During my first week I attended phlebotomy clinic that work with the nursing team. I asked my team leader if they allowed students to perform venipuncture in this trust and they do.I was working with two phlebotomist in clinic. I observed for the first few times making sure I understood and was confident in what I had practiced at school and how it is done within this practice. The team here were very supportive and welcoming. In the clinic, I was helping cleaning the arm to keep the field clean as possible before the needle goes into the vein as most children have numbing cream/ Ametop/Elma so its important to wipe it off once its done its job. Then attaching the tourniquet to be able to feel the vein and I soon observed that not every being can be seen by your eyes.

Also learning what blood bottles we needed so the most common is gold which is biochemistry/microbiology and immunology analysis- urea&electrolytes, bone profile, liver function tests, thyroid function tests, troponin, lipid profile, immunology, serology. We also used a lot of purple which is for a full blood count. We also used grey for glucose analysis and blue for coagulation.

The phlebotomist are very good at reassuring and talking to the children as this can be very scary for them. They show the parents the best way to safely hold their children in a blood test. At the end of the day I approached the person I was working with and asked if it was okay if I did the blood test. This was an older child which i thought was probably better for my first experience as younger children get very distressed and move a lot. With a lot of support I got into the vein and successfully got the blood test completed. After the blood test I double checked the patient was okay and didn’t feel funny after.

I spent the morning with the dietician. We spent the first ten minutes of her explaining her role and showing me how the different system works ( System One). We then saw patients that attended the clinic for a number of reasons. We discussed how patients have specific types of feeds or supplements that are suited best to them. Then they use guidelines from gosh to calculate feeds by weight and it also specifies for girls and boys how much they need every 24 hours. This varies due to age and weight however it may be altered if the Childs weight is higher or lower than what is for their age. The dieticians will decide what the maximum is for the child. The patients seen in clinic are either due to enteral feeding and need a review or their weight is under the acceptable rate and is altering their growth. I learned a lot about how you can add more calories into a Childs diet by adding yoghurt with honey or jam. Nuts to snack on. Or even adding cheese or olive oil to get extra calories into a meal. They also advise the patients to take vitamin D to reduce tiredness and promote energy. All extra calories and taking vitamin D is for to boost the patients energy.

Then I spent the day with Dietician and Speech and language therapist. They provide a clinic together to see patients with eating difficulties, not meeting nutritional needs, aspirations, dysphasia (swallowing difficulties) and falling under the centiles on growth charts.

We saw many patients and I learnt the importance of reassuring parents and teaching how to explore food through play to encourage children to put it into their mouth. I also learnt that children diagnosed with Down syndrome have a different growth chart as it’s calculated differently. The parents need to keep a record of feeding if with food to keep a week diary of food and water intake, if the baby is on breast milk or formula feed to give a number of volume for intake. Also I asked the speech and language therapist what she is looking out for when they observe the feeding in clinic. They are looking at the breathing and making sure the patients are taking breaks if needed, any change in colour of skin, any noises when swallowing, any nostril flaring, coughing, increase secretions and signs of chocking.