubin Collection

-Proper collection of infant bilirubin specimen is crucial to accuracy

C. Neonatal screening/ new-born screening

-Blood samples for new-born screening tests are typically collected by

- Test used to determine the ABD-Rh antigens present on patient’s RBCs.

• Scrapping of blood during collection

 Scrapping of blood during collection