Archive for January, 2013

Drawing Blood From Infants and Children

Normal* Blood Values For Infants

Haemoglobin Haematocrit Red Blood Cell (RBC)
Newborns:    17-22 grams/dL

1 week:        15-20 grams/dL

1 month:      11-15 grams/dL

Newborns: 44-64% Newborns: 4.8-7.1 mm/uL


*Normal values often vary among labs.  Blood types not shown have normal values that are the same as those for adults.

Reducing Heel Stick Pain in Infants

Given the infant distress observed during heel stick procedures, much attention has been devoted to methods of relieving pain. In addition to swaddling, providing an object for sucking and gentle leg massage may significantly reduce infant pain.

One team of neonatologists out of Naples, Italy found that non-nutritive sucking (e.g. sucking on a pacifier, finger, toy, or other item that does not provide nutrition) during the heel stick procedure significantly reduced behavioural distress in newborns2.  The group, led by M.G. Corbo, studied 26 neonates from birth to 2 weeks of age. The non-nutritive sucking reduced the level of increase in heart rate during the heel stick procedure, as well as the length of time the infants cried.

A second study, which examined 23 infants, aged 1-7 days, found that babies who received gentle massage of the leg on which the heel stick would be performed for 2 minutes prior to receiving the heel stick had significantly lower pain response and lower heart rates during the heel stick procedure3.

Phlebotomy And Phlebotomist

Phlebotomy is a procedure of blood extraction via vein puncture or a dermal puncture. Although it is considered as a safe procedure but sometimes can lead to serious complications if handled by some untrained or non experienced person. It is a highly specialized area and no one is allowed to perform it without proper training.

The complications may consist of nerve injury, thrombosis, vasovagal reactions and infections. The individual performing the procedure of blood extraction must be aware of the pathophysiology of these side effects, and must be trained in to avoid them and if occurred treat them properly. Phlebotomists should take the greatest precaution in order to avoid nerve injury as it sometimes can cause permanent motor or sensory nerve dysfunction of arms and hands. The professionals must select appropriate vein and carry out the careful procedure of vein puncture. Vasovagal reaction is a common complication that can lead to palor, hypotension and occasional syncope. In case of emergency, oxygen tanks, a bed and drug supplies must be provided in the room of Phlebotomy.

Especially the infections caused by the blood borne pathogens can become a serious complication. During the evacuated tube vein puncture procedure, blood collecting tubes are sterilized from the inside and the single use holders must be used in order to avoid infections via the back flow of blood. It is the responsibility of a Phlebotomist to follow the standard safety procedures presented in the guidelines to prevent the back flow of blood. Some other side effects caused by the phlebotomy certification procedures include anemia, hematoma,  allergy, hyperventilation, air embolism and thrombosis. It is also the responsibility of a Phlebotomist to carefully do the screening of the donor’s blood in order to avoid any complications regarding transfusions. Improper screening of the donor may cause serious reactions and blood borne diseases. It is very necessary for the medical staff to communicate with patients and inform them about the possibility of these side effects. The immediate step after the blood extraction is to bring down the hematocrit value of normal values which results in the improvement of the symptoms like headache, dizziness and ringing in the ear. Patients may become tired and need to take a rest for a short period of time.  Phlebotomy can also lead to the iron deficiency. It is necessary to monitor the iron levels in the patients whose blood is drawn from several times  and must be prescribed iron supplements by a doctor if it is essential.