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I. INDICATIONS

Cochrane review states that venipuncture, by a skilled operator, is the method of choice for blood sampling in term infants. It was found to be less painful than heel stick sampling and a more effective sampling method.

  1. Blood sampling for routine analysis or blood culture. Venipuncture typically allows a larger volume of blood (recommended if ≥1 mL is needed) to be collected and is the method of choice for obtaining blood cultures. It is preferred over capillary blood sampling for certain tests (drug levels, hemoglobin/hematocrit, karyotype, coagulation studies, and cross-matching blood). Arterial blood sampling is preferred for lactate, pyruvate, and ammonia.

  2. Central hematocrit. Venipuncture hematocrit is more reliable than heel stick hematocrit.

  3. Venous blood gas. This can be used in some diseases (neonatal sepsis/respiratory distress syndrome) to diagnose acid-base imbalance if an arterial blood gas cannot be obtained. Venous samples show good validity in terms of pH, PCO2, and HCO3.

  4. Administration of medications (infrequent application of venipuncture).

II. EQUIPMENT

Whenever possible, use safety needles that are self-shielding; 23- or 25-gauge syringe-mounted needles or 23- to 25-gauge winged infusion needles (butterfly needles; 23 gauge preferred to reduce risk of hemolysis or clotting), gloves (sterile for blood culture), 1- to 5-mL syringe, alcohol swabs, 3 povidone-iodine swabs (for blood culture), appropriate specimen containers (eg, red-topped tube, blood culture bottle[s]), a tourniquet or rubber band (for the scalp), 4 × 4 sterile gauze pads, optional localization devices if available (transilluminator, near-infrared visualization unit; eg, AccuVein, Palatine, IL, ultrasound).

III. PROCEDURE

  1. Use distal venous sites first to preserve venous access. Decide which vein to use. Use Figure 47–1 as a guide. Veins to use commonly include basilic, cephalic, or cubital veins in the antecubital fossa, veins on the dorsum of the hand (dorsal venous network) or foot (dorsal venous arch), wrist, greater saphenous vein at the ankle, scalp vein. Blood sampling proximal to intravenous sites should not be done.

  2. In cases of difficult vein localization. Transillumination (see Chapter 44), near-infrared spectroscopy vein imaging (eg, AccuVein AV300; see Chapter 25), or possible bedside ultrasound (more commonly used for peripheral intravenous IV access) can be used (see Chapter 44).

  3. Restrain the infant as appropriate.

  4. Pain management. The American Academy of Pediatrics (AAP) recommends topical anesthesia (eg, eutectic mixture of lidocaine and prilocaine [EMLA], applied 30 minutes prior to procedure), oral sucrose or glucose, and nonpharmacologic pain prevention and relief techniques, with a combination of sucrose or glucose and nonpharmacologic techniques considered more effective.

    1. Topical local anesthetics. AAP reports that topical anesthesia did decrease measures of pain during venipuncture. Cochrane review found there was not enough quality evidence to determine whether topical local anesthetics applied to the skin help relieve pain during needle-related procedures in newborn infants.

    2. Sucrose/glucose. Sucrose is more commonly used, but glucose can be used as an alternative. Cochrane ...

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