Effect of the Specific Training Course for Competency in Doing Arterial Blood Gas Sampling in the Intensive Care Unit: Developing a Standardized Learning Curve according to the Procedure's Time and Socioprofessional Predictors.

BACKGROUND: Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices. OBJECTIVES: The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve. DESIGN: A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement. METHODS: At first, the primary checklist was prepared to assess the nurses' ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package. RESULTS: According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills. CONCLUSIONS: Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971.

Peripheral venipuncture practices performed by nursing professionals in a university hospital / Práticas de venopunção periférica dos profissionais de enfermagem em um hospital universitário / Prácticas de venopunción periférica de profesionales de enfermería en un hospital universitario

Objective:The study's main purpose has been to characterize the peripheral venipuncture practices performed by nursing professionals providing care to pediatric and geriatric patients in a Brazilian Southern university hospital. Methods: It is a descriptive and observational study with a quantitative approach, which was performed in a Brazilian Southern university hospital over the period from December 2015 to June 2016, counting with 14 nursing professionals who were performing peripheral venipuncture in children and elderly people at the study's data collection time. Results: A total of 20 observations were made for the elderly group and 5 for the pediatric group. During all observations there was some divergence with the theoretical orientation that could result in harm to the patient and/or professional. Conclusion: By carrying out this study, it was noticed a variation of the technique and divergences between the practiced actions, therefore, underlining the importance of defining standard procedures and techniques based on scientific reasoning to promote patient safety

Objetivo: Caracterizar as práticas de punção venosa periférica executadas pelos profissionais de enfermagem no cuidado aos pacientes pediátricos e geriátricos em um hospital universitário do sul do país. Método: Quantitativo, observacional descritivo. Realizado em um hospital universitário da região sul do país, de dezembro de 2015 a junho de 2016, com 14 profissionais da equipe de enfermagem durante a realização da prática de punção venosa periférica em crianças e idosos. Resultados: Realizou-se 20 observações para o grupo de idosos e 5 para o grupo pediátrico, e em todas as observações houveram alguma divergência com a orientação teórica que poderia resultar em um dano ao paciente e/ou profissional. Conclusão: Ao realizar esse estudo, percebeu-se uma variação da técnica e divergências entre as ações praticadas, destacando a importância da padronização e desenvolvimento de técnicas a partir de fundamentação científica para promoção da segurança do paciente

Objetivo: Caracterizar las prácticas de punción venosa periférica que realizan los profesionales de enfermería en la atención de pacientes pediátricos y geriátricos en un hospital universitario del sur del país. Método: cuantitativo, observacional, descriptivo. Realizado en un hospital universitario de la región sur del país, de diciembre de 2015 a junio de 2016, con 14 profesionales del equipo de enfermería durante la práctica de venopunción periférica en niños y ancianos. Resultados: se realizaron 20 observaciones para el grupo de ancianos y 5 para el grupo de pediatría, y en todas las observaciones hubo alguna divergencia con la orientación teórica que podría resultar en daño al paciente y / o profesional. Conclusión: Al realizar este estudio se observó una variación de la técnica y divergencias entre las acciones realizadas, destacando la importancia de la estandarización y el desarrollo de técnicas con fundamento científico para promover la seguridad del paciente

Effects of Combined Use of Mother's Breast Milk, Heartbeat Sounds, and Non-Nutritive Sucking on Preterm Infants' Behavioral Stress During Venipuncture: A Randomized Controlled Trial.

PURPOSE: Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture. DESIGN: This study was a prospective, randomized controlled trial. METHODS: Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM-OT (n = 33); (condition 3) BM-OT + HBs (n = 33); or (condition 4) BM-OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3-6). FINDINGS: Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4-6, respectively) and body movements (stages 3-6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM-OT). CONCLUSIONS: The combination of BM-OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures. CLINICAL RELEVANCE: Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress.

Improving Access to Laboratory Monitoring in Individuals Living with Serious Mental Illness.

Safe prescribing for persons with severe mental illness requires laboratory monitoring for psychotropic drug levels and metabolic side effects. Barriers to appropriate and timely monitoring increase when clients must obtain phlebotomy services at a separate facility. This quality improvement project was conducted within a program for assertive community treatment (PACT). Specific aims were to increase access to laboratory testing, improve efficiency, and lower costs by implementing on-site specimen collection. Outcomes, measured three months post-implementation, indicate that over half of all labs were obtained on-site, clients and staff were pleased with increased efficiencies, and costs were reduced by 37%.

Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization.

BACKGROUND: Despite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs). AIMS: To evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay. DESIGN: A secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review. SETTINGS: Tertiary level neonatal intensive care unit. PARTICIPANTS/SUBJECTS: 242 stable preterm neonates born at less than 37 weeks gestational age. METHODS: Data were analyzed quantitatively using R for statistics. RESULTS: The 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non-tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions. CONCLUSIONS: Increased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.

The Use of the Buzzy, Jet Lidokaine, Bubble-blowing and Aromatherapy for Reducing Pediatric Pain, Stress and Fear Associated with Phlebotomy.

PURPOSE: This study aimed to investigate the effects of the Buzzy, Jet lidokaine, bubble-blowing and inhalation aromatherapy with lavender essence on pain, stress and fear in children undergoing phlebotomy. DESIGNS AND METHODS: This study was a prospective, randomized controlled trial. The sample was comprised of children aged 5 to 10 years requiring blood tests. Children were assigned to five subgroups through randomization performed using a computer program: the Buzzy group (n = 39), Jet lidokaine group (n = 39), bubble-blowing group (n = 39), inhalation aromatherapy with lavender essence group (n = 39) and control group (n = 39). The children's levels of pain were evaluated and reported by the parents, observers and the children, who self-reported using the Oucher Pain Scale. The children's fear levels were assessed using the Children's Fear Scale, and salivary cortisol analysis was conducted to evaluate stress levels. RESULTS: A significant difference was found between the intervention and control groups in terms of levels of pain during and after phlebotomy in favor of the Buzzy group (p < 0.05). There was a significant difference between the fear scores of the children in the intervention and control groups before phlebotomy (p < 0.05). This difference was found to be caused by the bubble-blowing method. There was a significant difference between intervention and control groups fear levels in favor of the Buzzy group during phlebotomy (p < 0.05). PRACTICE IMPLICATIONS: It is recommended that the Buzzy and bubble-blowing be used during phlebotomy in children to reduce the severity of their pain.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years. DESIGN: This study is a randomized controlled trial. METHODS: The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy. FINDINGS: A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group. CONCLUSIONS: The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

Venepuncture in adults.

Katy Skarparis, Lecturer, Adult Nursing, Northumbria University ( katy.skarparis@northumbria.ac.uk ) and Claire Ford, Lecturer, Adult Nursing, Northumbria University describe how to select a suitable site and take a blood sample using vacuum collection tubes.

[Reducing Blood Culture Contamination Rates in the Emergency Department].

BACKGROUND: Rate of contamination is a well-known indicator of quality of care in the emergency department. Blood-culture results may affect clinical decision making. From January 1, 2015 to December 31, 2015, the contamination rate of blood culture in our emergency department was 5.63%, which exceeded the maximum of 3% suggested by the American Society for Microbiology and the clinical laboratory at our hospital. PURPOSE: Using a quality improvement strategy, this project aimed to (1) identify potential factors contributing to the high blood culture contamination rate and (2) achieve a blood culture contamination rate below 3%. RESOLUTION: The factors that were identified as potentially contributing to the high blood culture contamination rate were: (a) Nursing staff: lack of related education and training and ignorance of related clinical guidelines; (b) The system: inconsistent and non-evidence-based clinical guidelines (e.g., no requirement to use sterile gloves when obtaining blood cultures and changing disinfectants); (c) The patient: older patients, residents of long-term care facility, and patients whose blood culture were in the first set were associated with higher blood culture contamination rates. Our quality improvement strategy included: design a new bedside working plate, develop slogans and posters illustrating the proper blood-drawing procedure, make a video introducing current standard technology, provide continuing education, monitor contamination rates, and provide individual feedback and retraining for those with higher contamination rates. RESULTS: The strategy was implemented from October 1, 2016 to December 31, 2016, during which period the blood culture contamination rate reduced from 5.63% to 1.51%. CONCLUSIONS: Conclusion: Improving equipment, using multiple teaching methods, and providing regular feedback not only significantly reduced the blood culture contamination rate but also enhanced the knowledge and skills of nursing staff in terms of blood culture sampling. We hope that our results are referenced by other nursing departments and used to improve the blood culture contamination rates in other clinical settings.

Application program to prepare child/family for venipuncture: experience report.

OBJECTIVE: To report the experience of development of an application program to prepare child and family for venipuncture. METHOD: Experience report on an application program developed in the professional nursing master's degree program in partnership with engineering undergraduate students. RESULTS: The application program allows the child to understand the venipuncture procedure in a ludic and interactive manner. Its development occurred in three stages: identification of client's needs, definition of components, and prototype elaboration. FINAL CONSIDERATIONS: The application program, besides being directed to care and education of children and families, is able to meet the nurses' needs to prepare them for venipuncture. Moreover, it is worth mentioning the importance of multidisciplinary approach for the concretion of similar projects.

Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration.

PURPOSE: Venipuncture generates anxiety and pain in children. The primary aim of the study was to evaluate two non-pharmacological techniques, vibration combined with cryotherapeutic topical analgesia by means of the Buzzy® device and animated cartoons, in terms of pain and anxiety relief during venipuncture in children. DESIGNS AND METHODS: 150 children undergoing venipuncture were randomized into four groups: the 'no method' group, the Buzzy® device group, the animated cartoon group and the combination of Buzzy® and an animated cartoon group. Children's pain and anxiety levels along with parents' and nurses' anxiety levels were evaluated by means of validated grading scales. RESULTS: Overall children's pain increased less in the non-pharmacological intervention groups as compared to the group without intervention. Notably, the difference was statistically significant in the animated cartoon group for children's perception of pain. Children's anxiety and parents' anxiety decreased more in non-pharmacological interventions groups as compared to the group without intervention. CONCLUSIONS: The study showed the effectiveness of non-pharmacological methods of pain management during venipuncture. Notably, distraction with animated cartoons was superior in terms of children's perception of pain when compared to Buzzy®, and to the combination of cartoons and Buzzy®. Buzzy® was significantly effective at the secondary analysis for children younger than 9. Children's and parents' anxiety is decreased by non-pharmacological methods. Furthermore, nurses' involvement in pediatric care can be enhanced. PRACTICE IMPLICATIONS: Non-pharmacological methods of pain management during venipuncture represent an easy way to achieve an increased level of compliance among children and parents.

Elementos morfológicos implicados en la enseñanza de las competencias para lograr una adecuada venopunción periférica / Morphological elements involved in the teaching of competences to achieve adequate peripheral venipuncture

RESUMEN: La venopunción periférica es un procedimiento muy común y necesario para la administración de múltiples sustancias. Cada enfermero(a) debe recibir la capacitación en varios aspectos que le permitan adquirir la competencia de realizar una venopunción segura. Uno de los elementos de mayor relevancia se relaciona con la anatomía aplicada, particularmente con la descripción de varios patrones de organización de las venas superficiales del antebrazo y su relación con estructuras neurovasculares cercanas. Los patrones de acuerdo a su distribución, podrían jugar a favor o en contra de las complicaciones durante o después de la punción. En este artículo describimos las respuestas de docentes de las escuelas de Enfermería de varias regiones de Colombia frente a la enseñanza de estos temas anatómicos. Sobresale el hecho que solamente en el 56,5 % de la escuela de Enfermería se realiza la enseñanza completa de los conceptos anatómicos que servirán para mejorar la seguridad del paciente en el momento de una venopunción periférica.

SUMMARY: Peripheral venipuncture is a very common and necessary procedure for the administration of multiple substances. Each Nurse must receive training in several aspects that allows him/her to acquire the competence to perform a safe venipuncture. One of the most relevant elements is related to applied anatomy, particularly with the description of various organization patterns of the superficial veins of the forearm, and their relation to nearby neurovascular structures. These patterns according to their distribution, could play for, or against complications during or after puncture. In this article, we describe the responses of teachers from the Nursing Schools of several regions of Colombia while teaching these anatomical subjects. It is noteworthy, that only 56,5 % of Nursing Schools included complete instruction of anatomical concepts that improve patient safety at the time of a peripheral venipuncture. Therefore, nearly 50 % of students do not receive information on updated anatomical terminology.

Application program to prepare child/family for venipuncture: experience report / Aplicación para el preparo del niño/de la familia en la venopunción: relato de experiencia / Aplicativo para preparo da criança/família na punção venosa: relato de experiência

ABSTRACT Objective: To report the experience of development of an application program to prepare child and family for venipuncture. Method: Experience report on an application program developed in the professional nursing master's degree program in partnership with engineering undergraduate students. Results: The application program allows the child to understand the venipuncture procedure in a ludic and interactive manner. Its development occurred in three stages: identification of client's needs, definition of components, and prototype elaboration. Final considerations: The application program, besides being directed to care and education of children and families, is able to meet the nurses' needs to prepare them for venipuncture. Moreover, it is worth mentioning the importance of multidisciplinary approach for the concretion of similar projects.

RESUMEN Objetivo: Relatar la experiencia de desarrollo de la aplicación para el preparo del niño y de la familia para la venopunción. Método: Relato de la experiencia sobre una aplicación desarrollada en la maestría profesional en enfermería en alianza con un curso de ingeniería. Resultados: La aplicación permite al niño comprender el procedimiento de la venopunción de manera lúdica e interactiva. Su desarrollo se dio en tres etapas: la identificación de las necesidades del cliente, la definición de los componentes y la elaboración del prototipo. Consideraciones finales: La aplicación puede atender a las necesidades de los enfermeros en el preparo del niño y de la familia para el procedimiento de la venopunción. Se destaca todavía la importancia de la multidisciplinariedad para la concretización de proyectos similares. La aplicación, que se presta al cuidado y a la educación del niño y de la familia, ha sido desarrollada con éxito.

RESUMO Objetivo: relatar a experiência de desenvolvimento do aplicativo para preparo da criança e família na punção venosa. Método: relato de experiência sobre um aplicativo desenvolvido no Mestrado Profissional em Enfermagem em parceria com um curso de Engenharia Resultados: o desenvolvimento do aplicativo aconteceu em três etapas, a saber identificação das necessidades do cliente; definição dos componentes e a elaboração do protótipo. O aplicativo permite à criança compreender o procedimento de punção venosa de forma lúdica e interacional. Considerações finais: acredita-se que o aplicativo possa atender às necessidades dos enfermeiros no preparo da criança e família no procedimento de punção venosa. Destaca-se, ainda, a importância da multidisciplinariedade para a concretização de projetos semelhantes a estes. O desenvolvimento do aplicativo foi realizado com sucesso por se tratar de uma tecnologia que se presta ao cuidado e a educação da criança e família.

Semiotics and semiology of Nursing: evaluation of undergraduate students' knowledge on procedures.

OBJECTIVE: to assess the knowledge of scholars on Nursing regarding simple hands hygiene (SHH), blood pressure measurement (BP), peripheral venipuncture (PV) with venous catheter and male urethral catheterization delay (UCD) procedures. METHOD: quantitative study carried out between February and May 2014, with 186 undergraduate Nursing students from 5th to 9th period of a public university of Rio Grande do Norte, with application of four questionnaires. One carried out descriptive and analytic analysis. RESULTS: the students presented low average percentage of right answers, especially in blood pressure measurement (55.5%); SHH's average was higher than 70%. The average of correct answers was the highest in SHH (8.6), followed by UCD (7.8), PV (7.4) and BP (6.7). The questions regarding the topic "concepts" showed less correct answers when comparing it to the topic "technique steps". CONCLUSION: it is necessary to establish knowledge monitoring strategies, in order to stimulate the constant improvement.

Factors associated with nursing students' adherence to venous blood collection practice guidelines - A cross sectional study.

Venous blood specimen collection is a common procedure that nursing students perform during pre-registration courses, and training for such collections takes place on campus as well as at clinical placements. However, levels of adherence to practice guidelines are still suboptimal among both nursing students and healthcare staff. We aimed to explore nursing students' adherence to the Swedish national venous blood specimen collection practice guidelines regarding patient identification and test request management and how this adherence is related to clinical experience, capability beliefs, research use, and the perceived social climate in clinical contexts. A survey with a cross-sectional design was conducted among 305 nursing students at a medium-sized university in Sweden. Descriptive statistics and logistic regression were used for data analysis. The survey showed that 82% of the students adhered to patient identification guideline practices and 80% to test request management practices. Factors associated with correct patient identification procedures were semester and frequency of research use. Factors associated with correct test request management were previous healthcare work experience, semester, and capability beliefs regarding academic abilities and evidence-based practice. We conclude that there is a need to develop educational tools to train students in research use and evidence-based practice in order to enhance guideline practice adherence and improve patient safety.

Assessing nursing students' knowledge and skills in performing venepuncture and inserting peripheral venous catheters.

Venepuncture and the insertion of peripheral venous catheters are common tasks in health care, and training in these procedures is included in nursing programmes. Evidence of nursing students' knowledge and skills in these procedures is limited. The main aim of this study was to assess nursing students' knowledge and skills when performing venepuncture and inserting peripheral venous catheters. Potential associations between level of knowledge and skills, self-training, self-efficacy, and demographic characteristics were also investigated. The assessment was performed by lecturers at a university college in Sweden using the two previously tested instruments "Assess Venepuncture" and "Assess Peripheral Venous Catheter Insertion". Between 81% and 100% of steps were carried out correctly by the students. The step with the highest rating was "Uses gloves", and lowest rating was 'Informs the patients about the possibility of obtaining local anaesthesia'. Significant correlations between degree of self-training and correct performance were found in the group of students who registered their self-training. No associations between demographic characteristics and correct performances were found. Assessing that students have achieved adequate levels of knowledge and skills in these procedures at different levels of the nursing education is of importance to prevent complications and support patient safety.

Factors affecting difficult peripheral intravenous cannulation in adults: a prospective observational study.

AIMS AND OBJECTIVES: This study aimed to identify risk factors for difficult intravenous cannulation in relation to characteristics of patients, healthcare providers and devices in adult patients accessing a radiology service. BACKGROUND: Early recognition of patients at risk for difficult peripheral intravenous catheterisation is important to adopt strategies able to increase the likelihood of success in intravenous cannulation, as well as to critically evaluate the use of alternative administration routes or venous devices. DESIGN: A prospective observational study was conducted in the radiology service of an Italian university hospital from January to August 2013. METHODS: Thirteen nurses observed 763 patients during intravenous insertion (53% were female, the mean age was 63 years and 65% had a diagnosis of cancer). For each patient, nurses collected data about potential predictors of difficult intravenous cannulation, which was defined as a procedure lasting more than one minute. Data included characteristics of patient, cannula required, venepuncture performed and operator(s) involved. Logistic regression was performed as univariate and multivariate analysis. RESULTS: The intravenous insertion time ranged from 45 seconds to 125 minutes. Overall, variables identified as significant independent predictors were chemotherapy received via peripheral cannula (OR = 1·42), veins with many valves (OR = 3·67), fragility (OR = 3·29), visibility (OR = 0·87) and palpability (OR = 0·79) as perceived by nurses. CONCLUSIONS: Although many risk factors were identified, the overall success rate was very high, suggesting that nurses' attention during cannulation protected at-risk patients from multiple attempts. Multicentre studies should further investigate risk factors across different radiology services and clinical settings. RELEVANCE TO CLINICAL PRACTICE: These results can help nurses to recognise risk factors for difficult intravenous access and pay appropriate attention when attempting a venepuncture to preserve patients' peripheral veins.

Current situation regarding central venous port implantation procedures and complications: a questionnaire-based survey of 11,693 implantations in Japan.

BACKGROUND: We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. METHODS: Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. RESULTS: We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications (P = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51-0.91; P = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). CONCLUSION: Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.

OC39 - The efficacy of a participatory approach in reducing pain related to venepuncture in children.

UNLABELLED: Theme: ETHICAL ISSUES: dignity and humanity. INTRODUCTION: Venepuncture represents traumatic experience in childhood due to pain and discomfort. AIMS: To compare the efficacy of a participatory approach with preliminary ice application to the skin. METHODS: Two age-groups (respectively 3-7 and *8 years) were considered during day-hospital, hospitalization, and ER accesses. Venepuncture was described to patients with fables or illustration according to the age-group. Ice or cool-water-pack was randomly applied to skin for one minute before venepuncture. Pain measurement scales were Wong-Baker and VAS. RESULTS: Preliminary data (55 patients) showed that the 3-7 years age group had better pain tolerance with a participatory approach, whilst ice was better in the older group. Generally previous venepunctures seem to worsen pain feeling. DISCUSSION: Imagination seems to influence pain feeling in the 3-7 age group, while ice is more important in the older group. Previous experiences mark negatively successive venepunctures. CONCLUSIONS: Participatory approaches can be cost-effective and influences positively venepuncture in the future.