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Transfusion Clinique Et Biologique :... Feb 2023Therapeutic phlebotomy allows for a controlled and gradual decrease in red cell mass leading to improved blood flow and symptomatic relief in polycythaemia. The present...
OBJECTIVES
Therapeutic phlebotomy allows for a controlled and gradual decrease in red cell mass leading to improved blood flow and symptomatic relief in polycythaemia. The present study was aimed to determine the impact of serial fixed volume and fixed interval therapeutic phlebotomy protocol on the laboratory and clinical parameters in patients of polycythaemia.
MATERIAL AND METHODS
This prospective longitudinal study was conducted over 18 months. The desired haematocrit for polycythemia vera and secondary polycythemia was 45% and 52% respectively. A fixed volume of 350 ml phlebotomy was performed every-three days till the achievement of desired haematocrit. Complete blood count was performed before and after each procedure and iron studies were done at the time of enrolment and after the achievement of desired haematocrit. Post-procedure symptomatic relief was assessed by a 10-point visual analogue scale (VAS).
RESULTS
Of the 29 patients enrolled in the study, 3 patients were lost to follow up and data of 26 patients was analyzed. Mean Hb declined from 17.84 ± 1.88 gdL to 14.67 ± 1.14 gdL (p < 0.001) and mean haematocrit decreased from a baseline of 57.11 ± 5.47% to 46.27 ± 3.763% (p < 0.001) upon achievement of desired haematocrit. There was a significant decline in serum iron from the baseline of 132.85 ± 94.136 μg dL to 69.41 ± 58.643 μg dL at desired haematocrit. A significant change in VAS score of almost all clinical parameters was observed. Post phlebotomy hematocrit correlated negatively with the number of procedures (p = 0.015).
CONCLUSION
Our protocol yielded rapid and marked improvement in patients of primary and secondary polycythemia with minimal adverse events and significant amelioration of clinical parameters.
Topics: Humans; Polycythemia; Phlebotomy; Longitudinal Studies; Prospective Studies; Polycythemia Vera; Hematocrit
PubMed: 35835318
DOI: 10.1016/j.tracli.2022.07.003 -
Journal of Fish Biology Jul 2020Blood sampling through the caudal vasculature is a widely used technique in fish biology for investigating organismal health and physiology. In live fishes, it can... (Review)
Review
Blood sampling through the caudal vasculature is a widely used technique in fish biology for investigating organismal health and physiology. In live fishes, it can provide a quick, easy and relatively non-invasive method for obtaining a blood sample (cf. cannulation and cardiac puncture). Here, a general set of recommendations are provided for optimizing the blood sampling protocol that reflects best practices in animal welfare and sample integrity. This includes selecting appropriate use of anaesthetics for blood sampling as well as restraint techniques for situations where sedation is not used. In addition, ideal sampling environments where the fish can freely ventilate and strategies for minimizing handling time are discussed. This study summarizes the techniques used for extracting blood from the caudal vasculature in live fishes, highlighting the phlebotomy itself, the timing of sampling events and acceptable blood sample volumes. This study further discuss considerations for selecting appropriate physiological metrics when sampling in the caudal region and the potential benefits that this technique provides with respect to long-term biological assessments. Although general guidelines for blood sampling are provided here, it should be recognized that contextual considerations (e.g., taxonomic diversity, legal matters, environmental constraints) may influence the approach to blood sampling. Overall, it can be concluded that when done properly, blood sampling live fishes through the caudal vasculature is quick, efficient and minimally invasive, thus promoting conditions where live release of focal animals is possible.
Topics: Animal Welfare; Animals; Blood Specimen Collection; Fishes; Phlebotomy
PubMed: 32243570
DOI: 10.1111/jfb.14339 -
Peripheral Venipuncture Education Strategies for Nursing Students: An Integrative Literature Review.Journal of Infusion Nursing : the... 2020This integrative literature review identified strategies to teach peripheral venipuncture to nursing students. The following databases were searched for primary studies:... (Review)
Review
This integrative literature review identified strategies to teach peripheral venipuncture to nursing students. The following databases were searched for primary studies: Biblioteca Virtual em Saúde (BVS), PubMed, Web of Science, Education Resources Information Center (ERIC), SCOPUS, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The final sample was composed of 24 studies. The literature ranged from descriptive studies to controlled clinical trials and methodologic studies to construct products/instruments for teaching peripheral venipuncture. The most frequently identified teaching strategies were theoretical contents taught via theoretical lecture, e-learning courses, video lessons, and demonstration by specialists combined with practical exercises using a mannequin, human arms, and/or haptic devices. Despite the different methods used currently, the best patient outcomes were achieved when the student received the theoretical content in an educational setting before the practical training on a mannequin and/or a virtual simulator.
Topics: Clinical Competence; Education, Nursing; Humans; Phlebotomy; Problem-Based Learning; Students, Nursing
PubMed: 31876771
DOI: 10.1097/NAN.0000000000000351 -
International Journal of Laboratory... Jul 2021There are many preanalytical variables (PAV) that are known to affect coagulation testing. The more commonly acknowledged PAV addressed by the clinical laboratory tend... (Review)
Review
There are many preanalytical variables (PAV) that are known to affect coagulation testing. The more commonly acknowledged PAV addressed by the clinical laboratory tend to start with their influence on blood collection, but realistically coagulation PAV starts with the patient, where the laboratory has less influence or control. Patient selection and appropriate timing for blood collection may be integral for assuring proper diagnosis and management. Laboratory control and assurance for ideal phlebotomy practice would mitigate most PAVs related to blood collection to minimize suboptimal sample collection. Laboratory oversight of sample transportation, processing and storage will assure sample integrity until testing can be facilitated. The purpose of this document is to review common PAV that should be taken into consideration when ordering, performing and interpreting a coagulation test result, with additional attention to the effect of direct oral anticoagulants (DOACs).
Topics: Administration, Oral; Anticoagulants; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Humans; Partial Thromboplastin Time; Phlebotomy; Prothrombin Time; Specimen Handling; Time Factors
PubMed: 34288452
DOI: 10.1111/ijlh.13585 -
BMJ Open Dec 2022Anaemia is highly prevalent in critical illness and is associated with impaired outcomes during and after hospitalisation. However, the impact of interventions designed...
INTRODUCTION
Anaemia is highly prevalent in critical illness and is associated with impaired outcomes during and after hospitalisation. However, the impact of interventions designed to attenuate or treat anaemia during critical illness on post-hospitalisation haemoglobin recovery and functional outcomes is unclear.
METHODS AND ANALYSIS
The Practical Anemia Bundle for Sustained Blood Recovery (PABST-BR) clinical trial is a pragmatic, open-label, parallel group, single-centre, randomised clinical trial assessing the impact of a multifaceted anaemia prevention and treatment strategy versus standard care for improvement of haemoglobin concentrations and functional outcomes after critical illness. The intervention, which will be delivered early in critical illness for those with moderate-to-severe anaemia (ie, haemoglobin <100 g/L), includes three components: (1) optimised phlebotomy, (2) clinical decision support and (3) pharmacological anaemia treatment directed at the underlying aetiology of anaemia. In-person assessments will occur at 1 and 3 months post-hospitalisation for laboratory evaluations and multidimensional functional outcome assessments. The primary outcome is differences in haemoglobin concentrations between groups, with secondary endpoints of anaemia-related fatigue, physical function, cognition, mental health, quality of life, phlebotomy volumes and frequency, transfusions, readmissions and mortality through 1-year post-hospitalisation.
ETHICS AND DISSEMINATION
The study has been approved by the Institutional Review Board of the Mayo Clinic in Minnesota, USA. A Data Safety Monitoring Plan has been created in accordance with the policies of the Institutional Review Board and the study funder, the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH). The study will comply with NIH data sharing and dissemination policies. Results will be presented at national and international meetings and published in peer-reviewed journals. Designing and testing strategies to optimise haemoglobin recovery and improve functional outcomes after critical illness remain important research gaps. The PABST-BR trial will inform the development of a larger multicentre clinical trial.
TRIAL REGISTRATION NUMBER
NCT05167734.
Topics: United States; Humans; Critical Illness; Quality of Life; Anemia; Phlebotomy; Heart; Randomized Controlled Trials as Topic
PubMed: 36460332
DOI: 10.1136/bmjopen-2022-064017 -
Developmental Psychobiology Jul 2022Needle procedures are common throughout childhood and often elicit distress in children and parents. Heart rate variability (HRV), as an index of emotion regulation, can... (Randomized Controlled Trial)
Randomized Controlled Trial
Needle procedures are common throughout childhood and often elicit distress in children and parents. Heart rate variability (HRV), as an index of emotion regulation, can inform both self-regulatory and co-regulatory processes. Mindfulness may serve to regulate distress; however, no research has studied mindfulness or parent and child regulatory responding concurrently during venipuncture. Stemming from a randomized controlled trial investigating a mindfulness intervention, this study sought to describe regulatory responding (via HRV) throughout pediatric venipuncture and the role of cognitive-affective factors (mindfulness, parent anxiety, catastrophizing) in 61 parent-child dyads (7-12 years). We examined (1) patterns of parent and child HRV throughout venipuncture and whether a brief, randomly assigned audio-guided mindfulness versus control exercise affected this pattern and (2) the extent to which changes in parent and child HRV were synchronized throughout venipuncture, and whether parent catastrophizing and anxiety moderated this association. HRV differed as a function of procedural phase. Practicing the mindfulness versus control exercise did not consistently affect HRV in dyads. Positive synchrony was observed during the end of the intervention in dyads with high parental catastrophizing. Otherwise, a pattern of nonsynchrony emerged. Results provide foundational knowledge regarding children's internal (self) and external (parent) regulation mechanisms. RCT registration: NCT03941717.
Topics: Anxiety; Child; Heart Rate; Humans; Mindfulness; Parents; Phlebotomy
PubMed: 35603416
DOI: 10.1002/dev.22277 -
International Journal of Clinical... 2023This study compared the effect of ultrasound-guided subclavian vein puncture with traditional blind puncture and the double-screen control method by evaluating the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study compared the effect of ultrasound-guided subclavian vein puncture with traditional blind puncture and the double-screen control method by evaluating the one-time puncture success and total success rates, the completion time for puncture and catheterization, and short-term complications.
METHODS
From January 2020 to January 2021, 72 patients with right subclavian venipuncture catheterization were collected, 12 of whom were excluded (including 3 cases of pneumothorax, 2 cases of hemothorax, 1 case of difficult positioning of thoracic deformity, 1 case of severe drug eruption, 3 cases of clavicle fracture, and 1 case of severe coagulation dysfunction). The remaining 60 cases were randomly divided into the traditional group ( = 30) and the improved group ( = 30). We record two sets of ultrasound localization time, puncture time, one-time puncture power, total puncture success rate, and short-term (24-hour) complications.
RESULTS
Compared with the traditional group, the ultrasound positioning time and puncture time in the improved group were significantly reduced and the puncture success rate was higher. There were no complications, such as incorrect arterial puncture and the occurrence of pneumothorax, in either group.
CONCLUSION
The improved ultrasound-guided subclavian vein catheterization technique can greatly reduce the catheterization time and improve the success rate of puncture and catheterization. It can also reduce the occurrence of complications and damage to adjacent tissues. The operation is simple, fast, and easy to master, and it has a high popularization clinical value.
Topics: Humans; Catheterization, Central Venous; Phlebotomy; Pneumothorax; Punctures; Subclavian Vein; Ultrasonography, Interventional
PubMed: 37457808
DOI: 10.1155/2023/5534451 -
Pain Management Nursing : Official... Jun 2020Venous blood sampling is a common procedure in the hospital setting and cause significant pain and stress for children. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Venous blood sampling is a common procedure in the hospital setting and cause significant pain and stress for children.
AIM
This study was conducted to determine and compare the effects of balloon inflation, ball squeezing, and coughing methods on levels of pain and fear during venipuncture in children aged 7-12 years.
DESIGN
Experimental, randomized controlled study.
SETTING
The study was conducted at a state hospital in Turkey between March and July 2017.
PARTICIPANTS/SUBJECTS
The study population comprised children 7-12 years of age who were subjected to venous blood sampling in the phlebotomy unit of a state hospital. The study sample included 120 children for a confidence interval of 95% and statistical power of 80%.
METHODS
The children were assigned to one of four groups (balloon inflation, ball squeezing, coughing, and control groups), each including 30 participants. The children's pain and fear were rated before and after the procedure by the children themselves, their parents, and a researcher using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively.
RESULTS
Mean scores for pain and fear after the procedure were lower in all intervention groups compared with the control group (p = .001). There was no statistical difference in pain or fear scores between the intervention groups; however, the children in the coughing group had the lowest scores for both pain and fear.
CONCLUSION
Balloon inflation, ball squeezing, and coughing were all effective in reducing pain and fear associated with venipuncture in children aged 7-12 years. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture with minimal equipment and preparation.
Topics: Anesthetics, Local; Child; Fear; Female; Humans; Lidocaine; Male; Pain Management; Pain Measurement; Phlebotomy; Turkey
PubMed: 31501078
DOI: 10.1016/j.pmn.2019.07.006 -
Die Anaesthesiologie Mar 2023Placement of a peripheral indwelling venous catheter is a routinely performed invasive procedure, in which complications are often underestimated. In difficult venous...
Placement of a peripheral indwelling venous catheter is a routinely performed invasive procedure, in which complications are often underestimated. In difficult venous conditions multiple puncture attempts are often required, which are time consuming, unnecessarily painful for the patients and nevertheless not always successful. Due to the close anatomical relationship between superficial veins and peripheral nerves in the arm, puncture-related nerve injury is not uncommon. Despite limited data it could be shown that ultrasound-guided peripheral venepunctures are superior to traditional landmark techniques in terms of success rates, time saving, avoidance of complications and patient satisfaction. In order to successfully integrate the sonographic puncture technique for vascular access into routine processes, a structured training and further education are prerequisites. This must include anatomical knowledge, basic knowledge of ultrasound formation and training in sonographic needle guidance techniques.
Topics: Humans; Ultrasonography, Interventional; Ultrasonography; Phlebotomy; Veins; Punctures
PubMed: 36752817
DOI: 10.1007/s00101-022-01228-2 -
Clinical Chemistry and Laboratory... Jan 2024The collection of capillary blood microsamples via finger-prick has several advantages over traditional blood collection. It is considered convenient and more... (Review)
Review
The collection of capillary blood microsamples via finger-prick has several advantages over traditional blood collection. It is considered convenient and more patient-centric, enabling collection of the sample by the patient at her/his home with subsequent analysis in the lab following postal shipment. Determination of the diabetes biomarker HbA in self-collected microsamples to remotely monitor diabetes patients seems to be a very promising option which could eventually lead to better treatment adaptations and disease control. This is especially convenient/relevant for patients living in areas where venipuncture is impractical, or to support virtual consultations using telemedicine. Over the years, a substantial numbers of reports on HbA and microsampling have been published. However, the heterogeneity of the applied study designs and data evaluation is remarkable. This review provides a general and critical overview of these papers, along with specific points of attention that should be dealt with when aiming at implementing microsampling for reliable HbA determination. We focus on the used (dried) blood microsampling techniques, collection conditions, stability of the microsamples, sample extraction, analytical methods, method validation, correlation studies with conventional venous blood samples and patient satisfaction. Lastly, the possibility of using liquid instead of dried blood microsamples is discussed. Liquid blood microsampling is expected to have similar advantages as dried blood microsampling and several studies suggest it to be a suitable approach to collect samples remotely for subsequent HbA analysis in the lab.
Topics: Humans; Female; Blood Specimen Collection; Dried Blood Spot Testing; Phlebotomy; Diabetes Mellitus
PubMed: 37419657
DOI: 10.1515/cclm-2023-0228