This article will discuss how to take blood and cannulate patients in the paediatric setting.

Preparation

If you think you will need to take blood from a paediatric patient, it is kinder to cannulate them once and take their blood whilst you are doing this than to subject them to the needle twice.

EMLA: ask the nurses or find the EMLA tube and plasters in the treatment room and apply this to the dorsal aspects of both hands and both anti-cubital fossae. Explain to the child that this is numbing cream and that you will need to put a little tube in their hand so you can do a blood test and give them medicine through the tube.

Cold spray: As a way to distract the patient, I also find gently spraying cold spray away from the site of cannulation can distract them enough to complete the procedure.

Equipment

• Blue or yellow cannula
• Alcohol swab
• Gauze
• Touniquet if child is older/similar size to an adult
• Blood bottle:
  • If this is a small child then you will need the little bottles where the cap comes off. You can prep them with the lids open in a little paper tablet cup in your tray so they are ready
  • If this is a child that is basically as big as an adult (12-17) year olds then you can use normal blood bottles and a blue-ended vacutainer adapter and vacutainer.
• Dressing: they like the ones with teddies on them
• Octupus and flush: primed and ready
• Wrap: some of the younger ones wont like seeing the cannula or will pull at it. You can use a wrap to cover everything with the octopus ends sticking out so that it is less distressing for them.

Procedure

Use some gauze to wipe off the EMLA cream at the site you wish to use.

If you are taking blood/cannulating an older child who is similar in size to an adult, then continue as you would with an adult. Do keep in mind they are still likely to be scared and will need plenty of reassuring. Many will not want to see the needle and will likely freak out if you hold it in front of them for too long. I have seen nurses in Paediatrics hold the cannulae behind their backs and only bring them round when they are ready to cannulate.

If you are taking blood from a smaller child then ask their adult to be a human tourniquet. Demonstrate on the adult how you want them to hold the arm of the child. This will help keep the child’s arm still and will be less traumatic than using a tight tourniquet. If their adult does not want to do it then ask a nurse or HCA to come help you. I have found medical students to be invaluable buddies when it comes to cannulating in Paediatrics.

In children, the veins that you see are very superficial and you do not need to go very deep. Angle the cannula needle nearly parallel to the skin, you do not need to have a very deep angle at all. When you have advanced the cannula in fully, remove the needle and use the little blood bottles you got ready to catch droplets of blood directly from the end of the cannula. Place the octupus into the cannula and flush as normal. Dress with teddy bear cannula dressing and a wrap if needed.

Make sure you remove the EMLA from the remaining sites if you did not need to try again.

Key notes

• Only try twice. Once at each site. Then ask a nurse to help you. They are very happy to help as long as you have given it a go.
• Do not dig around if you can help it. It causes unnecessary distress to the child and it would be better to just withdraw and try at a different site.
• Use a vein-finder if they have one. These are magic and the kids find them really cool.
• Make sure you have a good flat surface for your tray. Those little blood bottles don’t stand up as well as you’d like and you can’t put a lid on them until you’ve atleast taped down the cannula wings.
• Let the child sit in their adult’s lap if that is what they want. They can watch something on a phone or tablet or they can have a snack, anything to keep them occupied and comforted.
• Don’t be hard on yourself if you don’t manage or find it difficult to cope with a distressed child. The best thing you can do for both yourself and the child is to ask for help.

Written by Dr Cyra Asher (FY2)