Interventional procedures for neonates

Blood tests are performed on newborns to aid in diagnosis and treatment planning. Blood samples are collected from veins, capillaries, or arteries. This process requires high precision, skill, and clinical experience from the nurse.

Methods of Blood Sample Collection

First: Venous Blood Sampling

Used to collect large blood volumes for tests such as complete blood count (CBC), blood compatibility testing, bilirubin levels, or blood culture.

Equipment:

• Butterfly needle (sizes 23, 25)
• 70% ethyl alcohol
• Sterile cotton and gauze
• Sterile gloves
• 5 ml syringe
• Test tubes
• Tourniquet
• Adhesive tape

Note: Blood culture collection requires additional preparation with betadine and a culture bottle.

Order of Priority for Venous Access Sites:

1. Dorsal hand and foot veins
2. Wrist veins
3. Inner elbow veins
4. Scalp veins
5. Ankle veins

Steps:

• Perform routine handwashing and prepare equipment.
• Apply a pain-reducing method as blood collection is an invasive procedure.
• Perform surgical handwashing.
• Disinfect the skin at the chosen site with alcohol and allow it to dry.
• Open the butterfly needle package.
• Wear sterile gloves.
• Apply a tourniquet above the sampling site or instruct an assistant nurse to use their fingers to apply pressure.
• Hold the area around the puncture site firmly.
• Insert the butterfly needle into the vein with the bevel facing up until blood appears in the tubing.
• Release the tourniquet immediately after blood appears.
• Attach the syringe to the tubing and withdraw the required blood volume.
• Avoid intermittent squeezing as it may cause hemolysis and affect test accuracy.
• Transfer the sample gently into the test tube by running it along the tube wall.
• Remove the needle and apply pressure with sterile gauze to stop bleeding.
• Label the tube with the newborn's name, test type, and date.
• Send the sample to the laboratory immediately.
• Dispose of used equipment safely.
• Remove gloves and perform routine handwashing.
• Document the blood collection in the newborn's records.

Precautions:

• Use disposable equipment for every sample collection.
• Avoid using the femoral or jugular veins unless necessary.
• Do not use large veins in cases of blood clotting disorders or local infections.
• Avoid leaving adhesive tape over the puncture site for more than 15 minutes.

Second: Capillary Blood Sampling

Used to collect small blood volumes from capillary-rich areas such as the heel or fingers. In infants, the heel or the big toe is commonly used. This method is widely practiced in neonatal care units for tests like blood glucose and blood gas analysis.

Contraindications for Capillary Sampling:

• Severe circulatory shock
• Leg swelling (edema)
• Foot or heel infection
• Increased blood viscosity (polycythemia)

Equipment:

• 70% ethyl alcohol
• Sterile cotton
• Sterile lancet
• Capillary tubes
• Sterile gloves
• Adhesive tape
• Sterile gauze (2×2 cm)

Steps:

• Perform routine handwashing and prepare equipment.
• Warm the heel by wrapping it in a gauze pad soaked in warm water (40°C) for 5 minutes.
• Apply a pain-reducing method.
• Perform surgical handwashing.
• Select the puncture site.
• Disinfect the site with 70% alcohol using a single motion and allow it to dry.
• Wear sterile gloves.
• Hold the heel firmly.
• Quickly puncture the heel with a lancet.
• Wipe away the first drop of blood with sterile cotton.
• Gently squeeze to collect blood in the capillary tube, avoiding air bubbles.
• Apply sterile gauze to stop bleeding.
• Dispose of the lancet in a sharps container and other waste in a red bag.
• Perform routine handwashing.

Precautions:

• Do not use water above 40°C.
• Avoid lancets longer than 2.5 mm.
• Ensure alcohol dries completely before collecting blood.
• Avoid mid-heel punctures to prevent pain and infection.
• Do not excessively squeeze the heel.