Phlebotomy: Pediatric and Geriatric Considerations

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Questions and Answers

In geriatric phlebotomy, what specific precaution should be taken due to physiological changes associated with aging?

Increase the angle of needle insertion to account for decreased skin elasticity.
Apply extra pressure to the puncture site to prevent excessive bleeding, which can be more pronounced in older adults. (correct)
Select venipuncture sites on the dorsal side of the hand exclusively to minimize discomfort.
Use larger gauge needles to ensure adequate blood flow, compensating for potential vessel collapse.

Why is venepuncture considered the method of choice for blood sampling in term neonates, despite the challenges it may present?

It avoids the risk of bone damage associated with heel stick procedures in neonates with lower bone density.
It typically yields a larger volume of blood compared to skin puncture methods, which is essential for comprehensive testing. (correct)
It is less painful for the neonate, reducing the emotional distress associated with blood collection.
It eliminates the risk of infection since the venipuncture site is easier to sterilize compared to the heel.

What is the MOST critical consideration when selecting a lancet size for heel stick collection in preemies and infants?

The lancet size should be chosen based on the infant's weight rather than age to ensure adequate penetration.
The lancet size must not exceed a specific depth (e.g., 0.85mm for preemies, 1.25mm for infants) to prevent injury to underlying structures. (correct)
A universal lancet size can be used for all infants, adjusting the puncture pressure based on skin thickness.
The selected lancet size should primarily depend on the volume of blood required for the tests, opting for larger sizes for increased yield.

Why is it essential for new phlebotomists to initially practice pediatric blood collection procedures on older children rather than infants?

<p>Older children can provide feedback and cooperation, making it easier for new phlebotomists to refine their technique. (A)</p> Signup and view all the answers

In what scenario should a phlebotomist MOST likely request assistance from a more experienced colleague during a pediatric blood collection?

<p>When encountering difficulty locating a suitable venipuncture site after two initial attempts. (D)</p> Signup and view all the answers

Flashcards

Pediatric Phlebotomy

Blood collection in infants and children, which can be done through skin puncture or venipuncture.

Infant Age Range

From birth to 1 year old.

Pediatric Age Range

From 1 to 12 years old.

Venepuncture in Neonates

Venepuncture is generally preferred for blood sampling in term neonates, but requires a skilled phlebotomist

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Heel Stick Lancet Size

For heel sticks, lancet size should not exceed 2.0 mm to prevent injury.

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Study Notes

General phlebotomy procedures are different in infants, children and geriatric patients

Age Guidelines

Infant: birth to 1 year
Paediatric: 1 to 12 years
Adolescent: 10 to 19 years
Adult: 20 to 65 years
Geriatric: Older than 65 years

Pediatric Phlebotomy

Blood collection can be done by skin puncture or venipuncture
Knowledge of special collection equipment and observation of skilled phlebotomists is needed to gain skill in pediatric phlebotomy
Pediatric patients can be very challenging
Request assistance when needed

Choice of Procedure and Site

Selection of site and procedure depends on the volume of blood needed and the type of test to be done
The options are venous site, finger-prick, or heel-prick, (also referred to as "capillary sampling” or “skin puncture")
Venepuncture is the preferred method for blood sampling in term neonates
Venepuncture requires an experienced and trained phlebotomist

Heel Stick Collection Procedure

Avoid bruised areas and sites of previous punctures
The lancet size should not exceed 2.0 mm to avoid puncturing bones, nerves or tendons
Automatic puncture devices are available for preemies (0.85mm puncture depth) and infants (1.25mm)
Hold the heel gently as infants bruise easily
Avoid excessive milking or squeezing
Avoid the use of adhesive bandages
Check the site before leaving

Paediatric and Neonatal Blood Sampling

Patient identification
Use a winged steel needle (a butterfly) preferably 22 or 23 gauge, with an extension tube and small collection tubes.
Immobilize the child
Hand hygiene when drawing blood

Geriatric Phlebotomy Tips

Anchor the vein with the left hand, and hold needle with the right hand
Excessive bleeding might happen
Precaution to avoid excessive breathing
Thinner skin, smaller muscles can cause the veins to roll easier
Less elastic veins
Veins collapse easily during venepuncture
Bruise more easily
Medications could have effect on bleeding or balance
Select a smaller size needle - 22 or use a butterfly needle
Hand veins are favorable
Place the tourniquet over patient's sleeve, not too tight to prevent collapse of the vein
Release tourniquet slowly/gently to prevent bruising

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Description

Phlebotomy procedures vary for infants, children, and geriatric patients. Pediatric phlebotomy can be challenging, requiring special equipment and skilled phlebotomists. Site and procedure selection depend on blood volume and test type, with venipuncture preferred for term neonates.