WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy

6 Paediatric and neonatal blood sampling
The information given here supplements that given in Chapters 2 and 3. Users of these
guidelines should read Chapters 2 and 3 before reading the information given below. This
chapter covers background information (Section 6.1), practical guidance (Section 6.2) and
illustrations (Section 6.3) relevant to paediatric and neonatal blood sampling.
6.1 Background information on paediatric and neonatal blood
sampling
This chapter discusses aspects specific to paediatric and neonatal blood sampling (60, 61).
Anyone taking blood from children and neonates must be well trained and practiced in
venepuncture techniques. A uniform sampling technique is important to reduce pain and
psychological trauma.
6.1.1 Choice of procedure and site
The choice of site and procedure (venous site, finger-prick or heel-prick – also referred to as
“capillary sampling” or “skin puncture”) will depend on the volume of blood needed for the
procedure and the type of laboratory test to be done. Venepuncture is the method of choice
for blood sampling in term neonates (62, 63); however, it requires an experienced and trained
phlebotomist. If a trained phlebotomist is not available, the physician may need to draw the
specimen. Section 7.1 provides information on when a capillary blood specimen from a fingerprick
or a heel-prick is appropriate. The blood from a capillary specimen is similar to an arterial
specimen in oxygen content, and is suitable for only a limited number of tests because of its
higher likelihood of contamination with skin flora and smaller total volume.
Finger and heel-prick
Whether to select a finger-prick or a heel-prick will depend on the age and weight of the child.
Section 7.1 explains which procedure to select, based on these two elements.
Patient immobilization is crucial to the safety of the paediatric and neonatal patient undergoing
phlebotomy, and to the success of the procedure. A helper is essential for properly immobilizing
the patient for venepuncture or finger-prick, as described in Section 6.2.
6.2 Practical guidance on paediatric and neonatal blood
sampling
6.2.1 Patient identification
For paediatric and neonatal patients, use the methods described below to ensure that patients
are correctly identified before taking blood.
• Use a wrist or foot band only if it is attached to the patient; DO NOT use the bed number or
a wrist band that is attached to the bed or cot.
• If a parent or legal guardian is present, ask that person for the child’s first and last names.
• Check that the name, date of birth and hospital or file number are written on the laboratory
form, and match them to the identity of the patient.
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