When performing a blood collection on a 9 year old

At some point in their life, your child will need to have a blood test. Often it can be just as traumatic for the parent as it is for the child. Here are 4 tips to help prepare your little one and take the fear out of blood tests.

Explain the procedure – Explain what is going to happen a few days before. If your child asks “will it hurt?” Give the child an honest answer – “Some children say it hurts a bit, others are not so bothered.”

Distract them–Depending on whether you have an infant, toddler or teenager, distract them with food, toys, books, music or talking to them etc

Positioning – Try sitting your toddler on your lap which provides security and comfort. Older children may like to lie down or sit in the chair and watch the procedure. Maintain contact by holding their hand or giving them a hug.

Reward them – Stay with your child until they are calm. Give positive encouragement by saying they did a great job and how proud you are of them. Reward them for being brave.

A blood test is when a sample of blood is taken from the body to be tested in a lab. Doctors order blood tests to check things such as the levels of glucose, hemoglobin, or white blood cells. This can help them detect problems like a disease or medical condition. Sometimes, blood tests can help them see how well an organ (such as the liver or kidneys) is working.

What Is a Complete Blood Count?

A complete blood count (CBC) test is a blood test that helps doctors check the level of different types of cells in the blood. A CBC measures:

• red blood cells, which deliver oxygen to the different parts of the body
• white blood cells, which help fight infections
• platelets, which help blood clot to stop bleeding

Why Are CBCs Done?

A CBC can be done as part of a routine checkup to screen for problems or because a child isn't feeling well. The levels of red blood cells, white blood cells, and platelets can provide doctors with information about possible problems like anemia, infections, inflammation, and other conditions.

How Should We Prepare for a CBC?

Your child should be able to eat and drink normally unless also getting other tests that require fasting beforehand. Tell your doctor about any medicines your child takes because some drugs might affect the test results. Also let the doctor know if your child has had a blood transfusion or smokes. These can affect the CBC.

Wearing a T-shirt or short-sleeved shirt for the test can make things easier for your child, and you also can bring along a toy or book as a distraction.

How Is a CBC Done?

Most blood tests take a small amount of blood from a vein. To do that, a health professional will:

• clean the skin
• put an elastic band (tourniquet) above the area to get the veins to swell with blood
• insert a needle into a vein (usually in the arm inside of the elbow or on the back of the hand) 
• pull the blood sample into a vial or syringe
• take off the elastic band and remove the needle from the vein

In babies, blood draws are sometimes done as a "heel stick collection." After cleaning the area, the health professional will prick your baby's heel with a tiny needle (or lancet) to collect a small sample of blood.

Collecting a sample of blood is only temporarily uncomfortable and can feel like a quick pinprick.

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Can I Stay With My Child During a CBC?

Parents usually can stay with their child during a blood test. Encourage your child to relax and stay still because tensing muscles can make it harder to draw blood. Your child might want to look away when the needle is inserted and the blood is collected. Help your child to relax by taking slow deep breaths or singing a favorite song.

How Long Does a CBC Take?

Most blood tests take just a few minutes. Occasionally, it can be hard to find a vein so the health professional may need to try more than once.

What Happens After a CBC?

The health professional will remove the elastic band and the needle and cover the area with cotton or a bandage to stop the bleeding. Afterward, there may be some mild bruising, which should go away in a few days.

When Are CBC Results Ready?

Blood samples are processed by a machine, and it may take a few hours to a day for the results to be available. If the test results show signs of a problem, the doctor might order other tests to figure out what the problem is and how to treat it.

Are There Any Risks From CBCs?

A CBC is a safe procedure with minimal risks. Some kids might feel faint or lightheaded from the test. A few kids and teens have a strong fear of needles. If your child is anxious, talk with the doctor before the test about ways to make the procedure easier.

A small bruise or mild soreness around the blood test site is common and can last for a few days. Get medical care for your child if the discomfort gets worse or lasts longer.

If you have questions about the CBC, speak with your doctor or the health professional doing the blood draw.

The information given here supplements that given in Chapters 2 and 3. Users of these guidelines should read Chapters 2 and 3 before reading the information given below. This chapter covers background information (Section 6.1), practical guidance (Section 6.2) and illustrations (Section 6.3) relevant to paediatric and neonatal blood sampling.

This chapter discusses aspects specific to paediatric and neonatal blood sampling (60, 61). Anyone taking blood from children and neonates must be well trained and practiced in venepuncture techniques. A uniform sampling technique is important to reduce pain and psychological trauma.

The choice of site and procedure (venous site, finger-prick or heel-prick – also referred to as “capillary sampling” or “skin puncture”) will depend on the volume of blood needed for the procedure and the type of laboratory test to be done. Venepuncture is the method of choice for blood sampling in term neonates (62, 63); however, it requires an experienced and trained phlebotomist. If a trained phlebotomist is not available, the physician may need to draw the specimen. Section 7.1 provides information on when a capillary blood specimen from a finger-prick or a heel-prick is appropriate. The blood from a capillary specimen is similar to an arterial specimen in oxygen content, and is suitable for only a limited number of tests because of its higher likelihood of contamination with skin flora and smaller total volume.

Whether to select a finger-prick or a heel-prick will depend on the age and weight of the child. Section 7.1 explains which procedure to select, based on these two elements.

Patient immobilization is crucial to the safety of the paediatric and neonatal patient undergoing phlebotomy, and to the success of the procedure. A helper is essential for properly immobilizing the patient for venepuncture or finger-prick, as described in Section 6.2.

For paediatric and neonatal patients, use the methods described below to ensure that patients are correctly identified before taking blood.

• Use a wrist or foot band only if it is attached to the patient; DO NOT use the bed number or a wrist band that is attached to the bed or cot.

• If a parent or legal guardian is present, ask that person for the child's first and last names.

• Check that the name, date of birth and hospital or file number are written on the laboratory form, and match them to the identity of the patient.

Venepuncture is the preferred method of blood sampling for term neonates, and causes less pain than heel-pricks (64).

Equipment and supplies for paediatric patients.

• Use a winged steel needle, preferably 23 or 23 gauge, with an extension tube (a butterfly):

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  avoid gauges of 25 or more because these may be associated with an increased risk of haemolysis;

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  use a butterfly with either a syringe or an evacuated tube with an adaptor; a butterfly can provide easier access and movement, but movement of the attached syringe may make it difficult to draw blood.

• Use a syringe with a barrel volume of 1–5 ml, depending on collection needs; the vacuum produced by drawing using a larger syringe will often collapse the vein.

• When using an evacuated tube, choose one that collects a small volume (1 ml or 5 ml) and has a low vacuum; this helps to avoid collapse of the vein and may decrease haemolysis.

• Where possible, use safety equipment with needle covers or features that minimize blood exposure. Auto-disable (AD) syringes are designed for injection, and are not appropriate for phlebotomy.

Ask whether the parent would like to help by holding the child. If the parent wishes to help, provide full instructions on how and where to hold the child; if the parent prefers not to help, ask for assistance from another phlebotomist.

Immobilize the child as described below.

• Designate one phlebotomist as the technician, and another phlebotomist or a parent to immobilize the child.

• Ask the two adults to stand on opposite sides of an examination table.

• Ask the immobilizer to:

  –

  stretch an arm across the table and place the child on its back, with its head on top of the outstretched arm;

  –

  pull the child close, as if the person were cradling the child;

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  grasp the child's elbow in the outstretched hand;

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  use their other arm to reach across the child and grasp its wrist in a palm-up position (reaching across the child anchors the child's shoulder, and thus prevents twisting or rocking movements; also, a firm grasp on the wrist effectively provides the phlebotomist with a “tourniquet”).

If necessary, take the following steps to improve the ease of venepuncture.

• Ask the parent to rhythmically tighten and release the child's wrist, to ensure that there is an adequate flow of blood.

• Keep the child warm, which may increase the rate of blood flow by as much as sevenfold (65), by removing as few of the child's clothes as possible and, in the case of an infant, by:

  –

  swaddling in a blanket; and

  –

  having the parent or caregiver hold the infant, leaving only the extremity of the site of venepuncture exposed.

• Warm the area of puncture with warm cloths to help dilate the blood vessels.

• Use a transilluminator or pocket pen light to display the dorsal hand veins and the veins of the antecubital fossa.

Drawing blood

• Follow the procedures given in Section 2.2.3 for:

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  hand hygiene;

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  advance preparation;

  –

  patient identification and positioning;

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  skin antisepsis (but DO NOT use chlorhexidine on children under 2 months of age).

• Once the infant or child is immobilized, puncture the skin 3–5 mm distal to (i.e. away from) the vein (66); this 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.

• Draw blood slowly and steadily.

See Section 7.2, which describes the steps for both finger and heel-pricks, for paediatric and neonatal patients, and for adults.

Select the proper lancet length for the area of puncture, as described in Section 7.2.