Venesection for an infant, child or young person
The safe and effective care of a child or young person having a venesection within Starship Child Health.
Venesection is a clinical procedure involving the needle puncture of a vein, and withdrawal of a prescribed volume of blood based on the patient’s weight. The procedure takes approximately 15 - 30 minutes to complete.
Venesection is a treatment modality for patients with certain blood disorders in order to reduce excess iron stores, red cell mass, and blood volume. Polycythaemia and transfusion related iron overload are the medical conditions for which venesection is usually indicated for in the paediatric setting.
The reason for the venesection will determine the frequency of the venesection for the patient and the blood tests that are required prior to the venesection.
Contraindications
Patient is feeling unwell
Patient is dehydrated
Patient blood results are below their target for Haemoglobin (Hb), Haematocrit (Hct), or Ferritin levels
Possible complications
Note: Should any signs and symptoms of the following complications occur, including tachycardia, hypotension, and lightheadedness, stop the procedure and contact the medical team immediately, and/or action as per the Observation and Monitoring of an Infant, Child, and Young Person guideline.
Haematoma
Hypovolaemia
Vasovagal syncope
Phlebitis
Procedure
Note:
The clinician performing the venesection must remain with the patient throughout the duration of the procedure.
Check patient blood pressure (BP) and heart rate (HR) 5 minutely throughout the duration of the procedure, and document on Paediatric Early Warning Score (PEWS) Chart.
Do not inject directly into high vacuum wound drainage system via the 3 way tap as this can cause increased pressure in the system and lead to further complications e.g. air embolism.
Should you need to flush the PIV cannula or CVC with sodium chloride 0.9 %, or withdraw blood via the 3 way tap due to problems with blood flow, ensure the clamp on the high vacuum wound drainage system is clamped off prior to doing so.
Control rate of blood flow using a tourniquet, gravity, or by asking the patient to open and close their fist.
Equipment:
High vacuum wound drainage system (600 mL Medinorm bottle)
Double male luer lock adaptor
3 way tap extension set
Smartsite (needle-free valve)
Tourniquet
Appropriate IV cannula size/butterfly
Alcohol swabs
10 mL syringes
BD Posiflush syringes (Sodium Chloride 0.9%)
Gauze
Sterile guard
Blue tray
Non-sterile gloves
Plastic back absorbent sheet
Tegaderm IV
Pressure dot plaster
Heparin (100 units/1mL), if CVC insitu
Pre-procedure:
Ensure patient is seen by Consultant/Medical Team or confirmation that venesection procedure is to be performed
Check blood results as clinically indicated - Hb, Hct, Ferritin levels
Ensure the volume of blood to be withdrawn is prescribed on a Fluid Balance Chart
Prepare an Emergency Drug Worksheet, Paediatric Resus (Child Health), and ensure emergency equipment is available and functioning
Ensure baseline weight and vital signs are documented prior to performing Venesection procedure
Explain the procedure to the patient if it is their first Venesection
Ensure that the patient and/or family are aware of the possible complications and side effects of Venesection
Assess hydration status of patient, discuss with Consultant/Medical Team, and administer intravenous fluids as charted if required
Ensure oral fluids and sugary snacks are available for the patient
If not competent in Peripheral Intravenous (PIV) cannulation, arrange for the medical team to be available to insert PIV cannula/butterfly
If Central Venous Catheter (CVC) insitu, ensure CVC is functioning
Performing the procedure:
Position patient in a relaxed reclining position
Perform hand hygiene as per the Hand Hygiene - Infection Control policy
Gather required equipment
Apply gloves
Assemble required equipment using an Aseptic Non-touch Technique (ANNT)
Attach the double male leur lock adaptor to high vacuum wound drainage system
Attach the 3 way tap extension set to the double male leur lock adaptor (actual 3 way tap closer to high vacuum wound drainage system)
Attach the smartsite (needle-free valve) to the 3 way tap
Ensure clamp is closed on high vacuum wound drainage system
Apply tourniquet to patient
Insert PIV cannula/butterfly as per the Intravenous Catheters - Peripheral - In Adults and Children policy, or ensure CVC is ready for use
Attach opposite end of the 3 way tap extension set directly to PIV line (no smartsite required) or to CVC
Ensure 3 way tap is open to the patient
Release clamp on high vacuum wound drainage system
Withdraw prescribed volume of blood, observing the rate of blood flow and ensuring it does not flow too quickly
Once prescribed volume of blood has been withdrawn, close clamp on high vacuum wound drainage system
Remove tourniquet
Close 3 way tap to the patient
Disconnect 3 way tap extension from PIV line or CVC
Remove PIV line and apply pressure to site immediately, or flush CVC with 0.9 % sodium chloride and then heparin lock as per the Central Venous Catheter (CVC) Care for a Child Policy
Post-procedure
Ensure patient remains lying or sitting for 10-15 minutes before slowly getting up. Patient must remain on observation for up to 30 minutes post procedure.
Inspect venipuncture site for signs of haematoma
Patient must remain on observation for up to 30 minutes post procedure
Ensure patient replaces fluid volume orally
Document the actual volume of blood withdrawn on the Fluid Balance Chart, and in the patient clinical notes