Paediatric capillary blood gas sampling [advanced]

Introduction

• Wash hands, Introduce self, Patients name & DOB, Explain procedure and obtain consent form parents (or child if appropriate)

Preparation part

• Wash hands  
• Clean tray
• Gather equipment around tray (think through what you need in order)

• Wash hands
• Open packets and place equipment neatly in tray in plastic parts of packets
• Return to patient (with tray and sharps bin)

Patient part

Preparation

• Wash hands and apply gloves
• Identify appropriate site:
  • Lateral or medial plantar heel (in young infant)
  • Medial or lateral border of finger pulp (in older child)
• Apply Vaseline to area if available (to prevent blood globule dispersing in skin ridges)
• Warm the area
• If using the foot, hold the ankle dorsiflexed with one hand
• Sterilise area – wipe in spiral motion working outwards and wait 30 seconds for it to dry

Procedure

• Puncture skin with lancet/puncture system (then drop into sharps bin)
• Wipe off the first drop of blood with cotton gauze
• Once a blood globule has built up, holding the sample collection tube horizontally, press the end gently onto the globule of blood until the blood enters the tube
• Then move the collection tube away until the next globule has accumulated, then press the end onto the globule again
• Repeat this until the tube is filled
• Tips:
  • If blood if not forming freely, gently massage the area to encourage blood flow and gently squeeze the lower leg/ankle or digit (but let the capillaries refill intermittently)
  • Intermittently dab the area with cotton gauze swab to prevent coagulation of any blood left near the puncture site
  • There must not be any air bubbles in the tube or the gas machine will not be able to analyse it – keep the tube horizontal at all times to avoid this
• Once tube is full
  • Insert magnet rod into one end and place a bung on each end, then mix by inverting it slowly and label it with a patient ID sticker
  • Place gauze over the puncture site and tape down or apply plaster

To complete

• Thank patient and cover them
• Take sample to blood gas analyser immediately
  • Remove bungs
  • Place adaptor onto one end to allow insertion into blood gas analyser
  • Enter patient information and await printed results
• Bin waste and gloves, clean tray and wash hands
• Document procedure and results in patients notes