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Page 1 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic

Key Document code: WAHT-TP-098

Key Documents Owner: Sarah Weale

Approved by: Paediatric Quality Improvement meeting

Date of Approval: 26th March 2021

Date of review: This is the most current version and should be used until a revised document is in place

26th March 2024

Key Amendments

Date Amendment Approved by 17

th June 2020 New document approved Paediatric QIM

19th November 2020 Document extended for 1 year Paediatric QIM/Dr J West

26th March 2021 Approved with no amendments Paediatric QIM

1. Introduction

This SOP sets out the Worcestershire Acute Hospitals NHS Trust’s (covering all three sites namely, Redditch, Kidderminster and Worcester) performance of venepuncture. This SOP has been written to identify the procedures for venepuncture and to minimise the risk of bleeding patients by identifying evidence based safe systems of work.

2. Ice request All blood requests must be on the ICE system before any blood appointments are made.

3. Booking on Oasis

All appointments must then be booked in OASIS prior to the appointment taking place.

4. Phone advice Staff taking or making calls to patients must advise parents about any requirements for blood taking such as fasting. Staff must also explain the procedure in relation to anaesthesia. Parents must be told they can either obtain a prescription from their GP or collect from the Clinic. Advice must also be given on how to administer the anaesthetic cream.

5. Trained staff This SOP relates to the following groups of staff who are required to undertake venepuncture as part of their role:

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Page 2 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

Medical staff

Registered nurses

Healthcare assistants Staff undertaking these procedures must have provided their Manager with the competencies they obtained from relevant in house training.

6. Location

Venepuncture must only be undertaken in a suitable clinical environment by staff who are competent in this skill. At Worcester, this would be in the treatment room, 4 bedded bay or in one of the consultation rooms. This would be the treatment room in Kidderminster and Redditch. There must also be a paediatric consultant available on site when there are phlebotomy appointments.

7. Preparation 7.1 Choice of procedure and site

The choice of procedure is dependent on the volume of blood required, the type of laboratory test requested, the age of the patient and whether the patient has additional needs or needle phobias. The choice of procedure is either a venous sample or capillary sample (finger or heel prick). Venepuncture is the method of choice for blood sampling as capillary samples have a higher likelihood of contamination with skin flora and a smaller total of volume. However, as discussed in the paragraph above, a venous or capillary sample will be subject to the age and needs of the patient.

7.2 Equipment Equipment required to undertake a venous sample:

Winged blue needle

10ml syringe

Vacutainer

Tourniquet

Sterile Clinell 2% chlorhexidine in 70% alcohol skin wipes

Sterile gauze

Plaster

Sharps bin

Appropriate blood bottles

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Page 3 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

Equipment required to undertake a capillary sample:

Lancet – size appropriate for task (please see Annexure “A”)

Sterile Clinell 2% chlorhexidine in 70% alcohol skin wipes

Yellow soft paraffin (optional)

Sterile gauze

Plaster

Sharps bin

Appropriate blood bottles

7.3 Personal Protective Equipment All staff undertaking a phlebotomy procedure must wear:

Blue gloves

White apron

Any staff member assisting in holding the patient’s arm must wear blue gloves. Please refer to the Standard Infection Control Precautions: National Hand Hygiene and Personal Protective Equipment Policy on the Trust Intranet for advice on wearing goggles. 7.4 Infection control

Please see Annexure “B”.

7.5 Anaesthesia All patients must be offered appropriate anaesthesia ie LMX cream (there are other brands) or Ethyl Chloride spray (cold spray).

7.6 Distraction All patients must be assessed to ascertain whether they will require distraction. Distraction must be provided by a play specialist, if the play specialist is not available, another member of the nursing team can assist with this.

8. Patient identification and consent Check the patient’s identity by asking the patient, if the patient is too young, by asking the parent. The patient/parent must provide full name and date of birth. Consent must be obtained from the patient/parent before the procedure is undertaken.

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Page 4 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

9. Procedure Ask whether the parent would like to help by holding the child. If the parent wishes to help, provide full instructions on how and where to hold the child; if the parent prefers not to help, ask for assistance from another member of staff. Stretch an arm across a pillow and place the child in a seated position on the treatment bed. The parent can sit on the side you are not going to bleed. The play specialist can sit on the bed next to the patient. If the patient requires an arm-hold, another member of the nursing staff can hold the arm in place whilst sitting on the rolling nursing chair. Place the tourniquet around the upper arm of the patient. Clean the site for 30 seconds, allow to dry for 30 seconds and insert the needle at an angle of approximately 15°. Drawn sufficient blood from the vein into the syringe. Remove needle and syringe. Apply gauze and then plaster. Remove needle from syringe and place into sharps bin. Fill bottles following recommended order of draw.

10. Labelling of bottles

All bottles must be labelled by the bedside and before the patient leaves the room.

11. Draw order See Annexures “C” and “D” (Tube Guide and Order of Draw).

12. Last blood collection times

Kidderminster – 1500 Redditch – 1700 Worcester – 1800

13. References

WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organisation; 2010. 6, Paediatric and neonatal blood sampling. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138647/

WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva: World Health Organisation; 2010 . Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua-1

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Page 5 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

Annexure “A”

Lancets used in the Trust

The correct size lancet must be used for the appropriate task:

1. BD Microtainer Lancet

Purple - 30 gauge (low flow)

Pink - 21 gauge (medium flow)

Blue - 1.5mm (high flow)

2. Sarstedt Safety-Lancet

Blue – 28 gauge (mini)

Green – 21 gauge (normal)

Yellow – 18 gauge (extra)

Purple – blade 1.5mm (super)

Pink – blade 1.5mm (neonatal) All lancets can be used for finger pricks, but the size of the gauge is dependent on how much blood is required. For a single spot of blood for a blood glucose check – use either the purple BD or the blue Sarstedt. For many blood tests – use blue BD or purple Sarstedt. For neonatal and petite children use the pink BD and Sarstedt. For other lancet brands not mentioned above, refer to the manufacturer’s guidelines to ascertain the gauge before using.

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Annexure “B”

DO DON’T

DO carry out hand hygiene (use soap and water or alcohol rub), and wash carefully, including wrists and spaces between the fingers for at least 30 seconds (follow Trust’s hand washing guidance). DO use one pair of non-sterile gloves per procedure or patient. DO use a single-use device for blood sampling and drawing. DO disinfect the skin at the venepuncture site. DO discard the used device (a needle and syringe is a single unit) immediately into a robust sharps container. DO seal the sharps container with a tamper lid. DO immediately report any incident or accident linked to a needle or sharp injury, and seek assistance; start PEP as soon as possible, following protocols.

DO NOT forget to clean your hands. DO NOT use the same pair of gloves for more than one patient. DO NOT wash gloves for reuse. DO NOT use a syringe, needle or lancet for more than one patient. DO NOT touch the puncture site after disinfecting it. DO NOT overfill or decant a sharps container. DO NOT delay PEP after exposure to potentially contaminated material.

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Page 7 of 10 Phlebotomy Standard Operating procedure (SOP) for Children’s Clinic V7

Annexure “C”

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Annexure “D”

SERUM Small red Large gold

LIHIUM HEPARIN Small orange Large green

EDTA Small lilac Large purple

CITRATE Light blue

FLUORIDE Small grey Large grey

AFP Acyl carnitine ACTH Straight to lab

Clotting Free fatty acids

Alpha 1 antitrypsin Glucose

Amylase Amylase Ammonia Straight into lab

Factor V Leiden Lactate Lab within 2 hrs

ANA Amino acids Factor V111

ANCA Factor XA Oxybutyrate

Androstenedone Fibrinogen

ASOT

AST AST Lupus

B12 & floate B12 & folate

Bilirubin Bilirubin

Biotinidase

Bone profile Bone profile Von Willebrands

Bordetella CarboxyHbg

C3 C4 complement

CK CK

CMV Abs CMV PCR

Cortisol Cortisol Coombes test (DCT/DAT)

CRP CRP ESR

EBV serology EBV PCR

Ferritin Ferritin FBC

FSH

Func Abs Genetics + EDTA Genetics + Lith hep

GGT GGT Gland fever screen

Growth hormone G6PD screen

Homocysteine MONITORING Lab within 30 mins

Homocysteine DIAGNOSTIC Straight into lab

Hep B serology HbA1C

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SERUM Small red Large gold

LIHIUM HEPARIN Small orange Large green

EDTA Small lilac Large purple

CITRATE Light blue

FLUORIDE Small grey Large grey

HBsAg Hgbopathy screen Large tube

Hep C serology Hep C PCR

HIV serology HIV PCR

IgA IgA HLA typing

IgE IgE

IgF1 IgF1

Immunoglobs Immunoglobs

SERUM Small red Large gold

LIHIUM HEPARIN Small orange Large green

EDTA Small lilac Large purple

EDTA Large Pink

TRACE ELEMENTS Large Navy

Insulin Straight to lab

Group & Save Copper 1ml

Iron studies Lead X match Selenium 1ml

LDH Zinc 1 ml

LH PTH

Lipids Lipids

LFTs LFTs Tac level

Magnesium Magnesium 6TGN

Mast cell tryptase

Mumps serology TPMT

Oestradiol

17 OHP 17 OHP

Osmolality Osmolality Viral loads

Prolactin

RAST tests White cell enzymes

Rheumatoid factor

Rubella serology Renin studies FULL Green

TFTs TFTs

TA Abs TA Abs

TB T spot 2 Green

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SERUM Small red Large gold

LIHIUM HEPARIN Small orange Large green

EDTA Small lilac Large purple

CITRATE Light blue

FLUORIDE Small grey Large grey

Testosterone

TORCH

Toxo serology

TTG TTG

U & Es U & Es

Uric acid

Varicella serology

Vit A Protect from light

Vit A Protect from light

Vit D Vit D

Vit E Protect from light

Vit E Protect from light

VLCFA