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What is your technique for an effective heel stick to get good PKU results? I don't know if it is my technique or the fact that I have a phobia about needles but I can't seem to get enough blood from their little heels to fill the PKU form.<br><br>
Do you use heel warmers? hot washclothes? or what<br><br>
Thanks
 

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I am not a midwife, but instead am a mother of two dds who have PKU and so when they were little we had to do heel sticks very frequently (with my first dd that had it weekly at first and then monthly and with my second dd it was twice a week at first and progressed to once a month).<br><br>
Anyhow, when we did it we did use heel warmers and the really good lancets. We warmed the heel and then made sure it was lower then the heart and like I said used a really good lancet. I think the one we used back then was the Tenderlet or something like that. Sorry my youngest with PKU is already 9 1/2 yrs old so I am not positive of the name or if the lancets we used back then are still around. Now the girls get finger sticks and we do not have to use as much blood since they are only being tested for PKU and not all the other genetic disorders that the Newborn Screening tests for.<br><br>
One other thing - are you making sure that you are poking on the side of the heel? Sorry if that sounds like dumb advice, but I know when we started doing the girls I never got it right (dh is a medical technologist and was a phlebotomist before becoming a MT so he always got the right spot).
 

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I warm the heel by wrapping it in a disposable diaper full of hot water and I wrap the diaper around the entire leg. I hold it there for several minutes.<br><br>
As mentioned above, be sure you are poking in the right place. I know it sounds simple, but many people are not taught how to do it correctly.<br><br>
Also as mentioned, use the "good lancets". The Tenderfoot knock-offs are the best (because they're cheaper than Tenderfoots). You want a lancet that slices wide across the capillary bed, not a deep puncture.<br><br>
If you don't get an adequate of blood, wipe it away with alcohol and start over. The alcohol will stop the blood clotting that started while you've waited for the blood to flow. It may seem that you're wasting blood, but the small drop you've got isn't usable anyway so you might as well cut your losses and start over with a better chance for a bigger drop. (Quickly wipe the site with a sterile 2x2 after the alcohol as it can contaminate the sample.)<br><br>
If you can't get the baby to bleed well right away, go ahead and poke them again immediately with a new lancet. It is not the poking but the squeezing that it traumatic for the baby, so he's better off with a second poke.<br><br>
As long as the baby is bleeding I take more blood on a second card. You may need to check with your lab that this is ok, my lab says better to have too much than too little. I mark the second form with the baby's name and write "extra sample" across the form.
 

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Thought I'd mention, this is not clinically related, something I do to make things easier on me. I spread out a chux pad on the mom's lap under the baby (baby is usually nursing when I do the test). I just drop all my used junk on the chux so when it's over I just wad up the chux with all the trash inside and throw it away (no scrounging around for all the bloody alcohol pads and 2x2s). I also have the chux right there to dry the baby's heel when I take it out of the diaper, and it prevents getting blood on mom or the furniture if the baby starts flailing his foot around.
 

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Besides warming the foot, I have mom or dad stand, hold the baby upright over their shoulder so the baby's foot is dangling. Gravity works on blood flow, too! If blood flow slows, I "bicycle pump" the baby's legs, gets the blood flowing nicely. Wipe away clots between drops.<br><br>
Never had to poke a baby twice (knock on wood!)
 

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Thanks for all this good advice, womyn! I'm new at this part of things...finally past hating to poke em (not that I like it, but now I can do it right), finally found the right spot to get good flow. But this other stuff sounds like it will also help...I have had to poke some babies twice.
 

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I have a "mini-rice sock" that I made with a infant sock. I heat it in the microwave for about 20-30 seconds. Test to make sure it's nice and warm, but not too hot, and I hold that on the baby's heal for a minute. For those families that don't own a microwave, a glove filled with hot water works just as well. Although it's not as cute or reusable as a baby sock filled with rice. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
Have the baby's body as vertical as possible. Some moms want to nurse while you do the heel-stick, and I'll certainly work with them if that's what they want, but it usually takes longer. I prefer to do the baby in a "burp position", do the heal stick quickly and get the blood sample fast with gravity helping, and then go straight to a cradled position to slow the blood flow while they nurse.<br><br>
Gentleheel lancets (the Tenderfoot knock-off) are absolutely worth the extra price!<br><br>
And yes, poking in the right place makes all the difference in the world.<br><br>
I also make sure to hold the lancet firmly pressed against the skin when I depress the button. If it's barely touching the skin, you won't get as good of a flow, IME.<br><br>
I'm more often than not trying to STOP the blood from flowing after I've got enough on my test card.<br><br>
I've found the babies rarely cry when you stick them with a Gentleheel or Tenderfoot. It's when you hold their foot in place afterwards when they're trying to draw it up away from you that they get upset.<br><br>
HTH.
 

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here is a web site with instructions-- and a pic of where to stick-- see the little slant marks<br><br><a href="http://www.uihealthcare.com/depts/med/pediatrics/iowaneonatologyhandbook/procedures/obtainingblood.html" target="_blank">http://www.uihealthcare.com/depts/me...ningblood.html</a>
 

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Thanks for that link. Those are narrower margins than I was taught to use. I've had a lot of trouble getting heels to bleed... maybe moving closer to the edge will help.
 

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i was lurking in this forum and i just wanted to say thanks so much for this topic.<br>
when i had my son nearly 2 years ago (in a hospital with a mw) i held my 1 day old baby while the nurse jabed him repeatedly in his tiny arm with an iv type thing to get blood in a tube for the pku test. it was horrible and she just kept pokeing and wigeling it around while he screamed. after all the hospital interventions that i had protected him from i never expected anything but a simple heal prick for the pku, if i had known they would use a tube i would have refused come what may. he was a healthy 7lb13oz born at 40w5d so i dont know why they didnt do a heal prick. with this new baby who is due in a few months, i will insist on just the prick and bring a rice sock to warm his foot, thanks for the great advice, all.
 

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breachaplin I would say ask some questions about your son and the procedures they did- a tube sounds like they did more than a metabolic screening on him, you could get a copy of the records and see what other tests they did at the time.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">breachaplin I would say ask some questions about your son and the procedures they did- a tube sounds like they did more than a metabolic screening on him, you could get a copy of the records and see what other tests they did at the time.</td>
</tr></table></div>
<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/yeahthat.gif" style="border:0px solid;" title="yeah that">: That was my thought too.
 

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I know in some places they will collect the blood in a thin capillary tube, then apply the blood to the paper from the tube. This cuts down on the "flailing baby" factor of having enough blood but not being able to get it on the paper. But still they get the blood from the heel. Why would you poke the baby's arm instead of the heel?
 

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I once saw a student midwife (who said she had learned this from a midwife who does ALL pku's this way) use a butterfly in a baby's hand to get the drops of blood out. It was so simple and straightforward, and the baby didn't suffer as much as they seem to with the heel stick, and it was much faster and the drops of blood were all perfect. I thought it was a great way to do it.
 

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realy you think they may have tested him for more than just pku? i never thought of that. the pku was the only hospital policy type intervention that i alowed, no vit.k, no eye goop, no hep b shot, no nursery time ect. who would i contact to get his records, the hospital?
 

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Actually "PKU" is a misnomer. The test that people commonly refer to as "PKU" is actually "newborn metabolic screening" and tests for up 30+ different metabolic diseases in addition to PKU (which tests are included vary by state).<br><br>
What your baby went through was not normal for metabolic screening by anything that I was taught. But as I said, I have heard of people collecting blood with capillary tubes, and I have heard of getting the blood out of the hand, so maybe it was.
 

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Have any of you heard of the state maintaining DNA samples from blood from newborn metabolic screenings?
 

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This issue concerns me greatly, enough so that I have not had a screening test done on my newborn yet. I had it done with my two older children. I am very undecided if I am going to do it with this baby.
 

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I found this:<br><a href="http://www.cchconline.org/pdf/S_1858_NBS-DNAWarehouseFINAL.pdf" target="_blank">http://www.cchconline.org/pdf/S_1858...houseFINAL.pdf</a>
 
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