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Shiroshita Y, Yonezawa K, Ota E, Ozawa M. Effects of automatic heel lancet on invasiveness in neonates: A systematic review and meta-analysis. Acta Paediatr 2024. [PMID: 38730307 DOI: 10.1111/apa.17268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
AIM We conducted a meta-analysis comparing the invasiveness of automatic lancet devices, which can collect adequate amount of blood at shallow puncture depths, with conventional manual lance devices (lancet or needle) to statistically identify less invasive instruments for neonatal heel lance. METHODS We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Ichushi databases for studies comparing the invasiveness between automatic lancet and manual lancet or needle in term and preterm neonates in neonatal intensive care unit. RESULTS This review included 9 out of 449 searched articles, with 673 neonates. Automatic lancet had significantly lower pain scores (standardised mean difference: -2.0, 95% confidence interval: -3.3 to -0.7), heart rate (mean difference: -8.0, 95% confidence interval: -13.8 to -2.1), cry duration (mean difference: -21.5, 95% confidence interval: -32.5 to -10.4), number of punctures (mean difference: -0.6, 95% confidence interval: -1.1 to -0.2), and duration of procedures (mean difference: -37.7, 95% confidence interval: -75.2 to -0.2) than manual lancet or needle. Furthermore, peripheral oxygen saturation was significantly higher in automatic lancet than in manual lancet or needle (mean difference: 4.5, 95% confidence interval: 0.5-8.5). CONCLUSION Automatic heel lancet devices were less invasive than manual heel lance devices (lancet or needle).
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Affiliation(s)
- Yui Shiroshita
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Mio Ozawa
- Department of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Yun CK, Choi EK, Kim HJ, Kim J, Park BC, Park K, Choi BM. Comparison between a laser-lancing device and automatic incision lancet for capillary blood sampling from the heel of newborn infants: a randomized feasibility trial. J Perinatol 2024:10.1038/s41372-023-01857-4. [PMID: 38216679 DOI: 10.1038/s41372-023-01857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Chul Kyu Yun
- Department of Medicine, Korea University Graduate School, Seoul, Republic of Korea
- Department of Pediatrics, Gyeonggi Provincial Medical Center, Anseong Hospital, Anseong-si, Gyeonggi-do, Republic of Korea
| | - Eui Kyung Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Kyuhee Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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Hoffman MSF, McKeage JW, Xu J, Ruddy BP, Nielsen PMF, Taberner AJ. Minimally invasive capillary blood sampling methods. Expert Rev Med Devices 2023; 20:5-16. [PMID: 36694960 DOI: 10.1080/17434440.2023.2170783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Whole blood samples, including arterial, venous, and capillary blood, are regularly used for disease diagnosis and monitoring. The global Covid-19 pandemic has highlighted the need for a more resilient screening capacity. Minimally invasive sampling techniques, such as capillary blood sampling, are routinely used for point of care testing in the home healthcare setting and clinical settings such as the Intensive Care Unit with less pain and wounding than conventional venepuncture. AREAS COVERED In this manuscript, we aim to provide a overview of state-of-the-art of techniques for obtaining samples of capillary blood. We first review both established and novel methods for releasing blood from capillaries in the skin. Next, we provide a comparison of different capillary blood sampling methods based on their mechanism, testing site, puncture size, cost, wound geometry, healing, and perceptions of pain. Finally, we overview established and new methods for enhancing capillary blood collection. EXPERT OPINION We expect that microneedles will prove to be a preferred option for paediatric blood collection. The ability of microneedles to collect a capillary blood sample without pain will improve paediatric healthcare outcomes. Jet injection may prove to be a useful method for facilitating both blood collection and drug delivery.
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Affiliation(s)
| | - James W McKeage
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Jiali Xu
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Bryan P Ruddy
- Auckland Bioengineering Institute, University of Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Poul M F Nielsen
- Auckland Bioengineering Institute, University of Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Andrew J Taberner
- Auckland Bioengineering Institute, University of Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
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The Effects of Manual and Automatic Lancets on Neonatal Capillary Heel Blood Sampling Pain: A Prospective Randomized Controlled Trial. J Pediatr Nurs 2021; 58:e8-e12. [PMID: 33303279 DOI: 10.1016/j.pedn.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to determine the effects of manual lancets and automatic lancets on neonatal capillary heel blood sampling pain. DESIGN AND METHODS This was a parallel-group, prospective, randomized controlled and observational trial. Participants were randomly assigned (1:1) to the manual lancet (odd days of the month) and automatic lancet groups (even days of the month) for capillary heel blood sampling. The sample consisted of 60 term neonates divided into two groups: Manual lancet (n = 30) and automatic lancet (n = 30). Heart rate, oxygen saturation, duration of blood collection, presence of crying, number of heel punctures, possible complications and pain were measured. RESULTS The manual lancet group had significantly lower oxygen saturation (P = .000), higher mean heart rate (P = .008), more crying neonates (P = .000), higher number of punctures for blood sampling (P = .000) and longer mean duration of blood collection (P = .000) than the automatic lancet group. While there was no difference in the prevalence of elevated temperature, stiffness and edema between the two groups, the automatic lancet group had less redness (P = .028), bruising (P = .000) and a significantly lower mean Neonatal Infant Pain Score than the manual lancet group (P = .000). CONCLUSION Use of automatic lancets for heel blood sampling helps reduce pain in neonates which is of critical importance. PRACTICE IMPLICATIONS Use of automatic lancets for heel blood sampling helps reduce pain in neonates. Therefore, neonatal nurses should routinely use automatic lancets in clinical settings to cause less pain in neonates.
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Goto T, Inoue T, Kamiya C, Kawabe H, Higuchi M, Suyama M, Goto T, Koide W, Maki K, Ushijima K, Ban K, Yamada Y. Neonatal pain response to automatic lancet versus needle heel-prick blood sampling: A prospective randomized controlled clinical trial. Pediatr Int 2020; 62:357-362. [PMID: 31917874 PMCID: PMC7187310 DOI: 10.1111/ped.14142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Tatenobu Goto
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Takeshi Inoue
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Chinami Kamiya
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hiroyuki Kawabe
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Machiko Higuchi
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Megumi Suyama
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Tomoki Goto
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Wakato Koide
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Kanemasa Maki
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Katsumi Ushijima
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Kyoko Ban
- Division of Pediatrics, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasumasa Yamada
- Department of Perinatal and Neonatal Medicine, Aichi Medical University Sciences, Nagakute, Aichi, Japan
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Goodwin S, Supachana N. A safety lancet for neonatal blood spot tests: a design that facilitates pain-free, atraumatic samples. ACTA ACUST UNITED AC 2019; 28:S24-S28. [PMID: 30673311 DOI: 10.12968/bjon.2019.28.2.s24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Sarah Goodwin
- Quality and Education Neonatal Senior Sister, Bath Royal United Hospitals NHS Foundation Trust, UK
| | - Nichole Supachana
- Laboratory Services Inpatient Supervisor, St Elizabeth Medical Center, Utica, NY, US
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Dur S, Balci S. Assessing Neonatal Pain, Duration of Crying and Procedure Time following Use of Automatic or Manual Heel Lances: A Randomized Controlled Study. J Trop Pediatr 2018; 64:488-494. [PMID: 29253244 DOI: 10.1093/tropej/fmx100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to compare neonatal pain, duration of crying and procedure time following use of automatic or manual heel lancets. METHODS This randomized trial was conducted with neonates undergoing heel prick procedures in a neonatal intensive care unit for routine blood bilirubin monitoring. An information form, an observation form and the Neonatal Infant Pain Scale (NIPS) were used. Pain before, during and after (1 and 3 min) was assessed using NIPS scoring. RESULTS Seventy neonates were included (automatic lancet, n = 35; manual lancet, n = 35); there was no difference between the groups (p > 0.01). Pain scores were significantly lower, with automatic lancets compared with manual lancets (p = 0.001). The duration of crying after the procedure (p = 0.001) and procedure time (p = 0.001) was significantly shorter with automatic lancets compared with manual lancets. CONCLUSION Automatic heel lancets in neonates are more effective than manual lancets at reducing pain, and shorten the procedure time and duration of post-procedural crying.
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Affiliation(s)
- Sadiye Dur
- Pediatric Nursing Department, Istanbul University Florence Nightingale Faculty of Nursing, Istanbul 34381, Turkey
| | - Serap Balci
- Pediatric Nursing Department, Istanbul University Florence Nightingale Faculty of Nursing, Istanbul 34381, Turkey
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Noureldein M, Gowda H. Question 2: Is it safe to use the centre of the heel for obtaining capillary blood samples in neonates? Arch Dis Child 2018; 103:401-404. [PMID: 29348114 DOI: 10.1136/archdischild-2017-314214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/27/2017] [Accepted: 12/29/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Mona Noureldein
- Neonatal Unit, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Harsha Gowda
- Neonatal Unit, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
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Sorrentino G, Fumagalli M, Milani S, Cortinovis I, Zorz A, Cavallaro G, Mosca F, Plevani L. The impact of automatic devices for capillary blood collection on efficiency and pain response in newborns: A randomized controlled trial. Int J Nurs Stud 2017; 72:24-29. [DOI: 10.1016/j.ijnurstu.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 01/12/2023]
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Lago P, Garetti E, Bellieni CV, Merazzi D, Savant Levet P, Ancora G, Pirelli A. Systematic review of nonpharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines. Acta Paediatr 2017; 106:864-870. [PMID: 28295585 DOI: 10.1111/apa.13827] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/24/2016] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Abstract
The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and nonpharmacological interventions. CONCLUSION There was sufficient evidence to strongly support the use of nonpharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit; Women's and Children's Health Department; Azienda Ospedaliera-University of Padova; Padova Italy
| | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Modena; Modena Italy
| | | | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | | | - Gina Ancora
- Women's and Children's Health Department; Infermi Hospital; Azienda Ospedaliera of Rimini; Rimini Italy
| | - Anna Pirelli
- NICU; MBBM Foundation; San Gerardo Hospital; Monza Italy
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Cerebral Oxygenation and Pain of Heel Blood Sampling Using Manual and Automatic Lancets in Premature Infants. J Perinat Neonatal Nurs 2015; 29:356-62. [PMID: 26505850 DOI: 10.1097/jpn.0000000000000138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Heel blood sampling is a common but painful procedure for neonates. Automatic lancets have been shown to be more effective, with reduced pain and tissue damage, than manual lancets, but the effects of lancet type on cortical activation have not yet been compared. The study aimed to compare the effects of manual and automatic lancets on cerebral oxygenation and pain of heel blood sampling in 24 premature infants with respiratory distress syndrome. Effectiveness was measured by assessing numbers of pricks and squeezes and duration of heel blood sampling. Pain responses were measured using the premature infant pain profile score, heart rate, and oxygen saturation (SpO2). Regional cerebral oxygen saturation (rScO2) was measured using near-infrared spectroscopy, and cerebral fractional tissue oxygen extraction was calculated from SpO2 and rScO. Measures of effectiveness were significantly better with automatic than with manual lancing, including fewer heel punctures (P = .009) and squeezes (P < .001) and shorter duration of heel blood sampling (P = .002). rScO2 was significantly higher (P = .013) and cerebral fractional tissue oxygen extraction after puncture significantly lower (P = .040) with automatic lancing. Premature infant pain profile scores during (P = .004) and after (P = .048) puncture were significantly lower in the automatic than in the manual lancet group. Automatic lancets for heel blood sampling in neonates with respiratory distress syndrome significantly reduced pain and enhanced cerebral oxygenation, suggesting that heel blood should be sampled routinely using an automatic lancet.
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Chatterjee M, Ge X, Kostov Y, Luu P, Tolosa L, Woo H, Viscardi R, Falk S, Potts R, Rao G. A rate-based transcutaneous CO2 sensor for noninvasive respiration monitoring. Physiol Meas 2015; 36:883-94. [PMID: 25832294 PMCID: PMC4417034 DOI: 10.1088/0967-3334/36/5/883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pain and risk of infection associated with invasive blood sampling for blood gas measurements necessitate the search for reliable noninvasive techniques. In this work we developed a novel rate-based noninvasive method for a safe and fast assessment of respiratory status. A small sampler was built to collect the gases diffusing out of the skin. It was connected to a CO2 sensor through gas-impermeable tubing. During a measurement, the CO2 initially present in the sampler was first removed by purging it with nitrogen. The gases in the system were then recirculated between the sampler and the CO2 sensor, and the CO2 diffusion rate into the sampler was measured. Because the measurement is based on the initial transcutaneous diffusion rate, reaching mass transfer equilibrium and heating the skin is no longer required, thus, making it much faster and safer than traditional method. A series of designed experiments were performed to analyze the effect of the measurement parameters such as sampler size, measurement location, subject positions, and movement. After the factor analysis tests, the prototype was sent to a level IV NICU for clinical trial. The results show that the measured initial rate of increase in CO2 partial pressure is linearly correlated with the corresponding arterial blood gas measurements. The new approach can be used as a trending tool, making frequent blood sampling unnecessary for respiratory status monitoring.
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Affiliation(s)
- M Chatterjee
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - X Ge
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - Y Kostov
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - P Luu
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - L Tolosa
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
| | - H Woo
- Department of Pediatrics, University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD 21201, United States
| | - R Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD 21201, United States
| | - S Falk
- GE Healthcare, 8880 Gorman Rd Laurel, MD 20723, United States
| | - R Potts
- Fluorometrix Biomedical, 517 Court Pl, Pittsburgh, PA 15210, United States
| | - G Rao
- Center for Advanced Sensor Technology, Department of Chemical, Biochemical and Environmental Engineering, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland 21250, United States
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Martin NJ, Cooper HJ. Challenges and opportunities in mass spectrometric analysis of proteins from dried blood spots. Expert Rev Proteomics 2014; 11:685-95. [DOI: 10.1586/14789450.2014.965158] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bergomi P, Chieppi M, Maini A, Mugnos T, Spotti D, Tzialla C, Scudeller L. Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial. Res Theory Nurs Pract 2014; 28:335-48. [DOI: 10.1891/1541-6577.28.4.335] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart (“Sonata K. 448”) in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure. Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was randomized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA). Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was +3 in the control arm, +1 in the glucose arm, +2 in the music arm (p = .008). Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.
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Phillips C, Clifton-Koeppel R, Sills J, Lomax JM, Rapini M, Huffman ML, Modanlou HD. Capillary blood draws in the NICU: the use of the Innovac quick-draw whole blood collection system versus traditional capillary blood draws. Neonatal Netw 2011; 30:175-178. [PMID: 21576052 DOI: 10.1891/0730-0832.30.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE (1) To determine the rate of damaged and discarded capillary blood draws in the NICU; (2) to compare the rate of damaged and discarded samples between traditional capillary blood draws and the Innovac Quick-Draw device; (3) to determine whether in-service training for nurses on capillary blood draws decreased the rate of damaged and discarded blood samples. DESIGN During Phase I of the study, the rate of capillary blood draws by the traditional method was determined. At the completion of Phase I, the manufacturer provided in-service training to senior nurses in the NICU with the use of the Innovac Quick-Draw device. Additional in-service training was also provided for the traditional capillary blood draw technique. Within a month of in-service training, an openly randomized study (Phase II) was carried out comparing traditional versus Innovac device capillary blood draws. SAMPLE All infants admitted to the NICU between June 2008 and June 2009 were eligible to be in the study. There were no exclusion criteria based on weight, gestational age, or gender because the sampling method was the only variable being assessed. Phase I lasted two months, whereas Phase II lasted approximately four months. MAIN OUTCOME VARIABLE Occurrence of damaged capillary samples with the Innovac device versus the traditional method. RESULTS In Phase I, the rate of damaged and discarded samples was 10 percent (28/278). In Phase II, the rate of damaged and discarded samples for traditional and Innovac device was 7.2 percent and 10 percent, respectively. Comparisons between traditional and Innovac for different type of samples were as follows: complete blood count, 11.0 percent (12/104) vs. 13.4 percent (14/104); serum electrolytes, 6.4 percent (6/94) vs. 9.5 percent (9/95); C-reactive protein, 5.7 percent (4/70) vs. 8.0 percent (5/62); and liver panel, 5.3 percent (7/131) vs. 8.3 percent (9/108). There were no statistically significant differences of damaged and discarded samples for the overall or individual sample type comparisons.
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Abstract
PURPOSE To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group. DESIGN AND METHODS A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Infants in the experimental group (n = 22) were swaddled and held in an upright position during routine heel lance procedures while neonates in the control group (n = 20) remained in a standard care position. Pain was measured with the Neonatal Inventory Pain Scale (NIPS) at two points in time for each group (just before the heel lance procedure and at the completion of the heel lance). Total collection time was measured using a stopwatch accurate to 1/100th of a second. Specimen quality was measured based on the number of rejected specimens for each group. Descriptive statistics and t tests were used to analyze the data. RESULTS The mean NIPS score for neonates who were swaddled and held during the procedure (experimental group) was significantly lower (M = 1.3, SD = .9) than the score for infants in the standard position (control group) (M = 2.7, SD = 1.3), t (40) = -4.48, p < .001. Although the total collection time was lower for infants who were swaddled (2 minutes and 17 seconds, SD = 59) versus (2 minutes and 47 seconds, SD = 85) for controls, this was not a statistically significant difference (p = .45). CLINICAL IMPLICATIONS Swaddling combined with positioning neonates upright during routine heel lance procedures offers nurses a nonpharmacologic method of neonatal pain reduction for heel sticks. This technique can be easily implemented on any unit independent of facility protocols. Furthermore, the technique is not associated with any cost or policy development, making it more likely that nurses can use it in practice.
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De Lima J, Carmo KB. Practical pain management in the neonate. Best Pract Res Clin Anaesthesiol 2010; 24:291-307. [DOI: 10.1016/j.bpa.2010.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lim HB, Rhu MJ, Jung JM, Jeon GW, Sin JB. A Comparative Study of Two Different Heel Lancet Devices for Blood Collection in Preterm Infants. ACTA ACUST UNITED AC 2010. [DOI: 10.5385/jksn.2010.17.2.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Hyo Bin Lim
- Department of Pediatrics, Good Gangan Hospital, Korea
| | - Mi Joo Rhu
- Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ji Mi Jung
- Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jong Beom Sin
- Department of Pediatrics, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Lago P, Garetti E, Merazzi D, Pieragostini L, Ancora G, Pirelli A, Bellieni CV. Guidelines for procedural pain in the newborn. Acta Paediatr 2009; 98:932-9. [PMID: 19484828 PMCID: PMC2688676 DOI: 10.1111/j.1651-2227.2009.01291.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/20/2009] [Accepted: 03/09/2009] [Indexed: 11/27/2022]
Abstract
UNLABELLED Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions. CONCLUSION These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy.
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Abstract
Capillary blood sampling is an essential method of blood collection performed by nurses of all skill levels to obtain samples for routine laboratory tests in neonates. Accuracy of results depends on proper heelstick and sample collection technique. Recent advances including development of devices designed specifically for heelstick capillary blood sampling and research into expanded safe heel capillary sampling sites are discussed. A step-by-step guide to capillary blood sampling is outlined along with evidence-based practice incorporating neonatal-appropriate disinfection and nonpharmacological analgesia that contribute to improved infant safety and comfort during and after the procedure.
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Affiliation(s)
- Laura A Folk
- Neonatal Intensive Care Unit, Georgetown University Hospital, Washington, DC, USA.
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Shepherd AJ, Glenesk A, Niven CA, Mackenzie J. A Scottish study of heel-prick blood sampling in newborn babies. Midwifery 2005; 22:158-68. [PMID: 16386341 DOI: 10.1016/j.midw.2005.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Revised: 05/15/2005] [Accepted: 07/01/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to conduct a randomised-controlled trial to investigate the effectiveness of two heel-prick devices (Tenderfoot and Genie Lancet) used in the newborn-baby screening test. DESIGN a randomised-controlled trial. PARTICIPANTS AND SETTING the homes of 340 healthy term newborn babies discharged from the maternity unit of Stirling Royal Infirmary, Scotland. Data were collected between April and November 2003. INTERVENTIONS babies were randomly allocated to be tested with either the Tenderfoot or Genie Lancet heel-prick device. MEASUREMENTS primary study outcomes include (1) quality of the blood sample; (2) time taken to collect the sample; (3) number of heel pricks required to take the sample; (4) whether squeezing of heel was required; (5) pain expressed by the baby; and (6) presence of bruising. A potential intervening variable was the experience of the midwife. FINDINGS on all outcomes, the Tenderfoot device was more effective than the Genie Lancet. Experienced midwives were more efficient in sample collection. KEY CONCLUSIONS this study shows that the Tenderfoot device saves significant time for midwifery staff, improves baby care and reduces the need for more than one heel prick at each test, making it superior to the Genie Lancet device. IMPLICATIONS FOR PRACTICE there is a case to be made for midwives to be issued with the Tenderfoot device for neonatal screening.
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Affiliation(s)
- Ashley J Shepherd
- Department of Nursing and Midwifery, University of Stirling, Stirling, FK9 4LA, Scotland, UK.
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