Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Blood gasses are so routine in neonatal intensive care units that most staff wouldn't bat an eyelid if asked to do one which can be intimidating for new staff who are expected to perform this procedure without any expectation of training or supervision in the area. They are not always as easy as they first appear. And staff at all levels of experience could benefit from a refresher doctor Matthew Sayers, a consultant, pediatrician with over 10 years experience in pediatrics. And in this video, I will share my tips and techniques on how to perform a successful capillary blood gas, reducing the risk of an insufficient or rejected sample. Thanks to all guidelines and documents in this video are available in the video description and also on the Ola medical app. When should we do a capillary blood gas on a baby in a baby with respiratory distress, a capillary blood gas can give important information on how well they are oxygenating and ventilating as well as their metabolic compensation and end organ dysfunction. A capillary blood gas is also very useful if a baby is sleepy and has poor tone as it can identify possible hie and in babies that are generally unwell blood gas is very useful to help identify sepsis, metabolic decompensation and inborn errors of metabolism. Capillary blood gasses are affected by poor perfusion, no temperature and excessive squeezing. Make sure you use the lateral aspects of the heel to avoid damaging the plantar and calcaneal nerves which are located more immediately rotate sites as much as possible to avoid damaging the skin. We prefer a capillary blood gas over an arterial or venous blood gas arterial blood gasses are the gold standard in babies. However, they are not always appropriate. Uh if long term and repeated sampling is not required as they would require an arterial line. Single arterial venous puncture should not be performed in babies as these can damage small arteries causing complications and making future arterial line access more difficult venous blood gasses do have some advantages over capillary blood gasses. They are normally for your flowing and therefore the lactate is more accurate. However, they do not give an accurate P two measurement and this means you cannot use them for oxygenation index. They are also not very useful for measuring ventilation status in a baby as the PH is normally naught point naught. Five, lower the bicarb 2 to 3 higher and the P CO2 3 to 7 millimeters of mercury higher than an arterial ph. Prepare your equipment. You will need a lancet capillary tube, chloraprep and cotton ball for hemostasis sho should also be used for analgesia if required position, the baby's foot at or below the level of the body, hold it firmly with your palm and index finger, clean the insertion area with the chloraprep and allow it to dry. Use the lancet to puncture the skin on the medial or lateral aspect of the heel. As shown small drops of blood will appear in the lanced area position the capillary tube at a slight angle so that blood flows continually up the tube with minimal air bubbles. If a large air bubble occurs, tip the tube downwards to remove it with gravity and then start collecting again, gently pump the heel allowing time for capillary refill. Do not continually squeeze as this will result in a hemolyzed sample, aiming to fill the capillary tube completely. However, some machines can run limited blood gasses with smaller volumes if required. Check with nursing staff if the baby requires a blood glucose or guthrie card, as it is good practice to minimize repeated unnecessary sampling as much as possible. Apply gentle pressure with a cotton ball until the bleeding stops when carrying the capillary tube to the blood gas machine. If you occlude one end of it with your finger, the blood will not drop out. Thanks so much for watching. Please like this video, comment with any clinical questions or feedback you have and subscribe to the channel and our other social media accounts including Instagram, Twitter, Med all and Ola to stay up to date. With future videos. I look forward to seeing you again soon.