CHHS18/101

Canberra Hospital and Health ServicesClinical Procedure Blood Collection using Heel Lance Device (Neonates)Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Procedure...............................................................................................................2

Implementation........................................................................................................................ 4

Related Policies, Procedures, Guidelines and Legislation.........................................................4

References................................................................................................................................ 4

Search Terms............................................................................................................................ 4

Doc Number Version Issued Review Date Area Responsible PageCHHS18/101 1 16/03/2018 01/04/2022 WY&C – Dept Of

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Purpose

The purpose of this procedure is to provide clinicians with best practice information on the safe and effective technique to collect a blood sample using the heel lance device

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Scope

This document pertains to staff in the Division of Women, Youth & Children who are working within their scope of practiceThis document applies to: Medical Officers Nurses and Midwives Student nurses, midwives and medical students working under direct supervision

This document applies to neonates cared for in the Neonatal Intensive Care Unit (NICU), Special Care Nursery (SCN), Maternity and paediatrics.

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Section 1 – Procedure

ContraindicationsThe heel lance technique cannot be performed on babies with Oedematous feet Injured feet Infected feet Abnormalities that preclude putting pressure on the foot

Equipment: Alcohol Based Hand Rub (ABHR) Gloves Sterile cotton wool balls Heel warming equipment Heel lance device Blood sample containers as required +/-Newborn Blood Spot Collection card Sucrose Pathology request form

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Procedure 1. Attend hand hygiene by either washing or using ABHR2. Provide parents with information about the need for the collection of blood 3. Obtain consent for the procedure from the parents and obtain signature if Newborn

Screening Test (NBST)4. Assemble equipment5. Identify the infant as per Patient Identification and Procedure matching policy6. If required pre warm the heel by applying a warm cloth/foot warmer for 3-5 minutes7. Offer breastfeed/Expressed Breastmilk (EBM) or give sucrose according to standing orders8. Flex the foot between the thumb and fore finger9. Place heel lance device with the flat blade opening surface flush on the incision area as

demonstrated in diagram (below) without exerting pressure10. Depress trigger and remove device disposing in a sharps container11. After incising the heel wipe away the first drop of blood to discard cellular debris that

can contaminate the sample12. Apply gentle pressure to allow large drops of blood to form for collection13. Release pressure to allow capillaries to refill and repeat

Note:Avoid excessive heel squeezing to prevent unnecessary pain and sample compromise. Sample compromise can occur from fluid leakage, haemolysis and bruising

14. If blood stops flowing wipe site with a gauze swab to remove clot, ensure time for capillary refill then reposition your hand and reapply pressure

15. If blood does not flow choose another site and repeat procedure16. After completing collection of blood sample apply pressure to the incision site with

cotton wool 17. Continue comfort measures18. Discard equipment appropriately and attend hand Hygiene19. Document procedure attended in clinical records20. Label the sample and send it to pathology

Note:Avoid using adhesive dressings

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Safe incision areas are the sides of the heels on the plantar aspect of the foot. Research indicates that the plantar surface between those areas can be incised safely using a controlled-depth device if frequent sampling from the sides has rendered them unusable. Never incise the end of the heel (Advances in Neonatal Care 7(4) 175).

Implementation

This document will be implemented and communicated to staff through existing training programs, at in-services and orientation, emailed to staff and placed in work rooms.

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Related Policies, Procedures, Guidelines and Legislation

Policies Health Directorate Nursing and Midwifery Continuing Competence Policy Consent and Treatment

Procedures CHHS Healthcare Associated Infections Clinical Procedure CHHS Patient Identification and Procedure Matching Policy

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004

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References

1. Folk, L (2007) Guide to heel stick blood sampling in infants. Advances in Neonatal Care 7(4) 171-178

2. Shah V, Taddio A. 2005 Neonatal capillary blood sampling. Neonatology [serial online]. July 2005. Available at: www.bloodgas.org/6D672D2D-E340-4FD4-9B40-F0D64CEF118C.W5Doc.

3. Vedder T, Nimavat J (2015) Heel sticks. Medscape

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Search Terms

Heel prick, Heel lance, Heel stick, Blood collection, Blood spot, Neonatal screen test

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

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Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 14/03/2018 Complete Review Karen Faichney, A/g

ED WY&CCHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS12/087 Department of Neonatology - Blood Collection using Heel Lance

Device

Doc Number Version Issued Review Date Area Responsible PageCHHS18/101 1 16/03/2018 01/04/2022 WY&C – Dept Of

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register