Pediatric Venesection - Indications and Procedure

Introduction

During a clinical operation called venesection, a vein is punctured with a needle, after which a predetermined amount of blood is drawn based on the patient's weight. The process takes between fifteen and thirty minutes to finish. Venesection is a therapeutic procedure used to lower blood volume, red cell mass, and excess iron reserves in patients with specific blood diseases. In the pediatric context, venesection is typically suggested for the medical disorders of polycythemia and transfusion-related iron overload. The purpose of the venesection will dictate the frequency of the procedure for the patient as well as any necessary blood tests before the procedure.

How Is Iron Overload in Children Diagnosed?

The following should be included in the diagnosis of iron overload and the assessment of its clinical impact, regardless of the etiology (for example, repeated transfusions, increased iron absorption in hemoglobinopathies, or hemochromatosis): iron concentration in tissues, and organ dysfunction.

• Blood film, full blood count (FBC).

• Transferrin, transferrin saturation, ferritin, serum iron, and C-reactive protein (CRP).

• Hepatitis B/C serologies, liver and renal functions.

• Endocrine evaluation (such as thyroid function tests) if any symptoms indicating a malfunction of particular systems are observed.

• Hereditary hemochromatosis protein (HFE) genetic status.

• An unsedated magnetic resonance imaging (MRI) of the liver or heart can also be performed to estimate the iron concentration if the child or young person can handle it.

What Are the Indications for Pediatric Venesection?

Think about providing care or intervention for the following patients:

• Ferritin in serum > 1000 microg/L.

• Saturation of transferrin > 50 percent.

• MRI-derived estimated liver iron > 5 mg/d dry weight.

• T2* cardiac MRI < 20 ms.

• Any indication that the target organs, the pancreas, thyroid, hypophysis, liver, or heart, are dysfunctional due to iron. In these situations, a relevant organ biopsy may be required to link dysfunction to iron overload.

Venesection is an option for patients if:

• The aforementioned iron excess has been recognized as requiring therapy.

• Hb is within normal ranges; however, erythropoietin should be used concurrently if Hb levels are borderline, and venesections are still believed to be the most clinically suitable therapy option for treating iron overload.

• From a cardiovascular perspective, there is no clinical reason why the procedure can not be performed.

• Verbal patient or parent consent is available for the surgery.

How Are the Procedures of Pediatric Venesection Performed?

To manage iron overload, a specific volume of blood must be drawn by venepuncture every three to four weeks or as tolerated. If the venesections are well tolerated, they should be continued until the liver iron content is less than 5 mg/g dry weight or the ferritin levels are less than 300 microg/L.

Things to Be Asked Before the Surgery:

The following should be completed as a baseline before every venesection procedure:

• Blood pressure, weight, heart rate, respiration, and basal temperature.

• Verify the patient's clinical status and make sure there are no ongoing problems that need to be addressed.

• Transferrin, transferrin saturation, ferritin, c-reactive proteins (CRP), urea and electrolytes (U&Es), liver function test (LFTs), full blood count (FBC), reticulocytes, and serum iron should all be sent in and recorded in the iron overload screening chart.

• Make sure all of the patient's queries are addressed and that they are fully informed about the operation.

• If fainting has a history, remain still during the procedure and for 30 minutes following its conclusion.

• The patient's hunger and dehydration might cause them to faint during or after an operation. Therefore, the nurse must constantly make sure the patient is feeling well and has eaten.

• Before performing the surgery and reviewing the last venesection results, the patient's blood count (for example., ferritin and iron levels) must be evaluated.

• Before each venesection, the amount of blood to be drawn must be determined by the patient's weight (5-7 mls/kg up to a maximum of 350 mls), the amount previously drawn, or any notes made on the chart (such as fainting after 200 mls were drawn).

• The patient is venesected and cannulated for 30 minutes or more.

• For laboratory testing, the first blood specimen removed is used.

• Following the surgery, the patient should be able to sit up and enjoy a sugary beverage (parents are asked to bring a sweet drink at each visit). Normal saline (5–10 ml/kg) can be given if necessary.

• If all is okay, the patient may be released after 15 to 30 minutes.

During the Procedure:

• Place the patient in a comfortable, reclined position.

• Observe the Hand Hygiene-Infection Control policy when practicing hand hygiene.

• Assemble the necessary gear.

• Put on gloves.

• Utilizing the Aseptic Non-Touch Technique, assemble the necessary equipment (ANNT).

• Fit the twin male luer lock adapter to the wound drainage system with a high vacuum.

• The double male luer lock adapter should be connected to the three-way tap extension set (the actual three-way tap closer to the high vacuum wound drainage system).

• Connect the three-way tap to the smartsite (needle-free valve).

• Make sure the high vacuum wound drainage system's clamp is closed.

• Put the patient's tourniquet on.

• Make sure that the CVC is prepared for use, or insert the PIV cannula or butterfly by the Intravenous Catheters - Peripheral - In Adults and Children policy.

• Put in the PIV cannula or butterfly, or make sure the CVC is ready to go.
• Make sure the patient's three-way tap is open.

• Lift the high vacuum wound drainage system's clamp.

• Draw the required amount of blood, paying attention to the blood flow rate to make sure it does not happen too soon.

• After drawing the required amount of blood, secure the high vacuum wound drainage system.

• Take off the tourniquet.

• Close the patient's three-way tap.

• Unplug the 3-way tap extension from the CVC or PIV line.

• Either remove the PIV line and pressurize the area right away, or flush the CVC with less than one percent sodium chloride and then lock in the heparin.

Post-surgery:

• After the surgery, the patient must be under observation for up to 30 minutes.

• Make sure the patient rehydrates by mouth.

• Record the precise amount of blood extracted in the patient's clinical notes and on the Four Line Fluid Balance Chart.

What Precautions Do Parents Need to Take Post Surgery?

Before each discharge, parents and children are informed of the precautions:

• Reduce the daily activities to a minimum, such as skipping active sports, especially if the child is going back to school.

• If the child feels faint (cold, clammy) within a few hours of venesection, make them sit down and place their heads between the legs or rest flat.

• Try to have something sweet to drink.

• Continue lying or sitting until the child feels better.

• Return to the feet gradually.

• For the rest of the day, go easy.

• Report any fainting episodes.

What Are the Contraindications of Pediatric Venesection?

• The patient does not feel good.

• Dehydration is present in the patient.

• The hemoglobin (Hb), hematocrit (Hct), or ferritin levels in the patient's blood are below target.

What Are the Complications of Pediatric Venesection?

A few of the complications are:

• Phlebitis (hemorrhage or injury to the vein walls that results in vein itis, generally in the legs).

• Hematoma (a clump of blood that develops in an organ, tissue, or other area outside of blood vessels).

• Vasovagal syncope (a rapid drop in blood pressure and pulse rate that causes fainting, frequently brought on by a stressful stimulus).

• Hypovolemia (a disorder characterized by unusually low levels of extracellular fluid in the body).

Conclusion

A clinical operation called a "venesection" involves puncturing a vein with a needle and withdrawing a predetermined amount of blood based on the patient's weight. It takes 15 to 30 minutes to finish the treatment. Patients with specific blood problems can undergo venectomy as a therapy technique to decrease blood volume, red cell mass, and excess iron storage. Venesection is typically recommended in the pediatric context for the medical disorders of polycythemia and transfusion-related iron overload. The purpose of the venesection will dictate how often it happens for the patient and whether or not blood testing is needed beforehand.