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Venesection for an infant, child or young person

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The safe and effective care of a child or young person having a venesection within Starship Child Health.

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Nursing guidelines

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:

  1. Ensure patient is seen by Consultant/Medical Team or confirmation that venesection procedure is to be performed

  2. Check blood results as clinically indicated - Hb, Hct, Ferritin levels

  3. Ensure the volume of blood to be withdrawn is prescribed on a Fluid Balance Chart

  4. Prepare an Emergency Drug Worksheet, Paediatric Resus (Child Health), and ensure emergency equipment is available and functioning

  5. Ensure baseline weight and vital signs are documented prior to performing Venesection procedure

  6. Explain the procedure to the patient if it is their first Venesection

  7. Ensure that the patient and/or family are aware of the possible complications and side effects of Venesection

  8. Assess hydration status of patient, discuss with Consultant/Medical Team, and administer intravenous fluids as charted if required

  9. Ensure oral fluids and sugary snacks are available for the patient

  10. If not competent in Peripheral Intravenous (PIV) cannulation, arrange for the medical team to be available to insert PIV cannula/butterfly

  11. If Central Venous Catheter (CVC) insitu, ensure CVC is functioning

Performing the procedure:

  1. Position patient in a relaxed reclining position

  2. Perform hand hygiene as per the Hand Hygiene - Infection Control policy

  3. Gather required equipment

  4. Apply gloves

  5. Assemble required equipment using an Aseptic Non-touch Technique (ANNT)

  6. Attach the double male leur lock adaptor to high vacuum wound drainage system

  7. 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)

  8. Attach the smartsite (needle-free valve) to the 3 way tap

  9. Ensure clamp is closed on high vacuum wound drainage system

  10. Apply tourniquet to patient

  11. Insert PIV cannula/butterfly as per the Intravenous Catheters - Peripheral - In Adults and Children policy, or ensure CVC is ready for use

  12. Attach opposite end of the 3 way tap extension set directly to PIV line (no smartsite required) or to CVC

  13. Ensure 3 way tap is open to the patient

  14. Release clamp on high vacuum wound drainage system

  15. Withdraw prescribed volume of blood, observing the rate of blood flow and ensuring it does not flow too quickly

  16. Once prescribed volume of blood has been withdrawn, close clamp on high vacuum wound drainage system

  17. Remove tourniquet

  18. Close 3 way tap to the patient

  19. Disconnect 3 way tap extension from PIV line or CVC

  20. 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

  1. 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.

  2. Inspect venipuncture site for signs of haematoma

  3. Patient must remain on observation for up to 30 minutes post procedure

  4. Ensure patient replaces fluid volume orally

  5. Document the actual volume of blood withdrawn on the Fluid Balance Chart, and in the patient clinical notes

 

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