Gremlins ate my blood-draw post!

[MamaMolly]

It looks like my original post on DD's blood draw was one of the ones lost to the gremlins when the boards went down. I got one reply (with wonderful advice about preparing for future blood draws, thanks for that!) before things went ka-blooey, and was hoping I could re-post and hear what everyone had to say.

DD had a blood draw on the 2nd to check for several of the most common allergins. The long and short of it was that it was a nasty experience for both DD and me.

They had to stick her 3 times and only got 1/2 a vial of blood from her. Is it normal to draw blood from the arm of a 20# 15 month old? Or is a heel stick the preferred method?
They blamed me (!!!!) for it taking 3 tries and for not getting enough blood. (Ok that is just me griping, no real question there.)
It was a gruesome process with a LOT of digging around in her arm during all three tries. Is it normal to have to root around like that in a child's arm? I've had a lot (and I mean a LOT) of blood draws myself but have never seen anything like this!

As this was the lab specified by my ped for being 'good with babies' I have a lot I need to talk to him about. But I don't want to come off as a whiner or worrywart if this is pretty much normal stuff. If you have BTDT or replied to my first post could you please pretty please take the time and do it again? It would mean the world to me and hopefully give me some peace of mind in the matter.
Many, many thanks!

[tiapam]

Well, I had a bad experience at a blood draw for DD probably around the same age, maybe even younger. I was also made to feel at fault for how badly it went. They wanted to get it from her arm and that did not seem right to me, so then they pricked her finger and that was a shrieking, squirming, bloody disaster. Of course, since I questioned about the arm, it was my fault that the finger went so badly. I would say that my inexperience coupled with what I would call poor staff training (more than one person weighed in on this) were at fault. They never really explained what to expect and the pros and cons of the different methods. I do feel vindicated to hear that your experience with the arm was not any better. We have not needed any other blood drawn since then. I hope your next experience is better.

[Wife_and_mommy]

I had both kids drawn a few months ago(so Sept-Oct? kiddos--3.5 and 19-21m). I went in thinking it'd be a finger prick and was horrified to find they'd need a blood draw.

It went surprisingly well with both kids. I think the biggest point for it going well was that I held the dc in my lap. I held the arm out and distracted dc to look the opposite direction for the minute or so it took.

I learned when dd was a baby that vaccines went *much* more smoothly if they didn't splay her on the exam table to do it. The splaying scares them before anything even happens and it goes downhill from there.

I'm so sorry that things went awry for you. I hope your dd isn't permanently tramautized by it. I, personally, have a needle phobia that I try mightily not to pass to my dc's.

Hugs and hth. I don't remember seeing your post before.

Forgot to add that, yes, the nurse/m.a. was experienced. I wouldn't allow an inexperienced one near myself or my kids for this exact reason.

[nov04]

dd1 had a blood draw done at 10m for 6 vials (to rule out clotting disorders). It was a horrific 2 hours with 6 sticks and lots of digging. We almost needed to go for her scalp but decided we would try again another day.

We had absolutely amazing nurses who did a wonderful job although I will say that the physical experience for dd1 was the same as yours. Lots of digging in the arm, screaming and crying. I was extremely impressed with our first nurse who upon missing once enlisted the help of a colleague. These 2 women worked so hard for the next while, trying then letting her rest.

The second attempt was at another hospital with a team of nurses who decended on dd like she was a car at the Indy 500: fast, efficient and skilled.

We've always done blood draws at a hospital. I would never go to a lab, but its not something one who hasn't gone through this before should know. Young kids are really hard sticks as their veins are tiny and the volume is very low from what I've heard.

They sound like idiots for blaming you for multiple sticks.

[KrisM]

Ugh. That does not sound fun.

DS had a blood draw at about 15 months. We were in the ER at the time. I learned from someone here and told the nurse that she had exactly 1 try to get it right and if she wasn't completely confident, she should get someone from the NICU who does the babies there to do it. She got someone else and she did it in one try. It was in the back of his hand, not his arm though. I held him and he did okay, but had just had a seizure and was pretty out of it. I don't know how he would have done if he was himself at the time.

[o_mom]

We had draws for DS1 and DS2 around 9-12 months to check for lead. They drew about 3 vials each time because they added some other checks (iron levels, etc.) since we were getting it done anyway. They can't do a heel/finger stick for the amount of blood they need and heel sticks can be very painful.

Our experience was very good both times. I held them on my lap both times. I told them upfront that they would feel a little ouch and they would get a sticker after. It was done very fast. This was at a lab associated with a hospital, but not in a hospital.

It is not normal, IME, to have to dig around to find a vein in a 15 mo. A 3 mo can be hard, but by that age it shouldn't be a problem.

Some ideas for next time (or anyone else doing this):

Make sure they let you hold her

Make sure they use a 'butterfly needle' - these are much smaller and they have tubing attached instead of the big vial holder thingy (real technical term there!) That means that vial changes don't disturb the needle, which can be uncomfortable.

Go to a children's hospital if you can, otherwise a hospital lab will generally have more experience with kids than a stand alone facility.

Take your own stickers in case they don't have any.

You can ask for EMLA cream to use ahead of time to numb the area.

Don't lie and say it won't hurt. Don't play it up either, just say it very casually.

Ask upfront for the tech most experienced with kids.

[missym]

I don't know if that's a typical experience, but it's unacceptable. Poor baby and poor you!

Gwen had her first blood draw at around 12 months I think, and it was at a large Children's Hospital. The lady got it on the first try, drew a bunch of vials, and I wanted to fall down and kiss her feet. When we needed to have another draw done at 3 yo, we scheduled it at the outpatient clinic of the local children's "hospital" - really just a wing of the regular hospital. Again, the nurse was excellent. We may have just been lucky, but I would definitely go that route again.

[elephantmeg]

heel sticks are only useful for certain tests. At least where I work all allergen testing need vials of blood. It should not be your fault if they can't get it. Some suggestions: don't let any one person stick more than twice. Have someone trained hold her arm (the holder does make a big difference). If they are doing a lot of digging encourage them to warm her arm before trying again. The last 2 days at work we've had hugely hard sticks-6 sticks on one (dehydrated) baby Monday, and yesterday 5 sticks on a chunky 6 month old. I hate days like that but unfortunately blood draws on kids at times are very hard. Other times its no problem at all. And 12-24 month olds are very hard a lot of the time. Granted the kids we stick are all sick so that makes it harder. EMLA cream can sometimes cause vasoconstriction causing the veins to all but disapear. We don't use it at all, so be prepared if that's the answer. Be sure to tell them the next time that she was a hard stick-they'll bypass the regular people who are "good" and get the best person they have :)

[tnrnchick74]

Ok, NICU nurse checking in here :)

You can't do heel sticks for kids over 6 months. You also can't do them if over 2 ml of blood are needed.

ANY vein can be used for a blood draw, but most people choose to use the AC (crook of the arm) because the vein is more visible...unfortunately this is USALLY only true for adults and older children. Younger kiddos have a pocket of fat in that space that makes it difficult.

The veins on the arms (not necessarily AC), hands, feet, and yes scalp are much easier. DO NOT be afraid if the lab tech/rn/md states that it would be best to use the scalp. It hurts LESS, bleeds MORE (which is good because we WANT the blood to come out fast), and is generally easier for everyone involved except parents. The needle does NOT go into the brain, skull, or anywhere other than the superficial veins in the scalp. It looks a little scary because they will usually put a rubber band or a rubber strip of elastic around the head to get the vein to stand up better...this is only temporary and only looks bad to the parents.

For a bigger kiddo (>10 lbs) it is best to hold the baby tight. I usually let the parents hold and HUG them while I get the arm I need. If you use EMLA it HAS to be on the SPOT for an hour. Its hard to gauge exactly where a stick will be tried and anything less than 45 minutes does not numb the area.

Another little trick is to give the baby/small child a sugary drink a couple of minutes before the blood draw. OJ works GREAT. The sugar rush releases endorphins that makes the baby perceive less pain.

And yes, allow 1 tech/rn/md 1 stick. Then 1 other person can try before calling in the "experts". NICU nurses and MDs are WELL versed at finding tiny veins and milking all the blood we can!!!

[MamaMolly]

Thank you, Mamas! I feel a ton better now, and SO much better prepared when we have to do this again.

[ShanaMama]

told the nurse that she had exactly 1 try to get it right and if she wasn't completely confident, she should get someone from the NICU who does the babies there to do it. She got someone else and she did it in one try.

Good for you Kris! I know I am my kid's only advocate but can't imagine having that much guts!

To the op, every time DD had her blood drawn, they had me sit in the blood drawing chair with her in my lap. They had very explicit instructions of exactly how I was to hold her hands & feet so she didn't flail around. I don't recall the draw being particularly traumatic, so their directions must have worked.

[elephantmeg]

Just to chime in on the scalp veins. We have to have a specific order for kids over 3 months to do a scalp vein. At 18 months there is usually way too much hair to do them there!