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Objective: To investigate the effects of breast milk on cortical pain response and behavioral response in newborns during heel-prick procedure., Study Design: A prospective, randomized controlled trial was conducted on healty-term newborns, undergoing heel blood sampling. Infants were randomly assigned to study group with receive orally 2 ml breast milk (n = 45) or a control group with no intervention (n = 45). A near-infrared spectroscopy device was used to monitor regional cerebral oxygen saturation (rScO 2 ), while neonatal pain expression was assessed by Neonatal Pain, Agitation, and Sedation Scale (N-PASS)., Results: The N-PASS score (p = 0.001) and the crying time (p = 0.017) were significantly lower in the study group compared to the control group. Although the mean rScO 2 values decreased in both groups during the procedure, the percent change in rScO 2 was not significant difference between two groups., Conclusion: Breast milk administration decreases behavioral responses to a noxious stimulus without reducing the cortical response to pain., Clinical Trial Registration: This trial was registered under ClinicalTrials.gov identifier no. NCT05961904., (© 2024. The Author(s).)

Purpose: Difficult venous access (DVA), characterized by non-visible and non-palpable veins, is common in oncology patients. The objectives of this study were to compare the performances of two blood collection sets in an oncology phlebotomy setting: BD Vacutainer® UltraTouch™ Push Button (UT-PBBCS) and BD Vacutainer® Safety-Lok™ Blood Collection Set (SLBCS). The two sets were evaluated to assess whether use of a smaller gauge (G) needle (down-gauging) may reduce patient pain and improve peripheral venous access experience during phlebotomy in oncology patients., Methods: Questionnaires were used to record patient data (age, gender), phlebotomy procedural observations (venipuncture site, number of collected tubes, blood flow, needle repositioning, underfilled tubes), patient pain perception and phlebotomist difficulty perception scores (0-10 points scale). Specimen quality was evaluated by hemolysis index (HI) on Roche Cobas® 6000., Results: Subject groups showed no statistical difference. SLBCS (21/23G) or UT-PBBCS (23/25G) were used in 264 (45.8%) and 313 (54.2%) subjects respectively. Lower gauge was preferred for DVA (hand venipuncture), and DVA was associated with tube underfilling but no with type of blood collection set. For UT-PBBCS, pain perception, patients' anxiety level and phlebotomists' difficulty grade were lower when compared to SLBCS (p < 0.001). Blood samples collected with UT-PBBCS showed less hemolysis compared to samples collected with SLBCS (p < 0.001)., Conclusion: Provision of a smaller gauge UT-PBBCS option during phlebotomy in oncology patients with DVA reduces procedural pain and anxiety and improved phlebotomist' experience during sample collection. Despite the down-gauging, hemolysis was lower for UT-PBBCS, keeping sample quality while improving DVA patient comfort., Competing Interests: Declaration of competing interest Sirini S and Meyer B, declare Employment or Leadership and stock ownership in Becton Dickinson. Becton Dickinson was involved in the blood collection observations under the direction of the PI and following the study protocol. All other authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

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., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Context: As part of preventive health services, infants are exposed to painful procedures, such as venous interventions, injections, and heel blood collection. Infants, in particular, are sensitive and vulnerable to untreated pain., Objective: This study aims to evaluate the effect of Yakson touch and white noise on pain in newborn heel blood collection. Yakson touch include the interaction between the caregiver and the care recipient., Design: The study was conducted using a parallel randomized controlled experimental design. The research was conducted during the Guthrie screening test routinely performed on newborns., Setting: The study was carried out at the Family Health Center, which has the highest number of patients in a province in the Eastern Anatolia Region of Turkey between May 1st and August 30th, 2022., Participants: A total of 66 babies with a gestational age of 37-40 weeks were included in the study., Intervention: In the study, infant participants were randomly assigned to one of three groups: the Yakson Touch Group (n=22), the White Noise Group (n=22), and the Control Group (n=22). Infants in the Yakson Touch Group received the Yakson touch from the same researcher. Infants in the White Noise Group listened to a song "Don't Let Your Baby Cry 2" from the album "Colic". Infants in the Control Group received routine intervention procedures., Outcome Measures: The study data were collected using the Introductory Information Form and the Newborn Infant Pain Scale (NIPS)., Results: After the procedure, the mean Yakson Touch Group of the NIPS score was 2.04±1.17, the mean White Noise Group of the NIPS score was 2.80±1.47, and the mean Control Group of the NIPS score was 3.72±1.07. There was a significant difference between the groups after the procedure (P < .001; ηp2=0.248 ). The Yakson touch procedure was found to be the most effective at decreasing the pain score, and white noise was the second most effective., Conclusions: Yakson touch is more effective than white noise in controlling pain due to invasive procedures in babies.

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., Competing Interests: The authors have read the journal’s policy and have the following competing interests: Francine M. Ducharme has received unrestricted research funds from AstraZeneca, Covis Pharma, GlaxoSmithKline, Merck Canada, Novartis, Teva, Trudell Medical; GlaxoSmithKline and MEDteq in partnership with Thorasys Inc., as well as honorariums for consultancy work from AstraZeneca, Covis Pharma, Sanofi, Teva, and Thorasys Inc. and honorariums as an invited speaker from Covis Pharma, Jean-Coutu Pharmacy and Brunet Pharmacy. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Dasari et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling., Introduction: Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling., Inclusion Criteria: This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling., Methods: CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence., Review Registration: PROSPERO CRD42023455617., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

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 double‑blind 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, SPO 2 ) 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 SPO 2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test 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 SPO 2 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., (© 2024. The Author(s).)

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., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses.)

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 15.85/10 4 donations. The two AEs with the highest rates were Hypotensive and Phlebotomy events (8.32 and 5.91/10 4 donations, respectively). Females had higher overall AE rates than males (25.76 vs. 9.85/10 4 donations), and first-time donors had higher overall AE rates than repeat donors (136.66 vs. 12.37/10 4 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., (© 2021 Plasma Protein Therapeutics Association. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)

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 (♀ = 49, ♂ = 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., (© 2021 John Wiley & Sons, Ltd.)

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., (© 2021 AABB.)

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., (© 2021 Wiley Periodicals LLC.)

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.

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., Competing Interests: MC, CH, DG, FA, Mv, GS, LB, ED, MB, RE, GG, AH, RR, EA, FM, RS No competing interests declared, (© 2021, Cobo et al.)

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.

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.

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.

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, HbA 1c 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, HbA 1c 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, HbA 1c , 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., (© 2020 by the American Diabetes Association.)

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.

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.

Background: Intensive care unit (ICU) patients are at high risk of anemia, which is associated with adverse clinical outcomes and death. Blood sampling for diagnostic testing is a potentially modifiable contributor to anemia., Methods: We conducted a systematic review by searching MEDLINE and EMBASE from inception to October 5, 2017, for studies reporting the volume of blood taken for laboratory testing using blood sampling conservation devices compared to standard care or another intervention in adult ICU patients., Results: We identified 8 eligible studies (n = 1204 patients) that used 2 types of devices: arterial access devices (n = 5) and reduced-volume blood collection tubes (n = 3). All studies reported a reduction in the volume of blood taken for laboratory testing with devices compared to standard practice (range 19%-80%). The studies were judged to have serious risk of bias, and due to heterogeneity, pooling for meta-analysis was not considered appropriate., Conclusions: Devices used to reduce the volume of blood taken for laboratory testing in ICU patients appear to be effective, although study heterogeneity limited our ability to calculate pooled estimates of efficacy for each device. Further assessment of clinical outcomes may establish clinical benefit with minimal negative consequences for hospitals and laboratories to facilitate the use of small-volume tubes.

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.

Background: The early experience of pain can lead to complications such as tachycardia, tachypnea and increased metabolic needs of the body, thereby exacerbation of the behavioral and physiological responses to pain in neonates. The current study aimed to compare the effect of a mother's hug and massage on pain behaviors during and after blood sampling in neonates., Method: This study was a randomized clinical trial. A total of 135 healthy full-term neonates were selected by convenience sampling method. Samples were randomly assigned to a mother's hug group, massage group or control group. In all three groups, the behavioral responses of the neonate were measured and recorded before, immediately and 5 min after blood sampling by Neonatal Infant Pain Scale. Heart rate, respiratory rate and blood oxygen saturation were recorded with pulse oximetry, and the crying period was measured from start to silence using a stopwatch., Results: The results showed that after 5 min, the pain and heart rate in the mother's hug group decreased significantly compared to the massage and control groups (p < 0.001). There were no significant changes in the respiratory rate and blood oxygen saturation level in any of the newborns during blood sampling (p > 0.05). The duration of crying in the mother's hug group had more reduction than that of the massage and control groups (p < 0.001)., Conclusion: The placement of the baby in the mother's hug during painful procedures is recommended due to the reduction of pain, the improvement of physiological symptoms and the promotion of neonatal health., (© The Author(s) [2020]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

In the current study, two groups of rats (five per group) were administered a single oral dose of 500 mg/kg acetaminophen. For toxicokinetic assessment, the Group 1 animals were bled via conventional sparse (two animals/time point) sublingual vein bleeding (~0.5 ml) with anesthesia, while the Group 2 animals were bled via serial tail vein microsampling (~0.075 ml) without anesthesia. All collected blood was processed for plasma. Each Group 2 plasma sample (~30 μl) was divided into 'wet' and 'dried' (dried plasma spots). All plasma samples were analyzed by LC-MS/MS for acetaminophen and its major metabolites acetaminophen glucuronide and acetaminophen sulfate. In addition, plasma and urine samples were collected for analysis of corticosterone and creatinine to assess stress levels. Comparable plasma exposure to acetaminophen and its two metabolites was observed in the plasma obtained via conventional sparse sublingual vein bleeding and serial tail vein microsampling and between the 'wet' and 'dried' plasma obtained by the latter. Furthermore, comparable corticosterone levels or corticosterone/creatinine ratios between the two groups suggested that serial microsampling without anesthesia did not increase the levels of stress as compared with conventional sampling with anesthesia, confirming the utility of microsampling for plasma or dried plasma spots in rodent toxicokinetic assessment., (© 2020 John Wiley & Sons, Ltd.)

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., Competing Interests: The authors have declared that no competing interests exist.

Hospital-acquired anemia (HAA) is a prevalent condition that is independently associated with worse clinical outcomes including prolongation of hospital stay and increased morbidity and mortality. While multifactorial in general, iatrogenic blood loss has been long recognized as one of the key contributing factors to development and worsening of HAA during hospital stay. Patients can be losing over 50 mL of blood per day to diagnostic blood draws. Strategies such as elimination of unnecessary laboratory tests that are not likely to alter the course of management, use of pediatric-size or small-volume tubes for blood collection to reduce phlebotomy volumes and avoid blood wastage, use of closed blood sampling devices, and substituting invasive tests with point-of-care testing alone or bundled together have generally been shown to be effective in reducing the volume of iatrogenic blood loss, hemoglobin decline, and blood transfusions, with no negative impact on the availability of test results for the clinical team. These strategies are important components of Patient Blood Management programs and their adoption can lead to improved clinical outcomes for patients., Competing Interests: Declaration of competing interest AS has received research grants from CSL Behring, Gauss Surgical, Masimo, and HbO2 Therapeutics, honoraria from CSL Behring, Masimo, and Merck and acted as a consultant for CSL Behring, Gauss Surgical, Masimo Corporation, and Vifor. HC has no conflicting interest to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Maintaining and restoring patency in midline catheters has been a significant issue in the hospitalized patient requiring a multitude of infusates and frequent blood specimen collection. Currently, clinicians may not use this device as often as clinically indicated because they lack an approved intervention to treat thrombotic occlusions. The purpose of this research was to show evidence that alteplase, a US Food and Drug Administration-approved thrombolytic for central vascular access devices, is a safe and effective thrombolytic for midline catheters. A prospective open label study of 497 midline catheters was conducted from July 2018 to December 2018. Of those studied, 112 devices were treated with 1 mg of alteplase, and 109 had patency restored with 1 dose. None of the 112 patients had a major adverse event, and only 1 minor event was recorded and was resolved without removal of the midline catheter. Treating occluded central vascular access devices with 2 mg of alteplase has been safe and effective since 2001. With this research, safety and efficacy appears to be established for 1 mg of alteplase, repeat times 1 mg if necessary, in midline catheters. With the option to treat patients with occluded midline catheters rather than replace, clinicians can reduce cost, increase patient satisfaction, and preserve vein health.

Background: Blood culture contamination results in delayed or unnecessary treatments, increased morbidity risk, extended lengths of hospital stay, and increased health care costs. Collecting 2 sets of blood cultures from separate sites helps differentiate bloodstream infections (BSIs) from contamination., Local Problem: Blood culture contamination rates trailed the national threshold of less than 3% in one southeastern US emergency department (ED). Same-site and single-set collection issues were also identified., Methods: This pre-/postintervention quality improvement study included 1137 patients (preintervention: n = 560; postintervention: n = 577) of all ages with blood culture orders in a 13-bed tertiary care ED., Interventions: A staff educational program, blood culture collection checklist with protocol, and monthly collective and individual feedback were implemented., Results: Blood culture contamination rates decreased from 3.39% to 2.6%. Same-site collection rates decreased from 15.13% to 4.14%., Conclusions: The interventions effectively reduced blood culture contamination rates and same-site blood culture collections in the ED, enhancing the quality of care for patients with BSIs.

Objective: We aimed to test for an association between the amount of circulating fetal cell-free DNA and trisomy, and whether NIPS failure due to low fetal fraction indicates trisomy risk., Method: Maternal BMI, maternal age, fetal sex, gestational age, fetal cfDNA fraction, and NIPS results was collected on 2374 pregnancies. Additional clinical information was available for 1180 research consented patients. We investigated associations between fetal fraction and available variables and determined the success rate of repeat NIPS testing., Results: Fetal trisomy was marginally associated with decreased fetal fraction (P = .067). However, the proportions of trisomy events were not significantly increased in women who had failed NIPS due to low fetal fraction (<4%) (OR = 1.37 [0.3-7.4]; P = .714). 66% of repeated NIPS after a second blood draw were successful., Conclusion: Failure to meet the clinical cutoff of 4% fetal fraction established for NIPS accuracy did not suggest increased risk for trisomy in our cohort. Because repeat testing was successful in the majority of cases and most failures were explained by high BMI and low gestational age, a redraw may be an appropriate next step before invasive screening due to concerns for trisomic pregnancies., (© 2020 John Wiley & Sons, Ltd.)

Background: Effective and financially viable mitigation approaches are needed to reduce bacterial contamination of platelets in the US. Expected costs of large-volume delayed sampling (LVDS), which would be performed by a blood center prior to shipment to a hospital, were compared to those of pathogen reduction (PR), point-of-release testing (PORt), and secondary bacterial culture (SBC)., Methods: Using a Markov-based decision-tree model, the financial and clinical impact of implementing all variants of LVDS, PR, PORt, and SBC described in FDA guidance were evaluated from a hospital perspective. Hospitals were assumed to acquire leukoreduced apheresis platelets, with LVDS adding $30 per unit. Monte Carlo simulations were run to estimate the direct medical costs for platelet acquisition, testing, transfusion, and possible complications associated with each approach. Input parameters, including test sensitivity and specificity, were drawn from existing literature and costs (2018US$) were based on a hospital perspective. A one-way sensitivity analysis varied the assumed additional cost of LVDS., Results: Under an approach of LVDS (7-day), the total cost per transfused unit is $735.78, which falls between estimates for SBC (7-day) and PORt. Assuming 20,000 transfusions each year, LVDS would cost $14.72 million annually. Per-unit LVDS costs would need to be less than $22.32 to be cheaper per transfusion than all other strategies, less than $32.02 to be cheaper than SBC (7-day), and less than $196.19 to be cheaper than PR (5-day)., Conclusions: LVDS is an effective and cost-competitive approach, assuming additional costs to blood centers and associated charges to hospitals are modest., (© 2020 AABB.)

Introduction: Repeated blood sampling is a common procedure in laboratory mice, but at present it is unknown which technique has the least impact on the animals when large or repeated blood samples are required. Retro-bulbar sinus puncture is a reliable technique but has been shown to cause many changes in the animals, why sublingual and facial vein puncture have been suggested as suitable alternatives. This study investigated 1) which of the three blood sampling techniques had the least impact on nest building activity, level of faecal corticosterone metabolites, body weight, fur status, and macroscopic changes, 2) whether the blood sampling techniques gave rise to variation in blood quality between blood samples, and 3) whether sublingual and facial vein puncture should be performed with or without anaesthesia in female C57BL/6 mice., Method: Three hundred and sixty C57BL/6 female mice divided into five batches were included in the study and randomized to a short (blood sampling on Day 8, 9 and 10) or a long protocol (blood sampling on Day 8, 15 and 22). Each protocol consisted of six identical groups: sublingual vein puncture (SVP), sublingual vein puncture in isoflurane (SVPiso), facial vein puncture (FVP), facial vein puncture in isoflurane (FVPiso), retro-bulbar sinus puncture (RBP), and a control group (CONTROL) with only scruffing being performed. At baseline (Day 2) nest building activity (NBA) was assessed and faecal pellets collected for evaluation of faecal corticosterone metabolites (FCM). The day after each blood sampling day NBA and FCM were reassessed., Results and Conclusion: None of the blood sampling techniques proved to be superior to the others in any of the measured parameters. Finally, sublingual and facial vein puncture performed under anaesthesia gave rise to variation in the quality of the blood. A refinement of all three techniques are therefore warranted., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Inc.)

Background: With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings., Methods: This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16., Results: The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η 2  = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department., Conclusions: Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting., Trial Registration: Current Controlled Trials IRCT201408029568N9, 2014-09-08.

Objectives: This study aimed to assess various types of safety lancets in terms of blood volume and pain perception during capillary blood sampling, a routine finger-puncture procedure for obtaining a small amount of human blood for running various screening and diagnostic tests., Methods: Data were collected from 100 adult healthy volunteers following finger-puncture procedure. Four different types of safety lancets were tested (Acti-Lance, Prolance, Medlance Plus, and MediSafe Solo). Each type has its own versions, giving 16 different safety lancets in total., Results: A significant difference in the mean capillary blood volume was found between blade and needle equipped safety lancets. MediSafe Solo type lancet had no blade version, and hence its use was associated with the lowest mean collected capillary blood volume (42.4 μL). Acti-Lance and Medlance Plus type lancets had one blade version and the mean collected capillary blood volume was 82.2 and 99.0 μL, respectively. Prolance type lancet had two blade versions, and its use was associated with the highest mean capillary blood volume (118.3 μL). The level of pain intensity was evaluated as low by the majority of patients for all lancets. Medlance Plus was the least painful and Acti-Lance was the most painful type of safety lancet. On a 0-to-10 scale of pain, 75% of punctures were assessed by the participants at a level not exceeding 3 points., Conclusions: This study suggests that although all investigated safety lancets achieve adequate performance regarding the necessary capillary blood volume to run a diagnostic of test, lancets equipped with blades differ significantly from those equipped with needles in terms of the mean obtained capillary blood volume. Further, although all devices produced relatively low levels of pain, the amount of pain caused by blade versions of safety lancets has been found to be higher than that of needle versions., Clinicaltrials.gov Id: NCT04001348. (https://clinicaltrials.gov/ct2/show/NCT04001348?term=NCT04001348&draw=2&rank=1).

Background: Prolonged time elapsing between the blood drawing and separation of the cell mass may result in decreased sample glucose levels due to continuous glycolysis. This can lead to underdiagnoses of hyperglycemic states and overdiagnosis of hypoglycemia. We aimed to evaluate the clinical impact of shortened transit time and earlier centrifugation of laboratory specimens on reported glucose results and diagnosis of clinically significant hypoglycemia (<50 mg/dL) or elevated glucose levels (>100 mg/dL)., Methods: We assessed all fasting-serum glucose tests from the adult population (190 767 subjects) without known diabetes residing in Southern Israel. Before and after intervention periods were compared: 268 359 blood tests were performed during 2009-2010, and 317 336 during 2012-2013., Results: While glucose levels were 94.17 mg/dL ± 14.12 in 2012-2013 versus 83.53 mg/dL ± 14.50 in 2009-2010 (12.75% ± 0.88 increase, P < .001), the difference in glycated hemoglobin levels was statistically significant but clinically negligible: 5.84% ± 0.56 in 2012-2013 versus 5.88% ± 0.56 in 2009-2010 (0.53% ± 0.78 decrease, P < .01). There was an increased likelihood of a glucose result to be above 100 mg/dL following intervention: 9.80% versus 25.90%, P < .001. For clinics distanced over 40 km from the laboratory, age-adjusted odds ratio value was 1.26 (95% CI 1.13, 1.41). The proportion of samples with hypoglycemia values decreased from 0.33% to 0.03% ( P < .001)., Conclusions: We demonstrated an important change in glucose values over a two-year period following an improvement of the preanalytic processes. The intervention was related to an increase in the frequency of hyperglycemia results and a decrease in the number of hypoglycemia results. Future administrative projects should consider clinical consequences with involvement of all relevant stakeholders.

Background: Automatic lancets have been reported to be superior to manual lancets in terms of pain and treatment time. However, no studies have yet been published comparing automatic lancet and needle puncture heel-prick blood sampling. The objective of this study was to compare the pain response and efficiency between the automatic lancet and needle at the time of heel blood sampling. The design was a randomized controlled trial. The inclusion criteria for the participants were a birthweight of ≧1,500 g and a gestational age of ≧30 weeks., Methods: The study examined a total of 105 neonates who were randomized into an automatic lancet group (n = 53) and a needle group (n = 52). The parameters measured included blood collection time, number of calf squeezes, duration of audible crying, and the Neonatal Infant Pain Scale (NIPS) score. The main outcome measure was audible crying duration., Results: The duration of audible crying was significantly shorter in the automatic lancet group when compared to the needle group (median 3 s, interquartile range (IQR) 0-33 s vs median 39 s, IQR 5-91.5 s, P = 0.0023). The NIPS score at the time of puncture was significantly lower in the automatic lancet group than in the needle group (median 1, IQR 0-5 vs median 5, IQR 3-6, P = 0.0060). There was no significant difference in the blood collection time and the number of calf squeezes between the two groups. The automatic lancet was found to be less painful than the needle puncture in neonatal heel-prick blood sampling with no significant difference in blood sampling time., Conclusion: The automatic lancet was found to be less painful than the needle puncture in neonatal heel-prick blood sampling with no significant difference in blood sampling time., (© 2020 The Authors. Pediatrics International published by John Wiley & Sons Australia, Ltd on behalf of Japan Pediatric Society.)

Objective: To determine a method to reduce specimen hemolysis rates in pediatric blood specimens., Methods: A total of 290 blood specimens from pediatric patients were classified into the capped group or uncapped group. The hemolysis index and levels of lactate dehydrogenase (LDH) were measured using an automated biochemical analyzer. Also, we performed a paired test to measure the concentration of free hemoglobin in specimens from 25 randomly selected healthy adult volunteers, using a direct spectrophotometric technique., Results: The hemolytic rate of capped specimens was 2-fold higher than that of uncapped specimens. We found significant differences for LDH. Also, there was a significant difference in the concentration of free hemoglobin in the random-volunteers test., Conclusions: Eliminating the residual negative pressure of vacuum blood-collection tubes was effective at reducing the macrohemolysis and/or microhemolysis rate., (© American Society for Clinical Pathology 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Due to finalization of the ICH S3A Q&A focusing on microsampling, application of microsampling technique to regular non-clinical animal studies is expected for non-clinical safety assessment of pharmaceuticals. In Europe, microsampling from the tail vein or saphenous vein has often been used, whereas sampling from the jugular vein is thought to be more common for non-clinical studies in Japan. Therefore, we assessed the toxicological effects of serial microsampling from the jugular vein of SD rats in a common 28-day study at 4 independent organizations. Fifty microliter sampling was performed at 6 timepoints on day 1 to 2 and 7 timepoints on day 27 to 28 and its toxicological influences on body weight, food consumption, hematological and clinical chemistry parameters, and organ weights (on day 29 for 3 and day 28 for 1 organizations) were evaluated. The serial microsampling was shown to have no or minimal influences on the assessed parameters. The observed statistical differences for the 18 parameters were sporadic and did not appear to be systemically associated with microsampling. However, the sporadic changes were more often observed in females (14/18 parameters) than in males (6/18), suggesting the possibility that female rats were more susceptible to treatment-based influences. The current results indicate that serial 50 μL sampling from the jugular vein of SD rats had no or very slight toxicological effects, suggesting that this microsampling condition is applicable for toxicokinetic evaluation of non-clinical rat toxicity studies.

Background: According to research findings, pain experience in neonatal period leads to short- and long-term complications that could be prevented by means of neonatal pain relief. Therefore, this study aimed to investigate the effect of facilitated tucking position on neonatal pain during heel prick blood sampling. Methods: This is a cross over clinical trial was done on 40 premature neonates. During blood sampling, neonates were put in either facilitated tucking or routine positions randomly and Premature Infant Pain Profile (PIPP) was completed for each neonate. In the next sampling time, positions were changed and the process repeated. Data were analyzed using descriptive statistics, repeated measure ANOVA, and independent t -test. Results: Results showed that the mean pain intensity in each position was increased during sampling ( p  = .0001) and after that was decreased significantly ( p  = .001), but before, during, and after sampling there was no significant difference between the two positions ( p  > .05). Conclusions: Overall findings showed that comparing neonates in the two positions; there was no significant difference in their pain intensity. These results are almost in contrast with many researches findings in this area. It seems there is a need to further investigation regarding this subject.

Extreme leukocytosis may lead to false hyperkalemia when blood samples are conveyed by pneumatic tube system (PTS). The aim of this study was to define whether even moderate leukocytosis and also non malignancy cells like neutrophils may influence potassium values after PTS transportation., Materials and Methods: Uncentrifuged blood samples are sent to the local laboratory through PTS. Data were retrospectively collected from routine testing carried out on all specimens arrived in the laboratory between September 2017 and March 2018. Clinical chemistry testing is routinely performed using lithium-heparin tubes. When false hyperkalemia induced by leukocytosis is suspected, potassium measurement is then performed in serum (clotting activator tubes) or whole blood samples. The analysis was focused on samples with both leukocytosis (i.e., >15×10 9 /L) and plasma potassium >5.0 mmol/L, before any corrective therapeutic measure to lower potassium levels was established., Results: A total number of 18 samples were included in our analysis, 9 drawn from patients with hematologic malignancies and 9 without. In the 9 patients without hematologic malignancies (median leukocyte count, 20.4×10 9 /L), the median potassium value was 5.4 mmol/L in plasma and 4.5 mmol/L in serum or whole blood. In the 9 patients with hematologic malignancies (median leukocyte count, 151.9×10 9 /L; p <0.001), the median potassium value was 7.7 mmol/L in plasma and 4.3 mmol/L in serum or whole blood (median difference, 2.9 mmol/L; p <0.001)., Conclusion: The results of our study suggest that even modest leukocytosis (i.e., around 15x10 9 /L), which can be frequently encountered in clinical practice, may be associated with a significant variation of plasma potassium. This would lead us to conclude that plasma samples transportation by PTS should be avoided in patients with even mild leukocytosis.

Background: Ultrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain., Methods: In this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician)., Results: Thirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference -2.0 (95%CI, -3.4 to -0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference -1.45 (95%CI, -2.57 to -0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference -4.0 (95%CI, -5.8 to -2.3); p < 0.01., Conclusion: US guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: XB declares a competing interest as an ultrasound teacher for GE (GE MEDICAL SYSTEMS ULTRASOUND) customers. This does not alter our adherence to PLOS ONE policies and sharing data and materials. The other authors state they have no competing interests.

Background: Measurement of glomerular filtration rate by iohexol disappearance (iGFR) has become a gold standard in the pediatric chronic kidney disease (CKD) population. The need for serial phlebotomy can be difficult and minimizing venipunctures would be beneficial. Furthermore, finger stick collection for dried blood spot (DBS) may be more tolerable in the pediatric population, and equivalence between these two methods may further simplify the process., Methods: This was a cross-sectional study in children and adolescents 1 to 21 years with stages I-IV CKD. Iohexol was infused and blood drawn 10, 30, 120, and 300 min later. Blood spots on filter paper were collected by finger stick after each of the latter two blood draws. The rate of iohexol plasma disappearance was used to calculate GFR. Pearson's correlation coefficient and bias, Students t test, and Bland-Altman graphical representations were used to compare methods., Results: Forty-one patients were recruited. The mean creatinine was 1.13 mg/dL (SD 0.45), the mean 4-point iGFR was 73.2 ml/min/1.73m 2 (SD 27.5) and the mean 2-point iGFR was 75.6 ml/min/1.73m 2 (SD 27.3). Correlation between 2-point and 4-point venous GFR was r = 0.97; p < 0.001. The correlation between the DBS and the 2-point venous GFR was r = 0.95; p < 0.001, with no significant bias. Ninety-four percent of the 2-point GFR's were within 10% of the 4-point GFR's and 80% of DBS-GFRs were within 10% of the 2-point GFR's., Conclusions: The 2-point iGFR was highly correlated and agreed well with the 4-point iGFR. The same was true for the DBS method and the 2-point venous method. DBS sampling by finger stick sampling at 2 time points after iohexol infusion gave an acceptably accurate measurement of GFR.

Safety lancets are used to collect capillary blood samples to test if neonates have rare but serious congenital conditions, such as sickle cell disease, cystic fibrosis, congenital hypothyroidism and inherited metabolic diseases. Blood samples are taken from the heel, but the procedure can cause the neonate pain or discomfort, as well as a risk of local trauma to the nerves and blood vessels, bleeding, infection and scarring. This article explores the need for blood sampling in neonates, discusses the procedure and outlines the types of lancets available. It describes the Neoheel Safety Lancet (Smiths Medical), whose features are designed to avoid pain and trauma during the procedure. Three case studies are included to describe its use in clinical practice.

Background: Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs., Methods: In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates' pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors., Results: The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600-0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102-0.379)., Conclusions: The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN's clinical usefulness., Trial Registration: The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.

Background: Phlebotomy blood loss resulting in hospital-acquired anemia remains a significant problem in the critically ill population. A quality improvement project focused on decreasing phlebotomy blood loss and increasing nursing knowledge regarding blood conservation strategies was undertaken in the intensive care unit of a community hospital., Methods: The project followed a quasi-experimental design. Data were gathered using electronic chart review and surveys before and after educational sessions. Intensive care unit nurses attended educational sessions focused on increasing knowledge regarding phlebotomy blood loss, hospital-acquired anemia, blood conservation strategies, and utilization of blood conservation devices., Results: The study showed a statistically significant increase in nursing knowledge regarding hospital-acquired anemia, phlebotomy blood loss, and blood conservation device use (P < .001) and a statistically significant change in blood conservation device application practice in the posteducation period when compared with the preeducation period (P = .016)., Conclusion: The findings of this project support the added value of dedicated blood conservation education to nurses to promote increased knowledge, increased blood conservation device utilization, and decreases in phlebotomy blood loss.

Objectives: Arterial puncture for blood gas analysis is a painful procedure in the emergency department (ED). Local subcutaneous injection of anesthetics containing amino amides or esters is the usual painrelief technique applied before arterial puncture, but it is little used in some care settings, such as the ED. We aimed to analyze the literature on anesthetic approaches other than the traditional one of local injection of amino-amide or amino-ester compounds for pain relief during arterial puncture and to assess the efficacy of the alternatives., Material and Methods: . A systematic review of the literature was conducted in 6 bibliographic databases. We selected randomized clinical trials (RCTs) published in English or Spanish between 2000 and 2018. The trials compared self-reported pain immediately after arterial puncture for blood gas analysis. Some form of anesthesia other than local injection of an amino-amide or -ester compound was compared to another anesthetic technique, placebo, or no anesthetic., Results: We found 16 RCTs. Four compared the effect of topical anesthetic creams containing amino amides and/or amino esters, two assessed ultrasound-guided puncture, four used small-caliber needles or special syringes, one used a needle-free high-pressure anesthetic injection system, and five studied cryoanesthesia by application of ice or aerosols., Conclusion: The only effective alternative approaches to pain relief during arterial puncture for blood gas analysis were the use of very fine-caliber needles, the use of needle-free pressure injectors for subcutaneous delivery of amino amides, and the application of ice for at least 3 minutes.

Background: The use of anticoagulants may influence the composition of blood cells and interfere with plasma levels of IL-1ra when unprocessed EDTA blood samples are stored for long periods of time., Methods: Blood was drawn into EDTA and heparinized blood collection tubes from 11 HIV-1 negative men participating in the Multicenter AIDS Cohort Study (MACS) and 4 healthy volunteers. The blood was processed according to the experiments detailed in the method and after incubation; supernatants were collected and stored at -70 °C until batch testing using IL-1ra ELISA., Results: There was no difference between the levels of IL-1ra in EDTA blood collected into plastic and glass tubes (p = .911). There were significant increases from baseline levels of IL-1ra (p ≤ .05) after 24 h incubation for diluted whole blood and PBMC supernatants but not for granulocytes supernatants., Conclusion: EDTA as an anticoagulant influences the blood concentrations of IL-1ra in unprocessed blood. Thus, EDTA blood is not a suitable specimen for measurement of IL-1ra. Other types of anticoagulated blood should be processed within one hour of draw whenever measuring plasma levels of IL-1ra., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Metabolomics and lipidomics are of fundamental importance to personalized healthcare. Particularly the analysis of bioactive lipids is of relevance to a better understanding of various diseases. Within clinical routines, blood derived samples are widely used for diagnostic and research purposes. Hence, standardized and validated procedures for blood collection and storage are mandatory, in order to guarantee sample integrity and relevant study outcomes. We here investigated different plasma storage conditions and their effect on plasma fatty acid and oxylipid levels. Our data clearly indicate the importance of storage conditions for plasma lipidomic analysis. Storage at very low temperature (-80 °C) and the addition of methanol directly after sampling are the most important measures to avoid ex vivo synthesis of oxylipids. Furthermore, we identified critical analytes being affected under certain storage conditions. Finally, we carried out chiral analysis and found possible residual enzymatic activity to be one of the contributors to the ex vivo formation of oxylipids even at -20 °C., (Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.)