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While blood collection for an adult does not cause us major problems, many of us do not have experience Blood Collection for a Child, and at the sight of a toddler get heart palpitations. However, it turns out that the topic is not so difficult, and palpitations are unnecessary. All you need is some practice and compliance with several rules.
Preparing the child to collect blood
From my own experience, which I gained working at a collection point for children, I know that it is extremely important for parents to prepare a toddler well. Parents, knowing that the child will need blood donation, should make them aware of:
A) What awaits him,
B) Why awaits him
C) What will happen to him?
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It is a bad idea to bring Blood Collection for a Child and inform them about this fact only before the door to the office, or only after crossing the threshold. From many observations I know that such behavior of parents leads to bad reactions in children and even worse to bear the pain during Paediatric and neonatal blood sampling (01).
A child who will soon be made aware by the parent about what awaits him is usually calmer, works well with the parent and with the nurse. The parent should never lie to the child and tell him that the blood donation does not hurt.
It hurts – and the child must be aware of this. A child who feels pain (and probably will feel) will feel cheated. I have heard many times from the mouths of small patients:
There are different schools about whether children should drink and eat before taking blood. As a rule, infants and toddlers do not need to fast, a light breakfast is allowed, it does not significantly affect the majority of basic laboratory tests. One thing is certain – children should be watered before taking blood.
The absolute minimum is at least 20 minutes before downloading. It is unacceptable for a parent to bring a child who has not been drinking since the previous day to take a blood donation.
EMLA? A good idea?
Many parents want to save their children much pain. So they are looking for alternative ways to relieve it while taking blood. Emla patches and creams for local skin anesthesia are available in pharmacies.
From my own experience, I know that many parents stick the patch in the wrong place, forcing the nurse to take blood from the area marked by the patch, not acknowledging that there is no visible vein in this place.
Secondly, Emla does anesthetize the skin but also leads to its maceration and contraction of blood vessels, from which in most cases we are not able to collect blood later.
Ultimately, we need to prick our young patients a second time on the hand with an anesthetized cream. The conclusions are therefore obvious.
1- Source: How to apply EMLA Crem
Apply Emla Cream
Let us remember that it is not only the parent who should prepare the child for download. We should also do it in the office. It is important to explain the essence of the procedure to children, to remind them of the mosquito’s sting (highlighting the issue of pain), to remind the child that he is not alone, that his parents are with him, and that they will not let anything bad happen here.
Let’s also remember about the motivation – “if you are good, you will receive a brave patient sticker”, etc.
Apply Emla Patch
Preparing a parent to collect a child’s blood
It turns out that not only a child should be prepared for the examination. It is often the case that the parent needs to be prepared for the child’s blood collection. The first thing is to collect an interview or the parent does not faint during blood donations.
It happened many times in my practice that it was not the child who had the blood taken fainted, but the parent who accompanied the child. In particular, it is important when a parent helps us while collecting by holding the child on his lap. Fainting a parent could be dangerous to the child sitting on his lap as well as the parent and even the nurse.
The second point is to instruct the parent on how to hold the child: Nurses are definitely the iron rule when providing this information. Believe me, NIC doesn’t get to some parents and if you don’t tell them what to do firmly and decisively, downloading can be one big nightmare.
Besides, often parents are so upset about the whole situation that they completely do not control what they do, or what we say does not reach them at all. They nod and do something completely different.
That is why you must turn to them firmly stating that a good hold is a successful download. Many children are very torn during blood donation, and often two nurses cannot control a 3-year-old child.
Taking blood from a child
The child should lean with his back on the parent’s stomach and chest. The parent is comfortably leaning on the back of the chair, the child’s legs are held between the parent’s thighs in a way that prevents kicking and kicking.
A hand that is not stabbed must be firmly held by the parent. There were cases of pulling needles out of the hand after the child broke free from the grasp of an inattentive parent.
Some parents try to cover their eyes, turn their heads and hold their heads. I am not a supporter of such behavior, because the child may have the impression that something very bad is happening to his hand, and the parent covers his eyes so that they cannot see it.
It is better to distract the child by showing objects in the immediate surroundings, asking questions during this time. If the child wants to, you have to let him watch, most children See that nothing bad is happening calms down.
Let’s remember about the proper preparation of the position. It is necessary to place a disposable sheet or foundation under the child’s hand. In the event of an uncontrolled blood leak, it is worth having something close at hand to quickly wipe up the spilled blood collection so that the child is exposed to it as soon as possible.
The most important for us is choosing the right vein for puncture. And here I also met with several schools. One school is taking blood collection from the veins on the back of your hand. The second is blood collection from the elbow flexion.
1- Downloading from the back
Personally, I prefer the first method of downloading from the back of my hand. Already small babies make a catchy reflex with their hands, squeezing and turning everything in their fingers in their hands.
The veins on the hands become more visible, develop and become thicker than those in the elbow bend. This makes them easier to feel under the finger, observe with the naked eye, and puncture. The needles are used for this purpose. This is a technique for so-called dripping.
This technique requires some skill and skill, but it is not difficult at all. Most often, 0.9 mm or 1.1 mm needles are used for puncturing. It seems a bit scary because after all of our adult patients we sting 0.8 mm. But this technique requires the blood collection to flow freely from the needle, so its light must be larger.
In addition, the smaller the needle, the faster the blood clots in it. Of course, the needle is adjusted to the size of the vein you want to puncture. Two nurses are needed to collect blood from the back of the hand. One holds the stabbed hand immobilizing it in the elbow flexion.
A second nurse opens the needed tubes and places them on a tripod within reach. Two nurses are needed for blood collection from the back of the hand. One holds the stabbed hand immobilizing it in the elbow flexion.
A second nurse opens the needed tubes and places them on a tripod within reach. Two nurses are needed for Blood Collection for a Child from the back of the hand.
2-Source WHO Guideline of Collecting Blood
One holds the stabbed hand immobilizing it in the elbow flexion. A second nurse opens the needed tubes and places them on a tripod within reach.
In small infants and children with lesions and skin lesions / atopic dermatitis, we do not use alcohol-based preparations, we disinfect the skin with non-alcoholic OcteniSept products. We always tighten stasis on clothing or on a paper towel if the child has short sleeves.
Remember to keep children from tightening their stasis on bare skin. The stasis should not be clamped for more than 1 minute. The best way to get a “clean and bloodless” collection is to take the needle and test tube together so that they form one continuity.
At first, an inexperienced person can cause a lot of difficulties, those of us can come to the aid of a friend who will place and hold the tube right at the tip of the needle.
We always collect morphological tubes, correlogram, glucose, and then biochemistry first. Let’s not let the blood drip on the floor, parents are very sensitive about it, and children are very afraid of seeing blood.
When it comes to the technique of Blood Collection for a Child from the back of your hand, the key is to get your child’s hand well and hold it properly. Roll the child’s fingers to the middle of the palm.
We must remember to catch the child’s handle in such a way that it cannot perform any maneuver with the palm of our hand, and at the same time we must leave a free thumb in this handle, which we will need very much during the download.
We cannot let go of the child’s hand anymore, for a moment of inattention, and the child will release finger-to-hand from our grip. We introduce the needle into the vein as parallel as possible to the skin.
The thumb that has been free to us should not interfere. It is a mistake to hold the child’s fist and prick him from his thumb because it increases the angle at which the needle is inserted, which can lead to a vein puncture.
Needle Turn Angle
First, try to turn the needle 180 °. If that doesn’t work, we have to replace the internship with our own hands. We unfasten the stasis which is clamped (a tube at the outlet of the needle is held by a friend) and we simultaneously press the child’s fist and the area above the wrist with synchronous movements. Very often this procedure results in a free flow of blood from the needle.
Why do we need a free thumb? When the child is very anxious and our friend must hold the child’s hand with both hands, we have to manage on our own when changing tubes. As I mentioned before – let’s avoid “bloodshed”.
Our free thumb will help here, with which we lightly press the needle in the vein to stop the Blood Collection for a Child after a flow of blood until we put the already filled test tube on a tripod and put another one at the needle outlet.
Your thumb will also be useful when we poke out of the vein. Put the gauze pad around the puncture by lightly pressing it with your thumb, with the other hand we pull out the needle that we take from the patient along with the last tube.
In this way, we prevent blood from dripping onto the floor. Remember to press the swab firmly to the skin only when the needle is out of the vessel.
2- Elbow flexion method
The second method is Blood Collection for a Child from the elbow flexion. Here, too, we can use the technique for dripping (especially in small infants in whom we had trouble finding a vein on the top of the hand).
This technique does not work here because it requires a lot of skill and mastery because, as a rule, blood from the vein in the arm comes out under high pressure and it is often impossible to avoid a bloody draw here.
3- Vacuum method
An alternative to this method is the method for the so-called “butterfly”, i.e. collection by the vacuum method. The needle is small and short, and the attached hose draws blood under pressure into the tube.
Of course, older children ( 6-7 years of age) can use normal needles attached to a vacuum kit or syringe.
During the download, we should not forget about contact with our young patients, often by talking alone you can divert children’s attention from activities performed at that time.
It is also necessary to watch that the child does not turn pale and faint, then the collection should be stopped immediately. Move the child to the couch, lift the legs up and ensure access to fresh air.
< h2>What if the child says NO?
“No” and “I don’t want” are the most frequently spoken words by children at the collection point. Fear of pain causes children to behave differently. Some kick beat, and even spit on their parents, and they often get hurt by a nurse.
Children can hide anywhere just not to sit on the download armchair – under the desk/couch, and sometimes even squeeze between the furniture.
Often, there is no end to persuasion. The motivation of children by parents is important, but wise motivation – although there are often silly ones:
– “Agree, I’ll take you to McDonald’s”
– “Don’t shout, I’ll buy what you want”
Let us not be manipulated. I adopted the principle of wise motivation and quick download. The longer the worse. Sometimes parents do not show a bit of willingness and commitment, and all the motivation and persuasion of the child to download to the nurse.
Seeing this attitude of the parent, I motivate the child for some time, and when I see that the parent does not join in the negotiations, I quickly withdraw, hinting that it is the parent who must force the child to obey.
Never attempt to force Blood Collection for a Child who is pulling out. Children who are afraid of downloading acquire mysterious superhuman powers. If we combine it with the parent, who is unable to control the child and hold it properly, it is easy to puncture or sting a nurse. It’s not worth the risk. I adhere to the principle – my patient’s safety and safety above the medical prescription.
Proceedings after downloading
It is extremely important to compress the puncture site after collection. If you Blood Collection for a Child from the elbow flexion, do not bend the arm, keeping it upright causes the vein to collapse and prevents tissue bleeding.
The injection site should be press for at least 5 minutes. After downloading, the child should necessarily eat breakfast and drink something. The parent should watch and belay the child because also after the collection of the child fainting occurs.