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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
Do not use a vein that is proximal to IV fluid delivery.
Do not leave a tourniquet in place longer than necessary to prevent hemoconcentration, stasis, localized acidemia, and erroneous results for certain laboratory values. Ensure that the tourniquet does not occlude arterial flow.
If unable to obtain blood cultures in a timely fashion, do not delay antibiotics.
Venipuncture is used to obtain venous blood specimens. The procedure requires understanding the anatomy of primary arterial and venous blood supplies to the extremities and the principles of aseptic technique (Figure 1). Venipuncture is primarily used to obtain larger quantities of blood than is feasible with a heel stick or to obtain blood for culture.
For skin preparation, there is insufficient evidence to recommend a single product for all neonates.
To minimize harm from topical antiseptics in premature neonates, the antiseptic is removed with a sterile 0.9% sodium chloride solution or sterile water after the procedure is complete.1
Poor peripheral perfusion, local infection, bruising, injuries, loss of skin integrity, or any anomalies that prohibit putting pressure on the extremity are absolute contraindications to performing venipuncture.2 Caution should be used for patients with coagulation disorders.2 Potential complications of venipuncture include hematoma, infection, hemorrhage, injury caused by the needle to adjacent structures, phlebitis, and pain.2
Venipuncture also requires knowledge of which containers are used for the types of specimens being collected, the minimum required blood volumes for requested specimens, and the requirements for specimen labeling and handling.
Venipuncture has been determined to be less painful than a heel-stick procedure.3 However, this is the case only if a trained, skilled health team member is obtaining the blood specimen and multiple venipuncture attempts are not required. Selecting pain management methods requires consideration of the patient’s developmental level as it relates to clinical assessment and capillary blood sampling. Pain-management measures should be suitable to the patient’s age and developmental level.
Rationale: Pain should be assessed before all painful procedures for optimal pain management.
Consider using a transilluminator or ultrasound to improve the ability to locate veins.
Do not use veins that are indurated or that do not refill. Avoid extremities with bruising, phlebitis, dermatitis, cellulitis, fractures, or anomalies.5
Differentiate between arteries and veins by assessing for a pulse.
The veins of extremely low or very low gestational age neonates may be too small to support venipuncture.
Rationale: Applying light pressure causes vein distention, so the veins can be more readily identified and palpated.
2 Placing a gauze pad under the tourniquet decreases pinching of the skin and promotes healthy skin integrity.
Ensure that tourniquet time is 1 minute or less.8 Tourniquet time of 3 minutes or more may alter laboratory test results.8
Ensure that equipment is appropriately cleaned after each use. Follow the manufacturer’s directions for use of equipment.
Do not touch the site after preparation unless sterile gloves are worn.4
Rationale: A narrower angle is required with smaller neonates because they have less tissue to penetrate and their veins are superficial.
2 A greater angle is required with larger neonates because they have more tissue to penetrate and their veins are deeper. Inserting the needle with the bevel up decreases tissue damage during needle entry and exit.
2 Traction stabilizes the vein and allows smooth entry into the skin.
If bleeding or a hematoma occurs, occlude the vessel proximal to the insertion site. If a tourniquet is in place, release it, remove the needle, and apply pressure over the insertion site until the bleeding stops.
Do not use adhesive bandages on neonates.
At the completion of the procedure, ensure that all choking hazards (e.g., syringe caps) are removed from the patient’s linens and placed in the appropriate receptacle.
Notify the practitioner if pulses are weak or absent or if a color change is observed in the extremity.
Barandouzi, Z.A. and others. (2020). Comparison of the analgesic effect of oral sucrose and/or music in preterm neonates: A double-blind randomized clinical trial. Complementary Therapies in Medicine, 48, 102271. doi:10.1016/j.ctim.2019.102271
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