Chapter 12
Blood Collections in Special
Populations

Learning Objectives
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Describe two physiologic differences between children and adults that should be considered when collecting blood from infants and children. Describe steps that can be taken to help reduce a child’s anxiety and make the venipuncture experience more pleasant.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2

Learning Objectives
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Explain how blood collection supplies and the venipuncture procedure are modified for infants and children.
List the steps in dorsal hand vein procedure in children.
Define bilirubin, explain its significance, and describe precautions that must be observed when collecting blood for bilirubin testing.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

3

Learning Objectives
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

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Explain the usual procedure for collecting blood for neonatal screening tests, and list five tests that may be done.
Explain physical changes that may occur with aging that should be considered when collecting blood.
List conditions that may require blood draws for an extended period of time, and alternative collection sites for these patients.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4

Learning Objectives
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

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Define vascular access device, and describe eight types.
Describe how blood should be collected from a vascular access device.
List steps to be followed when collecting blood from a patient with an intravenous line in place.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

5

Special Populations
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Pediatrics and geriatric patients are among those that require special approaches and different equipment along with skill and experience to have a successful blood draw.
You gain this experience in the workplace by observing how others handle these situations.

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6

Pediatric Patients
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Special Physiologic Considerations.
- A 150 pound adult has 5 liters of blood-a
10 ml sample represents .2% of blood volume
-Children have a lower blood volume than adults-for a 1 year old-10 ml represents
1% of blood volume and for a newborn around 3% of blood volume

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7

Pediatric Patients
- The amount drawn must be monitored so as not to cause anemia or even cardiac arrest
-Infants and children should have no more than
5% removed in a 24 hr. period; 3% or less is preferred. -No more than 10% should be removed in a one month period unless medically necessary
-Removal of greater than 10% of a child’s blood volume can cause cardiac arrest

Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8

Pediatric Patients


Special Physiologic Considerations.
- Dermal punctures require less blood and are preferred when small amounts of blood are needed.
- Newborns may require more blood due to a higher ratio of RBCs to plasma than in adults. Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9

Pediatric Patients
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Special Psychological Considerations.
- Children bring different experiences, fears and levels of understanding to a blood draw. - Your job is to make the collection calm and as painless as possible so that it is a positive experience for both the child and the parent.
- Crying and stress can increase WBCs and blood pH levels and give the physician misleading data.
Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10

Successful Pediatric Draws
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Prepare materials ahead of time or out of view of the child.
For inpatients perform the draw in a treatment room inside of the child’s room which is his
“safe” area away from home.
Be friendly and patient, smile, and talk in a calm, soothing tone.
Explain the procedure in terms that the child can understand.