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Blood collection is a routine medical procedure that provides essential information about a person's health. However, the approach to collecting blood can vary significantly depending on the patient's age, health, and general wellbeing. We're summarising the nuances of choosing the right blood collection approach for children and elderly patients, taking into account factors such as the accessibility of their blood vessels, needle choice, and the potential use of different collection devices.
Children
Children often have smaller and more delicate veins, making blood collection a challenging task. It's important to use gentle techniques to minimize discomfort and anxiety, as traumatic experiences early in life may have long-lasting effects.
When collecting samples from infants and children, special training is required as advised in the WHO Guidelines on Drawing Blood.
In addition to adapting the collection system used to the size of the smaller vessels, it may be helpful to use local anaesthetics to ease pain, which should make the process easier.
According to the Clinical & Laboratory Standards Institute, the following strategies can help reduce stress and anxiety in children, in addition to the standard procedures that must be followed when taking blood:
Applying Verbal Communication Skills
Use age-specific vocabulary to communicate at the patient’s level
Patient Participation
When possible, giving a patient a role to play, such as “hold the plaster for later” can lessen anxiety by empowering the patient.
Distractions
Age-appropriate distractions (stimuli) have been shown to minimize stress and anxiety associated with painful medical procedures. Videos, movies, interactive electronic games, use of a vein visualization device, and involvement in counting or singing songs can be used.
Parents or Guardians as Coaches
Parental anxiety and stress can have a negative effect on the child’s coping mechanisms. It may be helpful for parents or guardians to participate by contributing coping strategies and direction and by providing positive reassurance.
Comfort Positioning
To help minimize anxiety, it is recommended that children be held by a parent or guardian when possible.
Performing Heel and Finger Punctures
These methods may be more successful alternatives to venepuncture for paediatric patients, provided that the required tests permit use of capillary blood samples.
Elderly Patients
Geriatric patients may have more fragile and less elastic veins, making blood collection more challenging. Limited range of motion can hinder manipulation and make it difficult to locate veins. Other factors may include dehydration and low blood pressure, which can contribute to difficulty in locating veins.
Device Selection
In the elderly, the choice of needle gauge becomes critical to minimize trauma to delicate veins. Larger diameter needles should be avoided to prevent collapsing veins.
A winged blood collection set, such as the SAFETY Blood Collection Set or VACUETTE® EVOPROTECT SAFETY Blood Collection Set, helps the phlebotomist access delicate veins with more control due to the longer tubing and flexibility in positioning. Blood collection sets with wings allow for easier holding and guiding the needle at a gentler angle.
Vein location
Finding suitable veins may be a challenge due to haematomas from previous venepunctures or ongoing treatment. Be sure to check for potential sites below any bruising and be very gentle.
Tailoring the approach based on the patient's age, health condition, and individual needs is essential for a positive and successful experience. By considering factors such as needle size, collection site, and the use of safety devices, healthcare professionals can ensure that blood collection is not only effective but also minimally invasive, contributing to the overall safety and satisfaction of patients across different age groups.
Sources
WHO Guidelines on Drawing Blood: best practices in phlebotomy, 2010.
CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI guideline GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017, p. 74.
A. BAGNASCO, E. PEZZI, F. ROSA, L. FORNONI*, L. SASSO, (2012), Distraction techniques in children during venipuncture: an Italian experience, J prev med hyg 2012; 53: 44-48
CLSI. Collection of Diagnostic Venous Blood Specimens. 7th ed. CLSI guideline GP41. Wayne, PA: Clinical and Laboratory Standards Institute; 2017, p. 75.