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Equipment

  • Clean tray

  • Tourniquet

  • Alcohol swabs/ Chlorhexidine swabs

  • Cannula ( multiple)

  • Connector which has been flushed with sterile normal saline

  • Sterile Adhesive plaster

  • Specimen containers (vials), blood culture bottles

  • Non-sterile gloves

  • Apron

  • Sharps bin

  • Assistants to help and distract the child

 

Procedure

  • Move the child with parents to a comfortable room which is well lit

  • Discuss the procedure with the parent and child in a confident manner

  • Check the identity of the patient and confirm what tests need to be done

  • Keep all the equipment ready. Open all the equipment and place them on a sterile paper. Make sure to prime the extension connector with saline.

 

Position

  • Children may be seated on parents lap facing them as to give a bear hug with their legs on either side of parents lap.

 

Finding the vein-

  • Approach the child and look for a good vein beforehand.

  • Apply the tourniquet proximal to the vein to make it prominent.

  • Make sure the tourniquet is not too tight to obstruct the arterial pulses

  • To make veins prominent, you can ask the patient to flex the joints repeatedly distal to the tourniquet

  • You can tap gently on the vein to make it prominent

  • If the periphery is cold, the veins are constricted. Try to warm them with warm water in gloves for a few minutes.

 

Continued procedure

  • Now Wash hands with soap and water and dry your hands.

  • Wear appropriates size gloves.

  • Clean the site of venepuncture about 5 cm diameter with chlorhexidine swab and allow to dry. Do not blow to dry.

  • Stretch the skin of the patient at the site of venepuncture with your non-dominant hand and hold it firmly

  • Now ask your assistant to give you’re the cannula with its cover opened. Enter the skin of patient just over the vein at about 30-45 degree angle and slowly insert until you get blood flush back. Once you find blood stop the insertion and remove the need from the cannula. Now bend the cannula trying to maintain it parallel to the patient skin surface and insert the plastic tube of cannula  without the need bit protruding)

  • Once in the vein, the cannula will bleed back comfortably. You should be able to collect blood from the open end once the needle is out.

  • You can control the blood flow by constricting the limb proximal to the entry of the cannula

  • If you do not get any flashback of blood then you may not be in the vein. Don’t remove the cannula from the insertion site. Instead, gently pull back and insert the need and gently insert it back at 30-degree angle until you again get a flashback. Then follow the same procedure.

  • Release the tourniquet and make sure the limb is held firmly

  • Attach the connector to the cannula

  • Now stick the adhesive to the cannula fixing it to the skin. You can use a splint to fix at the back of the limb to restrict excess movement at the joint

  • Make sure you have discarded all the sharps. Collect the sample and name them immediately. If you are unsure of any sample being from the patient, then discard it.

 

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