ABSTRACT
PURPOSE: Despite the importance of self-monitoring blood glucose (SMBG) for management of diabetes mellitus (DM), frequent blood sampling is discouraged by bleeding risk due to dual-antiplatelet agent therapy (DAPT) or thrombocytopenia. METHODS: We compared the bleeding time (BT) of sampling by using a laser-lancing-device (LMT-1000) and a conventional lancet in patients with DM and thrombocytopenia or patients undergoing DAPT. BT was measured using the Duke method, and pain and satisfaction scores were assessed using numeric rating scale (NRS) and visual analog scale (VAS). The consistency in the values of glucose and glycated-hemoglobin (HbA1c) sampled using the LMT-1000 or lancet were compared. RESULTS: The BT of sampling with the LMT-1000 was shorter than that with the lancet in patients with thrombocytopenia (60s vs. 85s, P = 0.024). The NRS was lower and the VAS was higher in laser-applied-sampling than lancet-applied sampling in the DAPT-user group (NRS: 1 vs. 2, P = 0.010; VAS: 7 vs. 6, P = 0.003), whereas the group with thrombocytopenia only showed improvement in the VAS score (8 vs. 7, P = 0.049). Glucose and HbA1c sampled by the LMT-1000 and lancet were significantly correlated in both the DAPT-user and the thrombocytopenia groups. CONCLUSION: The LMT-1000 can promote SMBG by shortening BT in subject with thrombocytopenia and by increasing satisfaction score, as well as by showing reliable glucose and HbA1c value.
Subject(s)
Blood Glucose Self-Monitoring , Blood Glucose , Hemorrhage , Lasers , Humans , Female , Male , Aged , Middle Aged , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose/analysis , Hemorrhage/etiology , Glycated Hemoglobin/analysis , Blood Specimen Collection/instrumentation , Blood Specimen Collection/methods , Blood Specimen Collection/adverse effects , Diabetes Mellitus/blood , Thrombocytopenia/blood , Thrombocytopenia/etiology , Capillaries , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
BACKGROUND: Home blood self-collection devices can enable remote monitoring, but their implementation requires validation. Our objectives were to explore (i) the impact of sampling sites and topical analgesia on capillary blood volume and pain perception and (ii) the safety, acceptability, and failure of capillary self-collection among adults and children using the Tasso-SST device. METHODS: We conducted a two-phase study. The investigational phase consisted of two on-site cross-sectional studies in healthy adult participants (≥ 12 years) and children (1-17 years) with their accompanying parent. Adults received 4 capillary samplings, where puncture sites and topical analgesia were randomized in a factorial design, and a venipuncture; children (and one parent) had one capillary sampling. The two co-primary outcomes were blood volume and pain. The implementation phase was conducted in two multicentre trials in participants choosing remote visits; blood volume, collection failure, adverse events, and satisfaction were documented. RESULTS: In the investigational phase, 90 participants and 9 children with 7 parents were enrolled; 15 adults and 2 preschoolers participated in the implementation phase. In the adult investigational study, the device collected a median (25%, 75%) of 450 (250, 550) µl of blood with no significant difference between the puncture site, topical analgesia, and its interaction. Using topical analgesia reduced pain perception by 0.61 (95% CI: 0.97, 0.24; P <0.01) points on the 11-point scale; the pain reduction varied by puncture site, with the lower back showing the most significant decrease. Overall, combining all studies and phases, the median volume collected was 425 (250, 500) µl, and the device failure rate was 4.4%; minor adverse effects were reported in 8.9% of the participants, all were willing to use the device again. CONCLUSION: Capillary blood self-collection, yielding slightly less than 500 µl, proves to be a safe and relatively painless method for adults and children, with high satisfaction and low failure rates. The puncture site and topical analgesia do not affect blood volume, but topical analgesia on the lower back could reduce pain.
Subject(s)
Blood Specimen Collection , Humans , Child , Adult , Male , Female , Adolescent , Blood Specimen Collection/methods , Blood Specimen Collection/instrumentation , Blood Specimen Collection/adverse effects , Child, Preschool , Middle Aged , Cross-Sectional Studies , COVID-19 , Infant , Phlebotomy/methods , Phlebotomy/adverse effects , Phlebotomy/instrumentation , Feasibility Studies , Young Adult , Pandemics , Capillaries , Blood VolumeABSTRACT
PURPOSE: The trial aimed to assess the impact on pain scores of the administration of oral glucose solutions at different concentrations and in combination with supportive positions during heel puncture procedures. DESIGN & METHODS: This trial was structured as a quadruple-blinded experimental study conducted at a single center - a Level II and IVa NICU between June 2022-2023. Included in the study were 128 premature infants born with a gestational age of between 33 and 36 weeks and a postnatal age of <7 days. For the heel puncture procedures, four distinct interventions were employed, each involving supportive positions and oral solutions. All interventions were recorded on video for analysis, and data were collected using the "Infant Information and Observation Form" and "Neonatal Pain, Agitation and Sedation Scale (N-PASS)". The N-PASS was rated by two independent nurses. The data were analyzed with the two-way repeated measures ANOVA and post-hoc Bonferroni tests. RESULTS: The descriptive and clinical characteristics were similar in all groups (p > 0.05). The pain scores, physiological variables and total crying times of the premature infants differed significantly depending on the interventional groups and times, and the interaction between the groups and times (p < 0.05). CONCLUSIONS: Combining glucose solutions with supportive positions led to a reduction in pain scores, a decrease in total crying time when compared to the use of supportive positions alone. PRACTICE IMPLICATIONS: Combining an oral 20% glucose solution with supportive positions can be recommended to reduce pain during unplanned heel puncture procedures in the absence of a parent in the unit.
Subject(s)
Glucose , Infant, Premature , Pain Measurement , Humans , Infant, Newborn , Glucose/administration & dosage , Female , Male , Blood Specimen Collection/adverse effects , Blood Specimen Collection/methods , Pain Management/methods , Punctures/adverse effects , Heel , Administration, Oral , Pain/etiology , Pain/prevention & control , Intensive Care Units, Neonatal , Phlebotomy/adverse effects , Phlebotomy/methods , Patient PositioningABSTRACT
INTRODUCTION: Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. METHODS: A doubleblind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants' faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent ttest in SPSS software version 20.0. RESULTS: Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30-3.80(, and (1.15 ± 0.84, 95%: 0.95-1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30-5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05-91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35-96.85), (91.5 ± 1.24, 95% CI:91.12-91.87), and (93.60 ± 1.27, 95% CI:93.85-94.50). CONCLUSION: This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.
Subject(s)
Blood Specimen Collection , Infant, Premature , Infant, Newborn , Humans , Blood Specimen Collection/adverse effects , Blood Specimen Collection/methods , Pain/etiology , Pain/prevention & control , Punctures/adverse effects , Pain Management/adverse effects , Pain Management/methodsABSTRACT
BACKGROUND: Capillary blood sampling (heel stick) in infants is commonly performed in neonatal care units. Before the procedure, warming the infant's heel is often a customary practice, but no consensus exists on the most effective heel-warming method. PURPOSE: To compare the effects of routinely used warming methods (glove, gel pack, or blanket) applied prior to heel stick on blood sample quality and infant's comfort. METHODS: This prospective, double-blind, randomized controlled trial conducted in the neonatal intensive care unit included infants (postmenstrual age of ≥28 + 0 weeks and ≤43 + 6 weeks) who were computer-randomized to 1 of 3 warming methods.The primary outcome was blood flow velocity at sampling. Secondary outcomes were hemolysis index, infant COMFORTneo score, and frequency of postprocedure skin injuries. In addition, irrespective of the warming method used, the correlation between heel skin temperature and postprocedure heel skin injury was analyzed. RESULTS: A total of 176 heel warmings were successfully randomized, and 173 were analyzed. Despite a significant difference in obtained heel skin temperature after warming between the 3 warming methods ( P = .001), no difference in blood flow velocity ( P = .91), hemolysis index ( P = .99), or COMFORTneo score ( P = .76) was found. Baseline skin temperatures above 37.0°C were associated with higher incidences of skin injury, and skin temperatures after warming were significantly higher in skin-injured heels ( P = .038). IMPLICATIONS FOR PRACTICE AND RESEARCH: All 3 warming methods had similar effects on blood sample quality and infant's comfort. However, excessive warming of the heel should be avoided to prevent skin injuries.
Subject(s)
Heel , Hemolysis , Infant, Newborn , Infant , Humans , Prospective Studies , Blood Specimen Collection/adverse effects , Blood Specimen Collection/methods , Infant, PrematureABSTRACT
BACKGROUND: Source plasma (SP) is the primary starting material for 87% of plasma-derived medicinal products globally. Plasmavigilance is a program designed to collect, analyze, and monitor donor adverse events (AEs) across the SP collection industry. Donor retention depends on donors having a safe and satisfactory experience. This study analyzes AE rates and SP donor characteristics that may be predictors of an AE. STUDY DESIGN AND METHODS: Donation data for 1.1 million donors making 12,183,182 SP donations over a 4-month period were analyzed. This represented approximately 72% of the donations collected by the U.S. plasma industry. The Standard for Recording Donor Adverse Events was used for AE definitions and classifications. RESULTS: The overall AE rate was 15.85/104 donations. The two AEs with the highest rates were Hypotensive and Phlebotomy events (8.32 and 5.91/104 donations, respectively). Females had higher overall AE rates than males (25.76 vs. 9.85/104 donations), and first-time donors had higher overall AE rates than repeat donors (136.66 vs. 12.37/104 donations). Weight, body mass index, age, and pre-donation estimated blood volume also were predictors of AE. DISCUSSION: SP donors have low AE rates with 90% being events classified as Hypotensive or Phlebotomy. Special attention and mitigation strategies should be directed to donors who are young, lightweight (between 100 and 124 pounds), female, or first-time donors to further reduce the incidence of AE, continue to ensure the donor has a safe experience, and facilitate donor retention.
Subject(s)
Blood Donors , Blood Specimen Collection/adverse effects , Plasma , Adult , Age Factors , Blood Volume , Female , Humans , Hypotension/etiology , Male , Phlebotomy/adverse effects , Plasma/chemistry , Risk Factors , Sex Factors , United StatesABSTRACT
This study aimed to determine and compare the perception, painfulness, and usability of the minimally invasive dried blood spot (DBS) collections from fingertip versus upper arm from different athlete populations: males and females representing sports dependent on hand/arm, sports less dependent on hand/arm and para-athletes. To accomplish this, 108 national level athletes from Denmark were recruited (â = 49, â = 59, 25 ± 6 years; mean ± SD) and 11 Doping Control Officers (DCOs) collected manual fingerprick DBS (HemaSpot HF) and automated upper-arm DBS (Tasso-M20) from each athlete. Athletes and DCOs responded to questionnaires regarding the perception of sample collection procedures. On a 0-10 scale, the athletes reported a low pain score and a very good general experience for both sampling sites, but following upper-arm DBS collection, the associated pain was rated lower (-0.4 ± 1.6, p < 0.05), and the general experience rated better (+0.6 ± 2.3, p ≤ 0.001) than after the fingerprick DBS collection. The DCOs rated the general experience with the upper-arm DBS collection better (+1.6 ± 1.1, p ≤ 0.01) than the fingerprick DBS collection, partly because problems occurred more frequently during the DBS collection from the fingertip (28%) than from the upper arm (6%). In conclusion, it appears that DBS sampling is affiliated with minimal sensation of pain and is preferred by both DCOs and athletes, independent of gender and discipline, over conventional sample collection methods. Collection of DBS from the upper arm was preferred over fingerprick by both athletes and DCOs.
Subject(s)
Blood Specimen Collection/methods , Doping in Sports/prevention & control , Dried Blood Spot Testing/methods , Pain/etiology , Adult , Arm , Athletes , Blood Specimen Collection/adverse effects , Denmark , Female , Fingers , Humans , Male , Pain Measurement , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Wrong blood in tube (WBIT) errors can lead to ABO mistransfusions. It is unknown if WBIT errors are more likely in specific healthcare locations or if specific collection practices influence the commission of WBIT errors. STUDY DESIGN AND METHODS: Data on pretransfusion samples from calendar year 2019 were collected retrospectively by 39 transfusion services in nine countries. We compared the proportion of WBIT errors made in emergency departments (EDs), inpatient wards, and outpatient clinics. RESULTS: In total, 143 WBIT errors were detected among 1,394,862 samples for an unadjusted aggregate WBIT proportion of 1.03/10,000 samples. Using a pooled random effects model, the WBIT proportion was estimated to be significantly higher in EDs (1.23/10,000 samples, 95% CI 0.62-2.43) than inpatient wards (0.71/10,000, 95% CI 0.44-1.14; p < .001) or outpatient clinics (0.24/10,000, 95% CI 0.08-0.65; p < .001) and significantly higher in inpatient wards than outpatient clinics (p = .043). The use of electronic positive patient identification (ePPID) systems was associated with a significantly lower WBIT proportion in the ED (odds ratio, OR: 0.32, 95% CI: 0.11-0.96, p = .041), but not in inpatient wards (OR: 0.45, 95% CI: 0.20-1.01, p = .054) or outpatient clinics (OR: 1.95, 95% CI: 0.39-9.74, p = .415). DISCUSSION: Normalized for the number of samples drawn per location, the WBIT proportion in EDs was 1.7 times higher than inpatient wards and 5.1 times higher than outpatient clinics. EDs represent higher-risk clinical locations for WBIT errors, and electronic positive patient identification (ePPID) may provide a greater impact on safety in EDs relative to other clinical areas.
Subject(s)
Blood Specimen Collection , Emergency Service, Hospital , Medical Errors , Blood Donors , Blood Specimen Collection/adverse effects , Blood Transfusion , Cross-Sectional Studies , Humans , Retrospective Studies , Transfusion Reaction/etiologyABSTRACT
BACKGROUND: Adverse donor events (ADEs) are usually mild and short-term with no sequelae, but may cause disinclination toward future donations. AIMS: To determine the impact of delayed ADEs (D-ADEs) in addition to immediate ADEs (I-ADEs) on the intention of future donations (IFDs) and to analyze the various associated factors. METHODS: ADEs were categorized following the ISBT working group on donor vigilance. Telephonic interviews of the donors were conducted 2 weeks after the whole blood (WB) and plateletpheresis donation to inquire about D-ADEs and IFDs. RESULTS: A total of 3514 WB and 531 plateletpheresis donors were included in the study. WB donors had an overall higher IFD as compared to plateletpheresis donors (89.53% vs 57.06%, P < .001). A higher IFD was observed in male WB donors as compared to female WB donors (89.95% vs 75%, P < .001). Repeat WB donors had a higher IFD as compared with first-time donors (93.66% vs 81.37%, P < .001). A total of 13.7% WB donors and 19.2% plateletpheresis donors reported D-ADEs. WB donors who experienced D-ADEs had a significantly lower IFD (78.38% vs 91.63%, P < .001) as compared with donors without any ADEs; a similar trend was observed in donors who experienced I-ADEs (69.90% vs 91.63%, P < .001). In WB donors, systemic D-ADEs such as fatigue had a more negative impact on IFDs as compared with localized D-ADEs such as bruises (63.93% vs 86.83%, P < .001). CONCLUSIONS: Both D-ADEs and I-ADEs negatively impact donors' intention to donate again. Systemic D-ADEs had a more negative impact on IFDs as compared with localized D-ADEs.
Subject(s)
Blood Donors , Blood Safety/adverse effects , Blood Specimen Collection/adverse effects , Plateletpheresis/adverse effects , Plateletpheresis/instrumentation , Adult , Blood Transfusion , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires , Telephone , Tissue DonorsABSTRACT
Despite the high burden of pain experienced by hospitalised neonates, there are few analgesics with proven efficacy. Testing analgesics in neonates is experimentally and ethically challenging and minimising the number of neonates required to demonstrate efficacy is essential. EEG (electroencephalography)-derived measures of noxious-evoked brain activity can be used to assess analgesic efficacy; however, as variability exists in neonate's responses to painful procedures, large sample sizes are often required. Here, we present an experimental paradigm to account for individual differences in noxious-evoked baseline sensitivity which can be used to improve the design of analgesic trials in neonates. The paradigm is developed and tested across four observational studies using clinical, experimental, and simulated data (92 neonates). We provide evidence of the efficacy of gentle brushing and paracetamol, substantiating the need for randomised controlled trials of these interventions. This work provides an important step towards safe, cost-effective clinical trials of analgesics in neonates.
Hospitalized newborns often undergo medical procedures, like blood tests, without pain relief. This can cause the baby to experience short-term distress that may have negative consequences later in life. However, testing the effects of pain relief in newborns is challenging because, unlike adults, they cannot report how much pain they are experiencing. One way to overcome this is to record the brain activity of newborns during a painful procedure and to see how these signals are modified following pain relief. Randomized controlled trials are the gold standard for these kinds of medical assessments, but require a high number of participants to account for individual differences in how babies respond to pain. Finding ways to reduce the size of pain control studies could lead to faster development of pain relief methods. Here, Cobo, Hartley et al. demonstrate a way to reduce the number of newborns needed to test potential pain-relieving interventions. In the experiments, the brain activity of nine babies was measured after a gentle poke and after a painful clinically required procedure. Cobo, Hartley et al. found that the babies' response to the gentle poke correlated with their response to pain. Further data analysis revealed that this information can be used to predict the variability in pain experienced by different newborns, reducing the number of participants needed for pain relief trials. Next, Cobo, Hartley et al. used this new approach in two pilot tests. One showed that gently stroking an infant's leg before blood is drawn from their heel reduced their brains' response to pain. The second showed that giving a baby the painkiller paracetamol lessened the brain's response to immunisation. The new approach identified by Cobo, Hartley et al. may enable smaller studies that can more quickly identify ways to reduce pain in babies. Furthermore, this work suggests that gentle brushing and paracetamol could provide pain relief for newborns undergoing hospital acute procedures. However, more formal clinical trials are needed to test the effectiveness of these two strategies.
Subject(s)
Brain/drug effects , Electroencephalography , Infant Behavior/drug effects , Pain Management , Pain Measurement , Pain Perception/drug effects , Pain Threshold/drug effects , Pain/prevention & control , Acetaminophen/therapeutic use , Age Factors , Analgesics, Non-Narcotic/therapeutic use , Blood Specimen Collection/adverse effects , Brain/physiopathology , Clinical Trials as Topic , Computer Simulation , Endpoint Determination , Female , Humans , Infant, Newborn , Male , Pain/diagnosis , Pain/etiology , Pain/physiopathology , Pain Management/adverse effects , Predictive Value of Tests , Prospective Studies , Research Design , Retrospective Studies , Therapeutic Touch , Treatment Outcome , Vaccination/adverse effectsABSTRACT
OBJECTIVE: To investigate the effect of acupressure applied to UB60 and K3 acupuncture points in order to relieve the procedural pain caused by heel lancing blood sampling process in the term newborns. METHODS: The data were collected by using the Information Form and the Neonatal Infant Pain Scale. Acupressure applied for 3 min before heel lancing blood sampling in the newborns in the experimental group (n = 31). No intervention was applied to newborns in the control group (n = 32). RESULTS: A significant difference was found between mean scores of the newborns in the control and acupressure group in favor of the acupressure group in terms of heart rate during and after the procedure, oxygen saturation before, during and after the procedure, duration of crying during and after the procedure (P < 0.05). It was found that there was a significant difference between groups in terms of Neonatal Infant Pain Scale mean scores during (P = 0.001) and after the procedure (P < 0.05), and the difference was found to be in favor of the acupressure group. CONCLUSION: As a result, acupressure was found to be an effective method in relieving pain caused by heel lancing blood sampling in newborns.
Subject(s)
Acupressure , Pain, Procedural/therapy , Acupuncture Points , Blood Specimen Collection/adverse effects , Female , Heel/blood supply , Humans , Infant, Newborn , Male , Pain Management , Pain, Procedural/blood , Pain, Procedural/etiologyABSTRACT
We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8-16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2-17.9; P < 0.001]) vs. 17.3% (95% CI 3.6-31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.
Subject(s)
Bacteremia/complications , Blood Culture/methods , Diabetes Complications/microbiology , Hypertension/complications , Neoplasms/complications , Aged , Aged, 80 and over , Bacteremia/microbiology , Bacteremia/pathology , Blood Specimen Collection/adverse effects , Chlorhexidine/adverse effects , Diabetes Complications/pathology , Diabetes Mellitus/microbiology , Diabetes Mellitus/pathology , Disinfectants/adverse effects , Emergency Service, Hospital , Ethanol/adverse effects , False Positive Reactions , Female , Femoral Vein , Hospitals, University , Humans , Hypertension/microbiology , Hypertension/pathology , Japan , Male , Middle Aged , Neoplasms/microbiology , Neoplasms/pathology , Povidone-Iodine/adverse effects , Prospective StudiesABSTRACT
OBJECTIVE: To evaluate the validity of laboratory tests for blood sampling from a peripherally inserted central catheter. METHODS: A total of 22 patients diagnosed with head and neck cancers were enrolled. In total, 101 paired blood samples were taken both via venipuncture and peripherally inserted central catheter for hematology and biochemistry testing. Paired t tests and linear correlation analysis were used to evaluate the results. Blood sampling-related pain was recorded by visual analogue scales and numerical rating scales. Infusion occlusion, hemolysis, and catheter-related blood stream infection were also recorded. RESULTS: The peripherally inserted central catheter-associated test results were slightly lower than those with venipuncture. Some parameters differed more than others. However, the degree of difference was less than 5% for every pair. There was a high correlation between the test results with two methods of blood sampling with the representative equation approximately being "y = x." According to visual analogue scales and numerical rating scale analysis, the pain degree with peripherally inserted central catheter was significantly lower than that of the venipuncture (p < 0.001). No case of infusion occlusion, catheter-related blood stream infection was reported with both methods. Hemolysis rate in blood samples from peripherally inserted central catheter (1/101) was much lower than that seen with venipuncture (11/101) with significant difference (p = 0.0056). CONCLUSION: Blood sampling via peripherally inserted central catheter and venipuncture showed equivalent reliability in laboratory testing. Compared with venipuncture, blood sampling via peripherally inserted central catheter causes less pain and is safer. Blood sampling via peripherally inserted central catheter is strongly recommended for clinical use.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Blood Specimen Collection , Catheterization, Central Venous , Catheterization, Peripheral , Head and Neck Neoplasms/drug therapy , Aged , Blood Specimen Collection/adverse effects , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/instrumentation , Catheters, Indwelling , Central Venous Catheters , Humans , Male , Middle Aged , Pain/etiology , Phlebotomy , Prospective Studies , Risk FactorsABSTRACT
Objectives: Aromatherapy has become popular in pain control in recent years compared with other complementary methods. Lavender (Lavandula angustifolia Miller) is a fragrant essential oil used in aromatherapy for its antibacterial, antifungal, muscle-relaxing, and analgesic effects. The smell of lavender oil, known for its soothing effect on adults, has not been adequately investigated in regards to pain control in premature infants. The purpose of our study was to assign the effect of the scent of lavender oil on pain in preterm infants during heel lancing. Design: A double-blind randomized controlled clinical study. Settings/Location: The study was conducted in a third-level neonatal intensive care unit of Bezmialem Vakif University Hospital from March 2019 to November 2019. It consisted of two groups. Subjects: Sixty-one premature babies (24-37 weeks of gestation) were enrolled in the study. Interventions: Heel stick sampling for metabolic screening was used for both study groups. The interventions were performed by two experienced nurses. Heart rate, oxygen saturation, and the baby's facial expression were recorded by a camera 3 min before the intervention, during the sampling, and 3 min after the procedure. After collecting the data, the head researcher and the assistant researcher separately watched the videos and scored them by using the Premature Infant Pain Profile-Revised (PIPP-R). Outcome measures: The difference of pain scores (PIIP-R) between two groups. Results: There was a statistically significant difference between the two groups in terms of PIPP-R scores during and after the sampling (p = 0.008 and p = 0.03 respectively). The PIPP-R scores at the beginning of the procedure were not found to be significantly different between the groups (p > 0.05). Conclusions: Inhalation of lavender scent is effective in pain control in premature infants. It is safe and low cost; it does not interfere with medical care.
Subject(s)
Aromatherapy , Infant, Premature/physiology , Oils, Volatile/therapeutic use , Pain Management/methods , Plant Oils/therapeutic use , Blood Specimen Collection/adverse effects , Double-Blind Method , Facial Expression , Female , Heart Rate/physiology , Humans , Infant, Newborn , Lavandula , Male , Pain/etiologyABSTRACT
Vasovagal syncope (VVS) is well-known to occur in patients undergoing phlebotomy, however, there have been no large-scale studies of the incidence of VVS in the blood collection room. The aim of our present retrospective study was to investigate the conditions of phlebotomy and determine the incidence/factors predisposing to the development of VVS. We investigated 677,956 phlebotomies performed in outpatients in the blood collection room, to explore factors predisposing to the development of VVS. Our analysis revealed an overall incidence of VVS of 0.004% and suggested that use of more than 5 blood collection tubes and a waiting time of more than 15 min were associated with a higher risk of VVS. The odds ratios of these factors were 8.10 (95% CI 3.76-17.50) and 3.69 (95% CI 0.87-15.60), respectively. This is the large-scale study to analyze factors of the development of VVS in the blood collection room, and according to our results, use of a large number of blood collection tubes and a prolonged waiting time for phlebotomy may be risk factors for the development of VVS.
Subject(s)
Blood Specimen Collection/adverse effects , Hospital Units/statistics & numerical data , Outpatients/statistics & numerical data , Phlebotomy/adverse effects , Syncope, Vasovagal/epidemiology , Syncope, Vasovagal/etiology , Adolescent , Adult , Aged , Blood Specimen Collection/instrumentation , Child , Child, Preschool , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Time Factors , Young AdultSubject(s)
Analgesia/methods , Blood Specimen Collection , Complementary Therapies/methods , Education, Nursing, Continuing/methods , Hematologic Tests , Neonatal Nursing/education , Pain, Procedural , Sucrose/administration & dosage , Blood Specimen Collection/adverse effects , Blood Specimen Collection/methods , Crying/physiology , Crying/psychology , Female , Hematologic Tests/adverse effects , Hematologic Tests/methods , Humans , Infant Care/methods , Infant, Newborn , Male , Maternal Behavior/psychology , Pain, Procedural/etiology , Pain, Procedural/therapy , Psychomotor Agitation/etiology , Psychomotor Agitation/prevention & control , Sweetening Agents/administration & dosageABSTRACT
OBJECTIVE: To investigate glycemic and psychosocial outcomes with hybrid closed-loop (HCL) versus user-determined insulin dosing with multiple daily injections (MDI) or insulin pump (i.e., standard therapy for most adults with type 1 diabetes). RESEARCH DESIGN AND METHODS: Adults with type 1 diabetes using MDI or insulin pump without continuous glucose monitoring (CGM) were randomized to 26 weeks of HCL (Medtronic 670G) or continuation of current therapy. The primary outcome was masked CGM time in range (TIR; 70-180 mg/dL) during the final 3 weeks. RESULTS: Participants were randomized to HCL (n = 61) or control (n = 59). Baseline mean (SD) age was 44.2 (11.7) years, HbA1c was 7.4% (0.9%) (57 [10] mmol/mol), 53% were women, and 51% used MDI. HCL TIR increased from (baseline) 55% (13%) to (26 weeks) 70% (10%) with the control group unchanged: (baseline) 55% (12%) and (26 weeks) 55% (13%) (difference 15% [95% CI 11, 19]; P < 0.0001). For HCL, HbA1c was lower (median [95% CI] difference -0.4% [-0.6, -0.2]; -4 mmol/mol [-7, -2]; P < 0.0001) and diabetes-specific positive well-being was higher (difference 1.2 [95% CI 0.4, 1.9]; P < 0.0048) without a deterioration in diabetes distress, perceived sleep quality, or cognition. Seventeen (9 device-related) versus 13 serious adverse events occurred in the HCL and control groups, respectively. CONCLUSIONS: In adults with type 1 diabetes, 26 weeks of HCL improved TIR, HbA1c, and their sense of satisfaction from managing their diabetes compared with those continuing with user-determined insulin dosing and self-monitoring of blood glucose. For most people living with type 1 diabetes globally, this trial demonstrates that HCL is feasible, acceptable, and advantageous.
Subject(s)
Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/drug therapy , Insulin Infusion Systems , Insulin/administration & dosage , Adult , Aged , Blood Glucose/drug effects , Blood Glucose/metabolism , Blood Glucose Self-Monitoring/instrumentation , Blood Glucose Self-Monitoring/methods , Blood Specimen Collection/adverse effects , Blood Specimen Collection/methods , Blood Specimen Collection/psychology , Female , Fingers , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Injections , Insulin/adverse effects , Male , Middle Aged , Needlestick Injuries/blood , Personal SatisfactionABSTRACT
Background The red blood cell (RBC) storage lesion is a series of morphological, functional, and metabolic changes that RBCs undergo following collection, processing, and refrigerated storage for clinical use. Since the biochemical attributes of the RBC unit shifts with time, transfusion of older blood products may contribute to cardiac complications, including hyperkalemia and cardiac arrest. We measured the direct effect of storage age on cardiac electrophysiology and compared it with hyperkalemia, a prominent biomarker of storage lesion severity. Methods and Results Donor RBCs were processed using standard blood-banking techniques. The supernatant was collected from RBC units, 7 to 50 days after donor collection, for evaluation using Langendorff-heart preparations (rat) or human induced pluripotent stem cell-derived cardiomyocytes. Cardiac parameters remained stable following exposure to "fresh" supernatant from red blood cell units (day 7: 5.8±0.2 mM K+), but older blood products (day 40: 9.3±0.3 mM K+) caused bradycardia (baseline: 279±5 versus day 40: 216±18 beats per minute), delayed sinus node recovery (baseline: 243±8 versus day 40: 354±23 ms), and increased the effective refractory period of the atrioventricular node (baseline: 77±2 versus day 40: 93±7 ms) and ventricle (baseline: 50±3 versus day 40: 98±10 ms) in perfused hearts. Beating rate was also slowed in human induced pluripotent stem cell-derived cardiomyocytes after exposure to older supernatant from red blood cell units (-75±9%, day 40 versus control). Similar effects on automaticity and electrical conduction were observed with hyperkalemia (10-12 mM K+). Conclusions This is the first study to demonstrate that "older" blood products directly impact cardiac electrophysiology, using experimental models. These effects are likely caused by biochemical alterations in the supernatant from red blood cell units that occur over time, including, but not limited to hyperkalemia. Patients receiving large volume and/or rapid transfusions may be sensitive to these effects.
Subject(s)
Arrhythmias, Cardiac/etiology , Blood Specimen Collection/adverse effects , Erythrocyte Transfusion/adverse effects , Hyperkalemia/etiology , Animals , Cell Culture Techniques , Disease Models, Animal , Electrocardiography , Electrophysiologic Techniques, Cardiac , Erythrocytes , Humans , Induced Pluripotent Stem Cells , Myocytes, Cardiac/physiology , Rats , Time FactorsABSTRACT
Laboratory mice are the most frequently used animals in biomedical research. In accordance with guidelines for humane handling, several blood sampling techniques have been established. While the effects of these procedures on blood quality and histological alterations at the sampling site are well studied, their impact on the animals' welfare has not been extensively investigated. Therefore, our study aimed to compare three commonly used blood sampling techniques regarding their effects on different indicators of animal welfare, including physiological and behavioural response stress parameters, including pain measures, home-cage behaviour and nest-building as well as exploratory activity and neophobia. Male C57BL/6J mice were subjected to a single blood collection from either the vena facialis, the retrobulbar sinus or the tail vessel, or were allocated to the respective control treatment. While all blood sampling techniques led to an acute increase in plasma corticosterone levels, the response was strongest in animals that underwent sampling from the vena facialis and the retrobulbar sinus. Similar results were observed when the time-course of adrenocortical activity was monitored via corticosterone metabolites from faecal samples. Blood collection from the vena facialis and the retrobulbar sinus also decreased exploration of novel stimuli, resulted in decreased nest-building activity and induced higher scores in the Mouse Grimace Scale. Moreover, locomotor activity and anxiety-related behaviour were strongly affected after facial vein bleeding. Interestingly, tail vessel bleeding only induced little alterations in the assessed physiological and behavioural parameters. Importantly, the observed effects in all treatment groups were no longer detectable after 24 hours, indicating only short-term impacts. Thus, by also taking the animal's perspective and comprehensively assessing the severity of the particular sampling procedures, the results of our study contribute to Refinement within the 3R concept and allow researchers to objectively select the most appropriate and welfare-friendly blood sampling technique for a given experiment.
Subject(s)
Adrenal Cortex Hormones/blood , Animals, Laboratory/physiology , Blood Specimen Collection/methods , Animal Welfare , Animals , Animals, Laboratory/metabolism , Behavior, Animal , Blood Specimen Collection/adverse effects , Blood Specimen Collection/classification , Male , Mice , Mice, Inbred C57BLABSTRACT
This randomized trial compared the analgesic effect of 4 nonpharmacologic interventions (breastfeeding, oral sucrose, nonnutritive sucking, and skin-to-skin contact) on term newborns between 24 and 48 hours of age who underwent a heel lance. The Neonatal Pain, Agitation, and Sedation Scale was used to evaluate pain. The newborns (N = 226) were assigned to one of 4 intervention groups (n = 176) or a control group without pain intervention (n = 50). The results indicate that all intervention groups showed decreased pain levels when compared with the control group (P < .01). The oral sucrose group experienced a superior analgesic effect when compared with the skin-to-skin contact group (P < .01), but no difference was observed when compared with the breastfeeding group (P > .05) or the nonnutritive sucking group (P > .05). All intervention groups showed a shortened crying time (P < .01) and reduced procedural duration (P < .01) compared with the control group. All of these interventions are clinically applicable and acceptable when caring for a newborn during a minor painful procedure.