Taking blood samples

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Authors

Binter J, Oude-Reimer M, Andritsou F, Camba F, Ceccatelli M, Hankes-Drielsma I, Jørgensen E, Silva E

Click on the image to read the standard in brief.

Target group

Infants and parents

User group

Healthcare professionals, neonatal units, hospitals, and health services

Statement of standard

The process of taking blood samples is carried out exclusively by experienced and specially trained healthcare professionals, under individualised developmental supportive care to minimise stress and pain for the preterm infant.

Rationale

Blood sampling is necessary to optimise and monitor neonatal care and treatment. The procedure of sampling carries certain risks (e.g. haematoma, infection, damage of nervous system, and pain). (1) Blood sampling should be performed exclusively by experienced and specially trained healthcare professionals. The necessity and the frequency of blood sampling should be individualised to reduce unnecessary blood sampling and pain experiences for the infant. Choosing the appropriate sampling method (venous, arterial, or heel puncture) depends on the type of investigation required. Furthermore, non-invasive methods for blood level determination (e.g. Bilirubin, glucose) should be applied.
Depending on the amount of blood needed, venous puncture is a preferred method, as it causes less pain than puncturing the heel. (2–4) As with all invasive procedures, appropriate arrangements regarding the infant’s comfort, environment and an effective pain assessment and treatment are necessary (see standard Support during painful procedures and pain assessment). It is also obligatory to comply with hygiene standards. There are no clear directives, guidelines, or recommendations regulating which skin disinfectant should be chosen for preterm and term infants (see Infant- & family-centred developmental care, Patient safety & hygiene practice)

Benefits

Short-term benefits

Long-term benefits

Components of the standard

Component

Grading of evidence

Indicator of meeting the standard

For parents and family

  1. Parents are informed by healthcare professionals about the importance and procedure of taking blood samples, which interventions are followed by the clinic, signs of stress and pain in the infant, and how to react accordingly (see standard Support during painful procedures and pain assessment).

B (High quality)

Patient information sheet1

  1. Parents are invited to be present at blood sampling and able to support (e.g. skin-to-skin care) their infant during the procedure. (11-13)

A (High quality)
B (High quality)

Parent feedback

  1. Parents are informed about non-pharmacological analgesic interventions (see Infant- & family-centred developmental care and standard Support during painful procedures and pain assessment). (11–16)

A (Moderate quality)
B (High quality)

Patient information sheet1

For healthcare professionals

  1. A unit guideline on the taking of blood samples is adhered to by all healthcare professionals.

B (High quality)

Guideline

  1. Training on venous and capillary blood sampling and the behavioural identification of stress and pain in infants is attended by all responsible healthcare professionals (see standard Support during painful procedures and pain assessment).

B (High quality)

Training documentation

  1. Non-pharmacological analgesic interventions are encouraged and applied, including skin-to-skin care and breastfeeding when parents are present (see Infant- & family-centred developmental care and standard Support during painful procedures and pain assessment). (11,13)

A (High quality)
B (High quality)

Guideline

For neonatal unit

  1. A unit guideline on the taking of blood samples is available and regularly updated.

B (High quality)

Guideline

For hospital

  1. Training on venous and capillary blood sampling and the behavioural indicators of stress and pain in infants is ensured.

B (High quality)

Training documentation

  1. Appropriate equipment and environment for blood sampling (e.g. needles matching the size of the infant) are available and individually used.

B (High quality)

Audit report2

For health service

N/A

1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.

2The indicator “audit report” can also be defined as a benchmarking report.

Where to go

Further development

Grading of evidence

For parents and family

  • Non-nutritive sucking using a pacifier or a pumped breast with only drops of milk left is considered as a non-pharmacological intervention while taking blood sample. (19,20)

A (High quality)

A (High quality)

For healthcare professionals

N/A

For neonatal unit

N/A

For hospital

N/A

For health service

  • Support and promote studies regarding invasive and non-invasive techniques to replace blood sampling. (11,13,16–18,21–24)

A (High quality)

Getting started

Initial steps

For parents and family

  • Parents are verbally informed by healthcare professionals about the importance and procedure of taking blood samples, which interventions are followed by the clinic, signs of stress and pain in the infant, and how to react accordingly.
  • Parents are invited to be present during their infant’s blood sampling.

For healthcare professionals

  • Attend training on venous and capillary blood sampling and the behavioural identification of physiologic and behavioural indicators of stress and pain in infants.

For neonatal unit

  • Develop and implement a unit guideline on blood sampling.
  • Develop information material on the importance and procedure of taking blood samples, which interventions are followed by the clinic, signs of stress and pain in the infant and how to react accordingly for parents.
  • Train all healthcare professionals with regard to individualised support of the infant, blood sampling, pain management and hygiene.

For hospital

  • Support healthcare professionals to participate in training on venous and capillary blood sampling and the behavioural identification of stress and pain in infants.

For health service

N/A

  1. Buowari OY. Complications of venepuncture. Adv Biosci Biotechnol. 2013;04(01):126–8.
  2. Dhingra N, Safe Injection Global Network, World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy [Internet]. 2010 [cited 2018 May 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK138650/
  3. Ogawa S, Ogihara T, Fujiwara E, Ito K, Nakano M, Nakayama S, et al. Venepuncture is preferable to heel lance for blood sampling in term neonates. Arch Dis Child Fetal Neonatal Ed. 2005 Sep;90(5):F432-436.
  4. Shah V, Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001452.
  5. Vinall J, Grunau RE. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr Res. 2014 May;75(5):584–7.
  6. Graven S. Sleep and brain development. Clin Perinatol. 2006 Sep;33(3):693–706, vii.
  7. Brummelte S, Chau CMY, Cepeda IL, Degenhardt A, Weinberg J, Synnes AR, et al. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology. 2015 Jan;51:151–63.
  8. Smith VC, Dukhovny D, Zupancic JAF, Gates HB, Pursley DM. Neonatal intensive care unit discharge preparedness: primary care implications. Clin Pediatr (Phila). 2012 May;51(5):454–61.
  9. Donia AE-S, Tolba OA. Effect of early procedural pain experience on subsequent pain responses among premature infants. Egypt Pediatr Assoc Gaz. 2016 Jun 1;64(2):74–80.
  10. Chau CMY, Ranger M, Sulistyoningrum D, Devlin AM, Oberlander TF, Grunau RE. Neonatal pain and COMT Val158Met genotype in relation to serotonin transporter (SLC6A4) promoter methylation in very preterm children at school age. Front Behav Neurosci. 2014;8:409.
  11. de Sousa Freire NB, Santos Garcia JB, Carvalho Lamy Z. Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. PAIN. 2008 Sep 30;139(1):28–33.
  12. Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatr. 2008 Apr 24;8:13.
  13. Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ. 2003 Jan 4;326(7379):13.
  14. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev. 2009 Sep;85(9):561–7.
  15. Akcan E, Yiğit R, Atici A. The effect of kangaroo care on pain in premature infants during invasive procedures. Turk J Pediatr. 2009 Feb;51(1):14–8.
  16. Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2014 [cited 2016 Jul 27]. Available from: http://doi.wiley.com/10.1002/14651858.CD008435.pub2
  17. Warren I, Hicks B, Kleberg A, Eliahoo J, Anand KJS, Hickson M. The validity and reliability of the EValuation of INtervention Scale: preliminary report. Acta Paediatr Oslo Nor 1992. 2016 Jun;105(6):618–22.
  18. Olsson E, Ahlsén G, Eriksson M. Skin-to-skin contact reduces near-infrared spectroscopy pain responses in premature infants during blood sampling. Acta Paediatr Oslo Nor 1992. 2016 Apr;105(4):376–80.
  19. Napiórkowska-Orkisz M, Gutysz-Wojnicka A, Tanajewska M, Sadowska-Krawczenko I. Evaluation of Methods to Minimize Pain in Newborns during Capillary Blood Sampling for Screening: A Randomized Clinical Trial. Int J Environ Res Public Health. 2022 Jan 13;19(2):870.
  20. Soltani S, Zohoori D, Adineh M. Comparison the Effectiveness of Breastfeeding, Oral 25% Dextrose, Kangaroo-Mother Care Method, and EMLA Cream on Pain Score Level Following Heal Pick Sampling in Newborns: a randomized clinical trial. Electron Physician. 2018 May;10(5):6741–8.
  21. Panda SK, Mishra A, Jena PK. Agreement between Noninvasive Hemoglobin and Laboratory Hemoglobin Measurements in Neonates: A Systematic Review and Meta-Analysis. Neonatology. 2023;120(1):24–32.
  22. Rizvi MR, Alaskar FM, Albaradie RS, Rizvi NF, Al-Abdulwahab K. A Novel Non-invasive Technique of Measuring Bilirubin Levels Using BiliCapture. Oman Med J. 2019 Jan;34(1):26–33.
  23. Banerjee A, Bhattacharyya N, Ghosh R, Singh S, Adhikari A, Mondal S, et al. Non-invasive estimation of hemoglobin, bilirubin and oxygen saturation of neonates simultaneously using whole optical spectrum analysis at point of care. Sci Rep. 2023 Feb 9;13(1):2370.
  24. Rana A, Williams PD, Baker EL, Hipp JA, Saremian J, Aysola AE. Suitability of Placental Blood Samples of Newborns for Pre-Transfusion Testing. Front Pediatr. 2021 Apr 30;9:661321.

Second edition, September 2022

Lifecycle

3 years/ Next revision 2025

Recommended citation

EFCNI, Binter J, Oude-Reimer M et al., European Standards of Care for Newborn Health: Taking blood samples. 2022.

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