VENIPUNCTURE USING BUTTERFLY WINGED SET & HEEL PRICK

VENIPUNCTURE USING BUTTTERFLY WINGED SET

BUTTERFLY SRYINGE

Is an intravenous device use for blood collection from pediatric patient and patient with tiny and fragile veins.

Consist of:Needle with plastic wingsPlastic tubingNeedle at the end of plastic tube

Length of needle is half inch and

23 & 25 gauge in size

Types: 21G (Green)23G (Blue)25G (Orange)

Can be use for: Geriatric patientOncology patientBurn victims

Indication :Blood collection

LOCATION

Preferable : Y region of vein, where 2 veins join together.

According to order of preference :Antecubital fossa ( basilic or cubital vein)Hand ( dorsal arch vein)Feet (dorsum arch vein)Forearm (median antebrachial or acessory cephalic vein)Ankle (small saphenous or greater saphenous vein)Scalp of baby’s head (supratrochlear, superficial temporal or posterior auricular vein)

SITESFOR INSERTION

PRECAUTIOUS

Avoid areas that adjacent to superficial skin loss or infection.Avoid vessels across joints.Differentiate between arteries and veins :Limb vessels : arteries collapse, veins fillScalp vessels: arteries fills from below, veins fills from above.Avoid using scalp vessels – increase vessels fragility

CONTRAINDICATION

Rash CoagulopathyHemodialysis

MATERIALS

Butterfly winged infusion set with syringe adapterGloveAlcohol swabsTourniquetEvacuated tubesTape (optional)Cotton balls

PROCEDURE

1. Select the site.2. If using the scalps vessel, cut hair with small

scissors close to scalp.3. Restrain extremity - by using armboard or

have an assistant to hold extremity or head. Blanket wrap around the baby except the extremity that want to use.

4. Apply tourniquet - If scalp vein is used, rubber band can be placed around the head above eyebrows.

PROCEDURE

1. Wear gloves.2. Clean the area with alcohol swab circular motion.

Leave it to dry.3. Remove the butterfly set from it’s package.4. Uncap the needle.5. Anchor the vein using your free index finger.6. Hold needle parallel to vessel in direction of blood

flow.7. Bend the wings together over the needle and insert

the needle into the vein. If the needle has entered the vein, flash of blood will appear in tubing above the needle.

PROCEDURE

1. Unbend the wings and let it rest on patient’s hand

2. Inject the other needle at the end of the plastic tube into the collection tube. Let the blood flow until the amount that needed.

3. The index finger that anchor the vein can massage the vessel to stimulate the blood flow.

4. After the blood collection, remove the tourniquet.

1. Bend the wings of the needle together and withdraw the needle from the patient's hand, placing cotton ball over the puncture site.

2. Dispose of the needles in the appropriate needle disposal container.

3. Label the filled tubes with the patient's name, number, date and time of collection, and your initials.

4. Check the patient condition for an hour – cyanosis, shock sign.

COMPLICATION

HematomaPhlebitisVasospasmInfectionInfiltration of subcutaneous tissueAir embolism or clot

SPECIAL NOTES!

Conserve sites to preserve limited venous access by using distal sites first whenever possible.

Use small needle or scalp vein butterfly. A 23-gauge needle is best. Hemolysis or clotting may occur with a 25 gauge or smaller.

Recent studies show that adequate pain control can be achieved during venipuncture with EMLA (lidocaine cream) applied 1 hour prior to procedure, if time allows

Oral sucrose solution (24% to 25%) provides quick and effective pain control for venipuncture

HEEL PRICK/CAPILLARY BLOOD SAMPLING

Is blood sampling collect from baby’s heelPurpose : To obtain capillary blood samples with minimal discomfort and potential for injury/infection Location: medial or lateral aspect of heel

INDICATION

Newborn metabolic screenCapillary blood gasesCapillary blood glucoseSerum bilirubinPKU testRoutine laboratory analysis (standard hematology, chemistries, toxicology/drug levels)

CONTRAINDICATION

Edema Injury or anomalies that preclude putting pressure on the footAreas that are bruised or injured by multiple previous heelsticksPoor perfusionLocal infection

MATERIALS

Stillete ( lancet device)Alcohol swabsCotton wool

ballsCapillary

blood tubesBlood spot

cardGloves

PROCEDURE

1. Check physician’s order. Ensure the correct specimen obtained for correct children.

2. Check if child allergic to any material use such as to iodine.

3. Prepare the child and the family by explain about the procedure. We could ask for assistant to comfort the child.

PROCEDURE

1. Stimulate the feet by using feet warmer an hour before procedure.

2. Prepare the materials or equipment.3. Wash hands and wear gloves.4. Select site.5. Remove the warmer.6. Wash site with soap and water or antiseptic

solution.7. Let the area dry completely before puncture.

PROCEDURE

Method of holding:

Position hand with fingers along the calf and thumb at ball of foot to stabilize. Apply pressure along calf toward heel.Heel: support dorsum of foot with thumb, and ankle by other fingers.

PROCEDURE

1. Using dominant hand puncture the site with 90° angel with quick and forceful motion.

2. Remove the lancet immediately.

3. Apply pressure to leg with counter pressure to ball of foot and allow blood drop to form.

4. Wipe away the 1st blood using a sterile cotton ball.

PROCEDURE

1. Allow the blood to collect at the puncture site.

2. Collect specimen by allowing the blood to flow into the collecting tube.

3. Collect blood gas sample first, then hematology samples, then chemistry/toxicology samples.

4. Using capillary action, fill blood gas in capillary tube, holding tube horizontally.

5. Release pressure, allowing capillaries to refill.

PROCEDURE

1. Wipe the puncture site with sterile cotton ball and apply pressure for 2-3 mins.

2. If needed apply bandage3. Discard equipment in the appropriate

container.4. Label the specimen and put in appropriate

bag or container along with laboratory form or slip.

5. Remove gloves and wash hand.6. Send specimen to laboratory.

SPECIMEN HANDLING

Ensure that blood gas samples are free of air bubbles. Place the tube horizontally so that the

blood is drawn by capillary action and does not collect air bubbles that can alter results. Apply caps to ends of tube.

Capillary blood gas samples should be analyzed within 10 minutes or should be kept horizontally on ice for up to 1 hour, and the tube must be rolled prior to analysis.

A. Heel puncture in safe area.B. Collection of specimen.C. Capping of specimen

SPECIMEN HANDLING (GUTHRIE TEST)

Newborn metabolic screen:Minimum 24 to 48 hours after birthAvoid touching filter paper, as oils from finger can compromise results.Single (no overlapping) drops on filter paper. Position infant so that incision is down, allowing a large drop of blood to form. Blood should drop freely onto designated circle on filter paper.Repeat for each circle.Do not apply blood using capillary tubes that contain anticoagulants or other materials that can interfere with lab results.

GUTHRIE TEST

Genetic test :TSH level – hypothyroidism, creatinismTripsinogen level- cystic fibrosisPKUGalactosemia

COMPLICATION

Pain –provide oral sucrose, swaddling/tucking, and pacifierInfection (cellulitis, abscess, perichondritis, osteomyelitis)Tissue loss and scarringCalcified nodules

CLINICAL TIPS!

Warming the heel prior to the procedure will improve blood flow.

Automated incision devices more consistently gauge depth and result in improved flow with less hemolysis.

Punctures should only be performed within the relatively small surface area of the heel.

Milking the heel activates clotting and causes �hemolysis.

The first drop of blood should be discarded.