Launceston General Hospital Clinical Guidelines WACSClinProc4.

11 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Newborn Capillary Blood Collection New Guideline To collect blood for diagnostic investigations Midwives and medical officers, QVMU heel prick Newborn Screening WACSClinProc4.10

Keys Points In newborns requiring repeated or frequent capillary blood collection venipuncture is preferable as it causes less pain, takes less time and is associated with less maternal anxiety. Equipment Tenderfoot automated lancet Alcohol swab/gauze swab if required Disposable gloves Correct specimen tube or newborn screening card Laboratory request form Cotton wool Preparation of the newborn Methods to reduce pain for the newborn include Skin to skin contact with the mother 10 to 15 minutes of skin to skin contact prior to the blood collection is an effective, easily implemented and safe method to reduce pain in the neonate Breastfeeding should be offered to alleviate procedural pain Swaddling/containment Administration of oral Sucrose Procedure Maintain universal precautions Check newborns ID bands Position the heel; lower than the neonates body to facilitate blood flow Use the most medial or lateral portions of the plantar surface of the heel Cleanse the heel site if the foot appears unclean (eg faecal material). Allow site to dry completely before proceeding Hold the infants heel with a firm grip with the forefinger at the arch and the thumb well placed well below the puncture site at the ankle Press lancet into heel firmly Wipe away first blood of drop Wait for spontaneous free flow of blood Allow time for capillary refill of the heel and apply gentle pressure to the heel with the thumb, ease intermittently, if necessary to continue blood flow
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Wipe the heel and apply cotton wool over the puncture site holding until the bleeding stops Avoid the use of adhesive tape or bandaids as they cause pain on removal Document as required. Puncture Site

Medial Plantar Nerve Lateral Plantar Artery Medial Plantar Artery Lateral Plantar Nerve

Medial Calcaneal Nerve

Serious complications of the heel prick can include necrotising chondritis, calcaneal osteomyelitis, and soft tissue damage.

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Attachments
Attachment 1 References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

ATTACHMENT 1 REFERENCES King Edward Memorial Hospital Clinical Guidelines 2007 Blood Collection from a neonate: Capillary blood collection (heel stab). Online: http://www.kemh.health.wa.gov.au/development/manuals/sectionb/index.htm#10 Royal Childrens Hospital Melbourne 2007 Newborn Screening Test Online: http://www.rch.org.au/rchcpg/index.cfm?doc_id=10896 Shah V & Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD001542. DOI: 10.1002/14651858.CD001452.pub2. Whatman 2007 Neonatal Screening Blood Specimen Collection and Handling Procedure Online: http://www.whatman.com/products/?pageID=7.59.324

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