Chapter 39

1. Indications

1. To obtain a blood sample for routine analysis or culture. (See also Chapter 31.) Venipuncture typically allows a larger volume of blood to be collected. It is the method of choice for obtaining blood cultures and preferred for certain blood levels (drug levels, hematocrit, karyotype, cross-matching blood).

1. To obtain a central hematocrit.

2. Equipment. A 23- or 25-gauge scalp vein needle (23 gauge preferred to reduce risk of hemolysis or clotting), alcohol and povidone-iodine swabs, appropriate specimen containers (eg, red-top tube), a tourniquet or rubber band (for the scalp), 4 × 4 sterile gauze pads, syringe.

3. Procedure

1. Decide which vein to use. Use Figure 37–1 as a guide. The antecubital fossa or the dorsum of hand or foot are most preferred.

1. Have an assistant restrain the infant. If an assistant is not available, restrain the specific area selected for venipuncture by taping the extremity on an armboard. Oral sucrose or a pacifier can help calm the infant. See Chapter 69.

1. "Tourniquet" the extremity to occlude the vein. Use a rubber band (for the head), a tourniquet, or an assistant's hand to encircle the area proximal to the vein.

1. Prepare the site with antiseptic solution. Wipe at least three times in concentric circles starting at the puncture site for blood cultures.

1. With the bevel up, puncture the skin, and then direct the needle into the vein at a 45-degree angle.

1. Once blood enters the tubing, attach the syringe and collect the blood slowly (or administer the medication).

1. Remove the tourniquet, and next remove and shield the needle. Apply gentle pressure on the area until hemostasis has occurred (usually 2–3 min). Distribute blood samples to the appropriate containers; gently mix tubes with additives.

4. Complications

1. Infection is rare complication that can be minimized by using sterile technique.

1. Venous thrombosis is often unavoidable, especially when multiple punctures are performed on the same vein.

1. Hematoma or hemorrhage is avoided by applying pressure to the site long enough after the needle is removed to ensure hemostasis.

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