Performing Pediatric Phlebotomy

Taking blood samples from children can be difficult for the phlebotomist. Ensuring safety while accounting for a pediatric patient’s emotional and physical well-being is of the utmost importance. Except in certain instances, the phlebotomist must follow the procedures for adult venipuncture as described in CLSI’s standard, GP41—Collection of Diagnostic Venous Blood Specimens.

In an interview published by CAP Today, Julie Piazza, a certified child life specialist at the University of Michigan Health System's C.S. Mott Children's Hospital spoke about a study focused on phlebotomists’ education, training, experience, and stress levels. Piazza’s research team observed 12 phlebotomists in practice to see which comfort techniques they used. The researchers observed the phlebotomists perform at least five different blood draws on different days. Over the course of the study, the team observed 120 venipunctures on patients ages three to 14 years. One of the key observations was whether the phlebotomist introduced himself or herself to the patient. The 12 phlebotomists in the study introduced themselves to a pediatric patient 58.8 percent of the time before drawing the child’s blood. The number was lower than what the research team expected. Piazza noted that introductions and building a rapport lessen a child’s anxiety.

Some other strategies to consider for reducing stress and anxiety for the pediatric population include:

• Patient participation. When possible, giving a patient a role to play can lessen anxiety by empowering the patient.
• Comfort positioning. To help minimize anxiety, it is recommended that children be held by parents when possible.²
• Use of an assistant. An assistant to stabilize the arm and comfort the patient is essential for every pediatric draw and preferable to restraining devices.
• Topical anesthetics
• Performing heel punctures and finger punctures. These methods may be more successful alternatives to venipuncture for pediatric patients.

Smaller-bore needles (eg, 23-gauge) and winged blood collection sets are recommended for accessing smaller, fragile veins. Syringe use should also be considered, because the vacuum pressure of an evacuated tube exerted on fragile vasculature can result in vein collapse and an unsuccessful collection. The use of low-volume collection tubes is also recommended to minimize the vacuum pressure that could otherwise cause vein collapse and minimize the volume of blood needed.

For detailed information about performing pediatric phlebotomy procedures consult CLSI’s GP41—Collection of Diagnostic Venous Blood Specimens.

1 Sparks LA, Setlik J, Luhman J. Parental holding and positioning to decrease IV distress in young children: a randomized controlled trial. J Pediatr Nurs. 2007;22(6):440-447.