If you are a nurse or phlebotomist please could you give me some advice?

[PolarTed]

I recently posted about a failed traumatic blood test for my 18 month old. She sat very still but her veins are tiny and they couldn't one/enough blood out and I stopped it after three goes.

We're going back tomorrow and an intensivist is taking blood. I asked about Emla cream and they said it was fine to use if I could find a vein in advance to put it on - but it took them ages with their torch so I'm worried I won't find a good one.

What am I looking for? I have two boxes of Emla and dressing and it says half a tube per site.

It's really important that we use it this time if possible I think because I don't want her to be distressed again, especially as she will need procedures in the future.

She had a cannula with Emla before and it all went really well.

Thank you in advance for any advice - all appreciated no matter how technical!

Put it on the back of the hands, inside her elbows or you might also see some on her feet. At this age you go by what you see rather than feel. You put it on about an hour before. You just put a blob on then cover it with the plastic cover.

I can get four doses out of the two boxes I have. I'll read up on this tonight but is it ok to use it all?

Being well hydrated will help.

I used 2 tubes on my dd before but she was 16yo. Does the leaflet say anything about max dose? When you put it on and put the dressing on it blobs out nicely and covers a large area. So put it on centrally on backs of hands and centrally inside of elbow.

I'd maybe try tops off feet.

2yo DS had a blood test last week and they failed with both hands (where they put the cream) and ended up going in through his foot

Keeping her well hydrated & warm & snuggly as long as possible will help as well.

It's fine to use all tubes, as already posted go with backs of hands the plaster will help it spread so just blob onto back of hand.
Elbows are not always easy in young children but you can ceases of elbows too if you like.
If DC is quite skinny you could try too if wrist follow back from thumb (may be able to feel this one) known as house officer friend. If they chubby don't bother.
Feet are sometimes a last resort, they can use freeze spray if cream hasn't been applied but this can sometimes make things worse (constricts veins)
Having an intensive at do the cannulation will help (they are very experienced particularly with very sick/dehydrated kids.
Thing is to remain very calm for DC they pick up on any of your fear and will react to that more than the actual procedure.
Hope everything goes ok
If they have a play therapist ask for them to be present even at a young age they can be incredible for reassuring kids

We always put in the back of both hands and on the inside of both elbows! We had many traumatic attempts in the children's department with play therapists involved and multiple nurses, it turned into a circus. We have since found our gp is the best at getting blood with no fuss. Our son knows him so is comfortable, no circus of people and he's gotten it first time every time.

Where was the cannula sited? Was that fairly straightforward? That might be a good place to start. Agree with others who’ve said use all the emla!

Best of luck to your dd (and to you!)

Ok, thanks for this. I will read the leaflets thoroughly tonight and then assuming no instructions not to I will use all of both tubes.

That gives me four sites so I will check both hands, feet and crooks of elbows and the best four of six is where I will put the cream.

I have a plan to keep her as hydrated and warm as possible.

Cannula was her hand so we'll give that one a go.

My DS has to have blood drawn at around ten months and the paediatric phlebotomist at Evelina went straight to back of hand. They were amazing. He didn't even cry! It had been a nightmare about a month before with a nurse.

I wouldn’t bother to be honest. The intensivist will probably strike gold at the first attempt.

How did it go OP?

Hope it went ok? I have to have regular bloods and cannulas and my veins are terrible, so I always feel so bad for children having blood taken

We had a long wait but it went really well thanks! I put the cream on one hand and foot before appointment but by the time we saw the insensivist about three hours had passed so we popped it on the other hand and foot in between and he used the more recently numbed hand.

It was amazing, he got blood immediately and it was done so quickly. She cried a bit but I think it was more the sensation of her hand being held, especially after last time. It was much less distressing and such a relief.

I was plying her with liquids all day and her nappy got heavy very quickly so hopefully the hydration helped, thank you. And several snuggly layers on

Now just the horrible wait for the results

Ah well done to both of you (and to the intensivist!)

All the very best of luck with the results, I hope that everything is ok

I have always had a problem providing a blood sample until a nurse suggested putting my arm in a bowl of warm water first.

Another trick is to carry a hot water bottle in a thermal lunch bag with a damp cloth. Ensure that the cloth isn’t too hot, then apply that to the site for a couple of minutes prior to the collection. (Phlebotomist)