How to Draw a Venous Bilirubin- Neonate : 11 Steps

I have been a Maternal Child nurse for the last 2 years. At the beginning of my career, I was terrified of drawing labs on a neonate (baby <28 days). With a lot of practice and research, I have become so comfortable that I want to teach other nurses how to draw venous bilirubins on a neonate. This instructable should give nurses greater confidence and correct methods on how to properly perform a venous puncture on an infant.

Step 1: Gather Supplies

This is the most important step, ensuring that all supplies are present and available before beginning the procedure. If parents are present in the room, this will decrease their fear a little bit because they see that you are prepared. It also eliminates the chance of sticking the baby and realizing you don't have a tube and then having to start all over again.

**Needed Supplies** (See Figure)

Alcohol pad (I always bring 2 just in case)

Needle- straight 25g 3/8 ( I always bring 2 just in case)

Gloves

Band-aid

Green top tube (to collect the blood) (color might be specific to facility)

Biohazard bag

Patient Sticker (this is not pictured for privacy reasons)

Step 2: Explain Procedure to Parents

Since your patient is a neonate you will explain the procedure to the parents. I always gather my supplies prior to this step so that when I finish explaining and answering any questions the parents may have I can take the infant with me to the nursery and begin the procedure. New parents are filled with anxiety and the fear of the unknown, so you must explain what the bilirubin is testing (I've found in my practice that more parents understand the term jaundice).

Step 3: Use Fingers As Tourniquet

I utilize my fingers as a tourniquet. I do this by taking my pinkie and ring finger and putting the neonate's arm between them squeezing gently. I find this to be more effective and less traumatic than using an actual tourniquet (although if you are more comfortable you can apply a regular tourniquet.

Step 4:

Step 5: Identify a Vein

Identify the vein you will use to draw the blood. I always go for the one that I can see best & that feels like a ball bouncy back up at you (although with neonates sometimes it takes some practice to be able to feel it).

Step 6: Clean With Alcohol

Now that you have chosen the site you plan to use, open your alcohol pad, and clean the site. I use circular motions starting in the middle.

Step 7: Use Needle to Puncture Vein

Make sure that you have the skin tight before you puncture with the needle utilize your non-dominant hand for this task. Once you ensure the skin is tight visualize the vein you intend to puncture and insert the needle. When you are in the vein you should see some flashback in your needle. ( I usually insert the needle around 1/2cm)

Troubleshooting:

Ensure you don't insert the needle too deep as you will go through the vein. If you don't see immediate flashback pull the needle back about 1/4 cm ensuring you don't remove from the skin, as this would cause contamination and you'd have to begin again. After you pull back 1/4 cm ensure you've used an alcohol wipe on your gloved finger and re-feel, then redirect the needle.

Step 8: Place Tube Under the Opening on Needle

Place the green top tube under the opening of the needle and allow blood to fill the tube. If blood is not reflowing you can utilize your extra fingers on the non-dominant hand to pump the hand to promote blood flow. Fill the green top tube until the first line (400 which is 0.4mL).

Step 9: Remove the Needle

Remove needle. Utilize your finger to put pressure on the puncture site and immediately place the needle in the sharps container. Grab your band-aid and place it on the puncture site.

Step 10: Place the Patient Sticker on the Tube

The laboratory is unable to run any labs without a patient identifier so ensure placing the label upon the tube. Also certain facilities require extra information on the person collecting the blood (my facility requires employee number, initials, and time)