Collection of blood samples in pediatrics is a delicate procedure that requires age-appropriate techniques, emotional support, and precision to ensure both sample integrity and child comfort. It can be done through venipuncture, capillary sampling, or heel sticks, depending on the child’s age, condition, and the volume required.
The puncture of a vein typically to withdraw blood for investigation or to administer medications through the vein.
Common Indications
| Purpose | Examples |
|---|---|
| Diagnostic testing | CBC, blood cultures, metabolic panels |
| Monitoring chronic conditions | Diabetes, anemia, infections |
| Preoperative or emergency workup | Blood typing, coagulation profile, crossmatching |
Preparation for Collection of blood samples
- Check if the laboratory form matches the patient’s identity.
- Successful venipuncture ideally requires advanced notice.
- The use of anesthetic gels and creams (e.g., EMLA cream) is vital to minimize pain and distress during procedure, and these must be applied in advance.
- If the procedure is urgent, then ethyl chloride spray is very useful.
- Depending on the age and level of understanding, as much as possible explain the procedure to the child and parents.
Parents must be offered the choice of whether to be involved in the procedure. - Use distraction techniques during the procedure.
Positioning
- Older children: Sitting or lying down
- Younger children: Need for supportive holding and restraint
- For babies up to 9 months: Swaddle them to include the three limbs being not used
- For children who can sit on a parent’s lap:
Cuddle them by putting the arm that you are using under the cuddler’s arm
Site for Venipuncture
- Dorsum of hand
- Antecubital fossa
- Scalp vein (neonates)
- Veins of ankle region
Procedure
- Perform hand hygiene and don gloves
- Select the appropriate vein for the blood collection.
- Immobilize the child
- Do skin preparation.
- Put the tourniquet on the patient with about 2 finger widths above the venipuncture site.
- Use a thumb to draw the skin tightly about 2 finger widths below the puncture site.
- Puncture the skin 3-5mm distal to the vein; this site allows good access without pushing the vein away.
- If the needle enters alongside the vein rather than into it; withdraw the needle slightly without removing it completely, and angle it into the vessel.
- Carefully collect the blood, not moving the needle in the vein.
- After the required amount of blood has been collected, release the tourniquet.
- Place dry gauze over the venipuncture site and slowly withdraw the needle.
- Ask the parent to continue applying mild pressure.
Post procedure Care
- Dispose the needle in a sharp’s container.
- Put on adhesive bandage on the patient if necessary.
- Label the tube with the patient’s ID number and date.
- Send the specimen bottles with proper requisition form immediately as possible.
- Properly dispose of all contaminated supplies.
- Remove gloves and perform hand hygiene.
General Instructions
- Ask the parents to rhythmically tighten and release the child’s wrist to ensure adequate flow of blood.
- Keep the child warm, which may increase the rate of blood flow by as much as sevenfold and in the case of infants, by swaddling in a blanket.
- Warm the area to be punctured with warm cloth to help dilate the blood vessels.
- Use a transilluminator or pen light to display the dorsal hand veins and the veins of antecubital fossa.
- Avoid 25-G needles because this may be associated with an increased risk of hemolysis.
- Place dry gauze piece over the venipuncture site and slowly withdraw the needle.
- Ask the parent to continue applying mild pressure.
Special Considerations
- Use distraction techniques (toys, songs, bubbles) to reduce anxiety.
- Avoid excessive milking or squeezing—can cause hemolysis.
- Keep the child warm to enhance blood flow.
- Monitor for bruising, hematoma, or fainting post-procedure.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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