Healthcare and Medicine Reference
Figure 22.5 Commonly used devices. From left to right: blood sampling
needle, Neofl on®, butterfl y needle, lumbar puncture needle, heel prick
device, T-piece to attach to cannulas.
Figure 22.4 Holding the hand for venepuncture or cannulation.
Intravenous medications and fl uids.
The general approach and skin preparation is the same as in
Frequent blood sampling (e.g. endocrine investigations).
Avoid areas of broken skin (e.g. eczema).
To obtain blood samples.
Veins that can be seen (less commonly palpated).
Dorsum of hands and feet. Feet are often the fi rst-line choice in
babies and toddlers.
Antecubital fossa or hands in older children. Avoid the antecu-
For babies and toddlers - use dorsal surface of hands and feet.
bital fossa and long saphenous vein in neonates, as these are sites
required for long lines.
For older children - use the antecubital fossa.
Hand or foot holding is crucial. With babies and small children,
encircle the foot or hand with your own hand, whilst pulling the
skin taut (Figure 22.4).
For babies, use the blood-sampling needle (Figure 22.5). Insert
See Chapter 10 for a step-by-step guide to cannulation. Below is a
list of helpful tips particular to paediatrics.
Apply local anaesthetic.
Preparation - see previous section.
slowly into a vein until blood drips from the end. Drip samples
into bottles - mix coagulation and FBC bottles to avoid clotting.
For toddlers, use a butterfl y needle with the tubing removed. This
Cannula choice depends on the age of the child. For neonates
and young infants use a Neofl on® (Figure 22.5). For toddlers and
young children, where possible use a blue (22G) cannula. For
older children and teenagers use a blue or pink cannula (20G).
Avoid using a tourniquet except for older teenage patients.
creates a lower pressure in order to obtain samples.
For older children, use a butterfl y needle attached to a syringe.
Don't pull back quickly on the syringe since the blood fl ows more
slowly than in adults.
Hold the foot or hand as described above (Figure 22.4).
Children's veins are very mobile. Be prepared to withdraw within
the skin and try to pierce the vein again.
Take it slowly - fl ashback is often slower due to the lower venous
Apply tape over the 'nose' of the cannula when inserted.
Drip blood into bottles.
Connect a prefl ushed T-piece (Figure 22.5) to the cannula and
Cannulation is indicated if a child requires intravenous fl uids or
antibiotics, but it is also reasonable to leave a cannula in after taking
bloods if the decision to treat depends on the results.
fl ush. This can also be used to advance a cannula that is jammed
against a valve.