SUN-199 PHLEBOTOMY PRACTICE IN A TERTIARY CARE PEDIATRIC HOSPITAL - AUDIT FOR IMPLEMENTING "SAVE YOUR VEINS" INITIATIVE

Abstract

Venipuncture is often done indiscriminately in hospitals leading to phlebitis and stenosis of veins. Patients with chronic diseases have difficult venous access and it is catastrophic in pediatric patients, more specifically those with chronic kidney diseases, hematological disease and cancers. Due to long life expectancy for paediatric chronic kidney patients, now all efforts must be focused on vein preservation for future use. Campaigns to preserve veins in kidney patients have been conducted worldwide, but not in developing countries. No paediatric specific data or campaigns are available. Hence, we reviewed the current practice of venipuncture in our pediatric department with special focus on nephrology patients. We aimed to assess the knowledge about vein preservation among our phlebotomists, nurses and junior doctors and review the current phlebotomy practice in pediatric patients in our center. A survey designed to test the knowledge among phlebotomists, nurses and junior doctors regarding vein preservation, assess current practice and willingness to get training was conducted and data was collected. Simultaneously we noted all venipunctures performed at the emergency department(ED), paediatric ward (PW) and paediatric outpatient department (OPD) in our hospital for 30 days. Data on admitting department, diagnosis, type of venipuncture (needle stick or cannula), purpose (sample collection or drug instillation), number of pricks and site preferred were collected. Outcomes like percentage of phlebotomies done by each group of health care personnel, preferred site and department or diagnosis associated with difficult venous access (2 or more attempts) were analysed. Out of 320 venipunctures recorded, 203 were considered for analysis (117 - insufficient data). The mean age of patients was 4.7 years. 85 (41.9%), 85(41.9%) and 33(16.2%) procedures were done in OPD, ED and PW respectively. General paediatrics department (n=116, 57.1%) had most patients, followed by nephrology (n= 34, 16.7%) and hematooncology (n= 33, 16.2%). 84/203 (41.3%) children were suffering from chronic disease. Nurses performed 103(50.7%), followed by phlebotomists (90 (44.3%)) and junior doctors (10(4.9%)). Only 17.2% requests had physician instruction regarding vascular access. 124 patients (61.1%) had needle stick and 79 patients (38.9%) had cannula placed. The preferred site used for needle stick method was cubital fossa (n=62, 50%) followed by dorsum of hand (n= 60, 48.3%). For cannula placement, 77/79 venipuncture attempts were made in dorsum of hand. 7% of patients required more than 1 attempt to obtain sufficient blood samples. Of 203 patients, 46 had difficult access and all these patients (100%) who had this difficult venous access were chronic disease patients (Kidney 50%, hematology 37.5%, endocrine 12.5% ). Only 60% of doctors and 33.3% of phlebotomists preferred dorsum of hand as first site. Vein preservation education is lacking and should be implemented in all hospitals. This strategy benefits children with chronic disease most, especially kidney disease. Interventions like flagging patients with chronic disease, use of wrist bands and bracelets, educating parents/children on vein preservation can help these patients.