PubMed · 10533680
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1999. Needlestick-prevention devices.. https://pubmed.ncbi.nlm.nih.gov/10533680/
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Human immunodeficiency virus type 1 viral load results were compared for paired samples collected in plastic and glass Vacutainer tubes, using both standard (n = 60) and ultrasensitive (n = 66) assays. The results showed a strong correlation (P < 0.0001), and plastic tubes can be substituted for glass tubes.
OBJECTIVES: To evaluate in a randomised blind study the effect on puncture site lesions of two different incision devices used to obtain blood samples from preterm infants by repeated heel sticks. SETTING: The neonatal intensive care unit at the Hospital for Children and Adolescents and Laboratory, Helsinki University Central Hospital. PATIENTS: A total of 100 preterm infants (birth weight below 2500 g) not previously subjected to heel stick sampling. INTERVENTIONS: The infants were randomly allocated to blood sampling from the heel with either a conventional manual lancet or an automatic incision device. The same type of lancet was used for any given baby throughout the study (2-21 days). MAIN OUTCOME MEASURES: The damage caused by sampling was evaluated using four criteria: bruising of the heel, inflammation of the heel, bruising of either the ankle or the leg, and skin healing at the puncture site. The evaluation was based on photographs presenting typical categories of each outcome. RESULTS: To obtain a sufficient volume of blood, on average 2.6 times more punctures were needed when the conventional manual lancet was used than when the automatic incision device was used. Heels punctured with the lancet had more bruising (100% v 84%) and more signs of inflammation (79% v 53%), and there was more bruising of the ankle or leg (92% v 53%) than when the automatic incision device was used. Skin healed equally rapidly in the two groups. CONCLUSION: The use of an automatic incision device for collecting repeated skin puncture samples from preterm infants is less traumatic than the use of a conventional manual lancet.
BACKGROUND: Management of pain in very low birth weight infants is limited by a lack of empiric knowledge about the multiple determinants of biobehavioral reactivity in infants receiving neonatal intensive care. OBJECTIVE: To examine relationship of early neonatal factors and previous medication exposure to subsequent biobehavioral reactivity to acute pain of blood collection. DESIGN: Prospective cohort study. Methods. One hundred thirty-six very low birth weight (</=1500 g) infants who underwent heel lance for blood collection at 32 weeks' postconceptional age formed the study sample, after excluding those with significant cerebral lesions (periventricular leukomalacia or cerebral parenchymal infarction [grade 4 intraventricular hemorrhage]) on cranial ultrasound. Pain reactions were assessed using the Neonatal Facial Coding System, infant state, and spectral analysis of change in heart rate variability from baseline to reaction to invasive stimulation. Factor analysis was used to provide an empirical basis for deriving summary pain scores, one factor was primarily behavioral and the other primarily autonomic. RESULTS: A normal reaction to procedural pain is characterized by facial grimacing and heightened cardiac sympathetic activity. The most significant factors associated with altered behavioral and autonomic pain reactivity at 32 weeks' postconceptional age were a greater number of previous invasive procedures since birth and gestational age (GA) at birth, both of which were related to a dampened response. After controlling for these variables, exogenous steroid exposure made an independent contribution to both the behavioral and autonomic pain scores, also in the direction of dampening the response. Conversely, previous exposure to morphine was associated with "normalized" (ie, increased) rather than diminished responses. In addition, higher mean heart rate at baseline was associated with lower GA at birth and longer time on mechanical ventilation. CONCLUSION: Early pain exposure at very low GA may alter the autonomic substrate, resulting in infants who are in a perpetual state of stress. The results of this study suggest that the judicious use of analgesia may ameliorate these effects on later pain reactivity. However, although early morphine exposure may "normalize" subsequent pain reaction, this study did not examine its effects on neurodevelopment.