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

© Christian Klant Photography

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 carePatient 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


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  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.
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  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.
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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.