Main Article Content
Abstract
BACKGROUND
Laboratory and clinical data suggest that 70% of laboratory errors take place in the preanalytical phase and it is the most neglected part of the laboratory process. Needle phobia and hemolysis are the major problems in the preanalytical process. Complications during venipuncture due to pain-related needle phobia may lead to puncture of artery instead of the vein and in certain cases nerve damage, pain, numbness and thus resulting in unhappy patient experience and anxiety. Hence, the current evaluation focused on pain perception during venipuncture and the incidence of hemolysis.
Objectives
The current study intended to find out that the BD Vacutainer® UltraTouch™ push button blood collection set (25G) a) can improve the experience of blood draw in terms of pain perception, b) had insignificant effect on hemolysis in terms of potassium value, c) had insignificant impact on result variation for lactate dehydrogenase, aspirate aminotransferase, iron, cholesterol, creatinine, RBC (Red Blood Cell), haemoglobin (Hb), and platelet count compared to the current blood collection practice.
METHODS
The study was divided into three phases: Phase 1 – determining pain perception during blood collection with BD Vacutainer® UltraTouch™ push button blood collection set (UTPBBCS), Phase 2 – comparing potassium value between the blood samples taken with UTPBBCS and those using BD Vacutainer® Flashback Needle (FBN), Phase 3 – comparing lactate dehydrogenase, aspirate aminotransferase, iron, cholesterol, creatinine, RBC (Red Blood Cell), haemoglobin (Hb), and platelet count.
RESULTS
This study found that 91.67% of participants responded with nil to negligible pain and there was no evidence of hemolysis and the evaluated parameters (K+ - Potassium, lactate dehydrogenase, aspirate aminotransferase, iron, cholesterol, creatinine, RBC, haemoglobin, platelet count) were found to be consistent.
CONCLUSIONS
Phlebotomists found UTPBBCS to be a reliable device and well-received by the volunteers as it minimized pain. Also, there was no hemolysis due to the 25G needle. Therefore, UTPBBCS (25G) can be considered as less painful blood collection device due to a significantly better blood collection experience without compromising sample quality.
Keywords
Article Details

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References
- Bonini PA, Plebani M, Ceriotti F, et al. Errors in laboratory medicine. Clin Chem 2002;48(5):691–8.
- Kader S, Kirmit A, Akdag T, et al. Evaluation of BD vacutainer eclipse and BD vacutainer ultra-touch butterfly blood collecting sets in laboratory testing. Turk J Biochem 2021;46(6):685-91.
- Lima-Oliveira G, Volanski W, Lippi G, et al. Preanalytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest 2017;77(3):153-63.
- Lippi G, Lima-Oliveira G, Brocco G, et al. Estimating the intra- and inter-individual imprecision of manual pipetting. Clin Chem Lab Med 2017;55(7):962-66.
- Lundberg GD. Acting on significant laboratory results. JAMA 1981;245(17):1762-63.
- Plebani M, Lippi G. Closing the brain-to-brain loop in laboratory testing. Clin Chem Lab Med 2011;49(7):1131-33.
- Lima-Oliveira G, Lippi G, Salvagno GL, et al. Laboratory Diagnostics and Quality of Blood Collection. J Med Biochem 2015;34(3):288–94.
- Gelena HJ. Complications occurring from diagnostic venipuncture. J Fam Pract 1992;34(5):582-84.
- Ohnishi H, Watanabe M, Watanabe T. Butterfly needles reduce the incidence of nerve injury during phlebotomy. Archives of Pathology and Laboratory Medicine 2012. doi:10.5858/arpa.2011-0431-L
- Sander HW, Conigliari MF, Masdeu JC. Antecubital phlebotomy complicated by lateral antebrachial cutaneous neuropathy. N Engl J Med 1998;339(27):2024.
- Berry PR, Wallis WE. Venipuncture nerve injuries. Lancet 1977;8024:1236–37.
- Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract 1995;41:169-75.
- Boas EP. Some immediate causes o f cardiac infarction. Am Heart J 1942;23(1):1-15.
- Cass N [letter], Anaesth Intensive Care. 1978;6:169-70.
- Dale WA. Cardiac arrest: review and report of 12 cases. Arm Surg 1952;135(3):376-93.
- Kulvin MM. Scared to death [letter], JAMA 1966;198:90.
- Lockey RF, Benedict LM, Turkeltaub PC, et al. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79(4):660-7.
- Lockhart RJ. Toxic erythema; TAB (intravenously); coronary thrombosis; sudden death. Br J Dermatol 1939; 51(7):318-21.
- Morland A. Pleural shock. Lancet 1949;254(6588):1021-3.
- Rutsky EA. Bradycardic rhythms during peritoneal dialysis. Arch Intern Med 1971;128(3):445-7.
- Sauls LJ. Sudden death at impasse. Psychoanal Forum 1966;1:88-93.
- Turk LN, Glenn WWL. Cardiac arrest. N Engl J Med 1954;251:79 5-803.
- Turkeltaub PC, Gergen PJ. The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements. J Allergy Clin Immunol 1989;84(6):886-90.
- Zukerman CM. Fatality in a blood donor; a case report, with a review o f the literature. Ann Intern Med 1947;26(4):603-8.
- Gill HS, Prausnitz MR, Does needle size matter? J Diabetes Sci Technol 2007;1(5):725-29.
- Heyer NJ, Derzon JH, Winges L, et al. Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012;45(13-14):1012-32.
- Lippi G, Salvagno GL, Montagnana M, et al. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. CCLM 2006;44(8):1009-14.
- Koseoglu M, Hur A, Atay A, et al. Effects of hemolysis interference on routine biochemistry parameters. Biochem Med 2011;21(1):79-85.
- de Jonge G, Dos Santos TL, Cruz BR, et al. Interference of in vitro hemolysis complete blood count. J Clin Lab Anal 2018;32(5):e22396.
- Wan Azman WN, Omar J, Koon TS, et al. Hemolyzed specimens: major challenge for identifying and rejecting specimens in clinical laboratories. Oman Med J 2019;34(2):94-8.
- Likert scale questions - How it helps measure respondent attitude. https://www.questionpro.com/article/likert-scale-survey-questions.html
- May B. Verbal numerical rating scale: a reliable pediatric pain assessment tool. 2017. https://www.clinicalpainadvisor.com/pediatric-pain-management/verbal-numerical-rating-scale-a-reliable-pediatric-pain-assessment-tool/
- World Health Organization WHO guidelines on drawing blood: best practices in phlebotomy. 2010. http://www.who.int/en/
- Calculation for the Chi-Square test. 2022. Interactive Chi-Square Tests (quantpsy.org)
- Homogeneity of Variance Calculator–Levene’s Test. 2022. https://www.socscistatistics.com/tests/levene/default.aspx
- Descriptive statistics and CI of mean. 2022. https://www.graphpad.com/quickcalcs/CImean1/?Format=C
- t Test calculator. 2022. https://www.graphpad.com/quickcalcs/ttest1/?format=C
- American Opinion Research Strategic. Patient Preference for Blood Collection Devices. 2012. Research based on interviews with 201 patients.
- Hirsch L, Gibney M, Berube J, et al. Impact of a modified needle tip geometry on penetration forceas well as acceptability, preference, and perceived pain in subjects with diabetes. J Diabetes Sci Technol 2012;6(2):328-35.
- Arendt-Nielsen L, Egekvist H, Bjerring P. Pain following controlled cutaneous insertion of needles with different diameters. Somatosens Mot Res 2006;23(1-2):37-43.
- Kennedy C, Angermuller S, King R, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs 1996;22(6):566-69.
- Van Cleve L, Johnson L, Pothier P. Pain responses of hospitalized infants and children to venipuncture and intravenous cannulation. J Pediatr Nurs 1996;11(3):161-8.
- Baba LR, McGrath JM, Liu J. The efficacy of mechanical vibration analgesia for relief of heel stick pain in neonates: a novel approach. J Perinat Neonatal Nurs 2010;24(3):274-83.
References
Bonini PA, Plebani M, Ceriotti F, et al. Errors in laboratory medicine. Clin Chem 2002;48(5):691–8.
Kader S, Kirmit A, Akdag T, et al. Evaluation of BD vacutainer eclipse and BD vacutainer ultra-touch butterfly blood collecting sets in laboratory testing. Turk J Biochem 2021;46(6):685-91.
Lima-Oliveira G, Volanski W, Lippi G, et al. Preanalytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest 2017;77(3):153-63.
Lippi G, Lima-Oliveira G, Brocco G, et al. Estimating the intra- and inter-individual imprecision of manual pipetting. Clin Chem Lab Med 2017;55(7):962-66.
Lundberg GD. Acting on significant laboratory results. JAMA 1981;245(17):1762-63.
Plebani M, Lippi G. Closing the brain-to-brain loop in laboratory testing. Clin Chem Lab Med 2011;49(7):1131-33.
Lima-Oliveira G, Lippi G, Salvagno GL, et al. Laboratory Diagnostics and Quality of Blood Collection. J Med Biochem 2015;34(3):288–94.
Gelena HJ. Complications occurring from diagnostic venipuncture. J Fam Pract 1992;34(5):582-84.
Ohnishi H, Watanabe M, Watanabe T. Butterfly needles reduce the incidence of nerve injury during phlebotomy. Archives of Pathology and Laboratory Medicine 2012. doi:10.5858/arpa.2011-0431-L
Sander HW, Conigliari MF, Masdeu JC. Antecubital phlebotomy complicated by lateral antebrachial cutaneous neuropathy. N Engl J Med 1998;339(27):2024.
Berry PR, Wallis WE. Venipuncture nerve injuries. Lancet 1977;8024:1236–37.
Hamilton JG. Needle phobia: a neglected diagnosis. J Fam Pract 1995;41:169-75.
Boas EP. Some immediate causes o f cardiac infarction. Am Heart J 1942;23(1):1-15.
Cass N [letter], Anaesth Intensive Care. 1978;6:169-70.
Dale WA. Cardiac arrest: review and report of 12 cases. Arm Surg 1952;135(3):376-93.
Kulvin MM. Scared to death [letter], JAMA 1966;198:90.
Lockey RF, Benedict LM, Turkeltaub PC, et al. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79(4):660-7.
Lockhart RJ. Toxic erythema; TAB (intravenously); coronary thrombosis; sudden death. Br J Dermatol 1939; 51(7):318-21.
Morland A. Pleural shock. Lancet 1949;254(6588):1021-3.
Rutsky EA. Bradycardic rhythms during peritoneal dialysis. Arch Intern Med 1971;128(3):445-7.
Sauls LJ. Sudden death at impasse. Psychoanal Forum 1966;1:88-93.
Turk LN, Glenn WWL. Cardiac arrest. N Engl J Med 1954;251:79 5-803.
Turkeltaub PC, Gergen PJ. The risk of adverse reactions from percutaneous prick-puncture allergen skin testing, venipuncture, and body measurements. J Allergy Clin Immunol 1989;84(6):886-90.
Zukerman CM. Fatality in a blood donor; a case report, with a review o f the literature. Ann Intern Med 1947;26(4):603-8.
Gill HS, Prausnitz MR, Does needle size matter? J Diabetes Sci Technol 2007;1(5):725-29.
Heyer NJ, Derzon JH, Winges L, et al. Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012;45(13-14):1012-32.
Lippi G, Salvagno GL, Montagnana M, et al. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. CCLM 2006;44(8):1009-14.
Koseoglu M, Hur A, Atay A, et al. Effects of hemolysis interference on routine biochemistry parameters. Biochem Med 2011;21(1):79-85.
de Jonge G, Dos Santos TL, Cruz BR, et al. Interference of in vitro hemolysis complete blood count. J Clin Lab Anal 2018;32(5):e22396.
Wan Azman WN, Omar J, Koon TS, et al. Hemolyzed specimens: major challenge for identifying and rejecting specimens in clinical laboratories. Oman Med J 2019;34(2):94-8.
Likert scale questions - How it helps measure respondent attitude. https://www.questionpro.com/article/likert-scale-survey-questions.html
May B. Verbal numerical rating scale: a reliable pediatric pain assessment tool. 2017. https://www.clinicalpainadvisor.com/pediatric-pain-management/verbal-numerical-rating-scale-a-reliable-pediatric-pain-assessment-tool/
World Health Organization WHO guidelines on drawing blood: best practices in phlebotomy. 2010. http://www.who.int/en/
Calculation for the Chi-Square test. 2022. Interactive Chi-Square Tests (quantpsy.org)
Homogeneity of Variance Calculator–Levene’s Test. 2022. https://www.socscistatistics.com/tests/levene/default.aspx
Descriptive statistics and CI of mean. 2022. https://www.graphpad.com/quickcalcs/CImean1/?Format=C
t Test calculator. 2022. https://www.graphpad.com/quickcalcs/ttest1/?format=C
American Opinion Research Strategic. Patient Preference for Blood Collection Devices. 2012. Research based on interviews with 201 patients.
Hirsch L, Gibney M, Berube J, et al. Impact of a modified needle tip geometry on penetration forceas well as acceptability, preference, and perceived pain in subjects with diabetes. J Diabetes Sci Technol 2012;6(2):328-35.
Arendt-Nielsen L, Egekvist H, Bjerring P. Pain following controlled cutaneous insertion of needles with different diameters. Somatosens Mot Res 2006;23(1-2):37-43.
Kennedy C, Angermuller S, King R, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs 1996;22(6):566-69.
Van Cleve L, Johnson L, Pothier P. Pain responses of hospitalized infants and children to venipuncture and intravenous cannulation. J Pediatr Nurs 1996;11(3):161-8.
Baba LR, McGrath JM, Liu J. The efficacy of mechanical vibration analgesia for relief of heel stick pain in neonates: a novel approach. J Perinat Neonatal Nurs 2010;24(3):274-83.