Introduction: Venipuncture is a starting point of most diagnostic processes and a common source of pain and anxiety in many patients. The study aimed to evaluate and report the pain perception upon needle insertion during phlebotomy using the novel UltraTouch™ Push Button Blood Collection Set (UTPBBCS) with a five-bevel tip and assess the recommendation from the patients to use UTPBBCS for future blood collections. Materials and Methods: The blood samples were collected with UTPBBCS (23 g) from 100 adult patients who reported at the outpatient department phlebotomy room for routine blood tests. The pain level was distributed into five scores. Consent and feedback were collected from all the patients. Results: In the current study, 89% of individuals reported “No Pain” (score 1), and 11% reported a score of 2. 100% of the study population reported less pain during the blood collection process with UTPBBCS. All the individuals who had undergone blood collection with an UltraTouch needle recommended this device for future blood collections. Conclusion: The results of this observational study provided insights on the use of technology such as the penta bevel needle and ultra-thin wall cannula, which reduced the pain during phlebotomy and improved patient experience. This can lead to a practice change in phlebotomy, especially for trypanophobia patients and patients with difficult venous access (thin and fragile veins) such as pediatric, geriatric, dialysis, and oncology patients. By reducing the number of phlebotomy attempts, pain, and hematoma, the patient's satisfaction score is improved, and they feel safe to come back to the hospital when seeking a health-care facility.
Keywords: Gauge, needle, pain, phlebotomy, sample collection
| Introduction|| |
Venipuncture is a starting point of most diagnostic processes and a common source of pain and anxiety in many patients., A study has shown that 30% of people presenting with needle phobia during phlebotomy had experienced an excruciating procedure related to needle insertion in the past. Among multiple factors contributing to the level of pain experienced by the patient, the needle gauge is an essential factor. In phlebotomy, the needle gauge typically ranges from 21 to 23 G. During skin penetration, the needles with smaller outer diameters produce lesser pain than those with larger outer diameters.,, Hence, decreasing the pain perception during venipuncture might reduce anxiety and fear during the blood collection procedure. A previous study showed that a five-bevel needlepoint design decreases penetration forces by 23% on average compared to a three-bevel design of the same gauge size. BD currently markets the BD Vacutainer® UltraTouch™ Push Button Blood Collection Set (UTPBBCS), which offers a reduced external diameter of the cannula while maintaining the inner diameter (Right Gauge™ ultra-thin wall technology) and a five-bevel tip, shown to reduce needle insertion forces. This allows a phlebotomist to select a smaller gauge needle without compromising sample quality or tube fill times, the trade-offs commonly associated with a smaller gauge needle. Together, the PentaPoint™ Comfort and Right Gauge™ technologies seek to reduce peak penetration forces and, ultimately, patient discomfort during peripheral venous blood collection.,
This study aimed to evaluate and report the pain perception upon needle insertion during phlebotomy while using UTPBBCS and also to assess the recommendation from the patients to use UTPBBCS for future blood collections.
| Materials and Methods|| |
Study design and objective
This prospective observational study was conducted at the outpatient phlebotomy room of Apollo Main Hospital, Chennai. It was designed to analyze the pain perception of the patients during blood collection with UTPBBCS and their recommendation to use it for future blood collections. The blood samples were collected with UTPBBCS (23 g) from 100 adult patients who reported at the outpatient department phlebotomy room for routine blood tests from 10 a.m. to 2 p.m. on June 10, 2022. In the current study, the pain level was distributed into five scores. It was hypothesized that pain perception would be less if an individual reported scores of 1 and 2. Beyond these two levels, the pain level was considered unimproved. A consent form was collected according to the institution's policy, and a feedback form was composed after the completion of the procedure.
All patients who reported to the phlebotomy room between 11 a.m. and 02:00 p.m. and gave consent for the blood collection with UTPBBCS.
Patients who did not give consent for the blood collection with UTPBBCS.
Description of the study device
The study device was the newly developed BD Vacutainer® UTPBBCS with PentaPoint™ Comfort five-bevel needle technology. This device has been approved by the United States Food and Drug Administration (USFDA) to obtain blood specimens from patients with difficult venous access. As shown in [Figure 1], the five-bevel tip is cut at five different angles in contrast to the three angles of the standard three-bevel needle tip design. The unique design of the UTPBBCS reduces the needle penetration force by creating a flatter, thinner surface, which helps to penetrate the skin with greater ease. UTPBBCS also incorporates Right Gauge™ technology, which reduces the cannula wall thickness and increases the inner diameter of the cannula [Figure 2], enabling the use of a smaller gauge needle for blood collection.,
|Figure 2: A comparison of a standard thin wall cannula (a) with an ultrathin wall (b) cannula|
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Data collection procedure
Following the collection of written consent to participate in the study, a trained phlebotomist assessed and identified at least one venipuncture site. Once identified, venipuncture was performed on each subject by the phlebotomist using BD Vacutainer® UTPBBCS and tubes, as per the tests mentioned on the requisition form. Following blood collection, all boxes collected were sent to the laboratory following local procedures. At the end of each blood collection procedure, a questionnaire was used to record the following information for each observed venipuncture, thereby compiling the patient's response to pain and their recommendation for using this device for future collections.
The data were analyzed and presented as a percentage analysis for pain perception and patient recommendation for blood collection with UTPBBCS.
| Results|| |
In the current study, 89% of individuals reported “No Pain” (score 1) and 11% reported a score of 2. According to our present study hypothesis, 100% of the study population reported less pain during the blood collection process with UTPBBCS. Out of these 100 individuals, there were 58 males and 42 females. Out of 58 males, 54 reported scores of 1, and 4 reported scores of 2. Out of 42 females, 35 reported a score of 1, and 7 reported a score of 2 during blood collection. Eighty-six percent of patients in the age group of 15–39 and 40–60 years experienced “No Pain,” i.e., (1), and 14% reported a score of 2. The study also found that 100% of individuals in the age group of more than 60 years experienced “No Pain” with the UTPBBCS during blood collection [Table 1].
The study also found out that all the individuals who had undergone blood collection with an UltraTouch needle recommended this device for future blood collections [Table 2].
|Table 2: Patient recommendation to use UltraTouch Push Button Blood Collection Set|
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The validity of all the samples collected was retained, and there was no sample rejection.
| Discussion|| |
The results clearly showed that utilization of UTPBBCS used in this study reduced the pain perception of patients during phlebotomy and improved the patient satisfaction score with overall service. Similar findings were published in multiple studies. In a 2017 study, the investigators concluded that the UTPBBCS provided less pain and discomfort to the patient during phlebotomy. In a 2021 study, the investigators concluded that using UTPBBCS improved the patient experience and specimen quality during phlebotomy in relevant oncology patient populations. In a recent study, the investigators concluded that UTPBBCS provided less pain and improved the ease of use for phlebotomists in a pediatric patient population.
Phlebotomy usually is considered to be a very simple procedure. In this aspect, a large multicenter study, which reported an average completion time of 6 min in about 50% of procedures, also showed that in 10% of cases, the blood draw required at least 21 min or even an hour to be accomplished, with a third of the patients experiencing more distress or pain than expected.
Pain and its impact on patient satisfaction
Blood collection is mostly the first interface of the patient to the laboratory. Any unpleasant experience there, in terms of multiple punctures, pain, bruising, hematoma, etc., can negatively impact the patient's overall experience with the laboratory and cause significant anxiety and apprehensions for future blood sampling. An American Opinion Research survey found that three-fourths of 200 plus patients reported that the phlebotomist had difficulty collecting their blood, and, of those, 90% suffered bruises and 84% felt more pain. Overall, eight out of ten patients surveyed indicated that the experience of blood collection affected their level of satisfaction and their confidence in the staff and institution and its ability to provide exemplary patient service.
The author would like to acknowledge a few limitations in the study, such as the lack of comparative data between the 23-gauge UTPBBCS with a similar 23-gauge blood collection set currently used in the hospital. In addition, there might have been a bias in the study participants, as those with trypanophobia may not have agreed to participate.
| Conclusion|| |
The results of this observational study provided additional insights on the use of technology such as the penta bevel needle and ultra-thin wall cannula, which reduced the pain during phlebotomy and improved patient experience. All the patients recommended this device for future use. This can lead to a practice change in phlebotomy, especially for trypanophobia patients and patients with difficult venous access (thin and fragile veins) such as pediatric, geriatric, dialysis, and oncology patients. By reducing the number of phlebotomy attempts, pain, and hematoma, the patient's satisfaction score is improved, and they feel safe to come back to the hospital when seeking a health-care facility.
The author would like to thank Mr. Marudhupandian from the Department of Hematology and Clinical Pathology assisted with the study.
Conflicts of interest
There are no conflicts of interest.
Ethics committee approval
Ethics committee approval was not done for the study as the product is FDA approved and is already being used for sample collection. We did not do any extra intervention on the patients. Patients' consent was taken.
Dr. Mamta Soni: Conception of the idea, conducting the study, drafting the manuscript, submission, and final approval of the version to be published.
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Department of Hematology and Clinical Pathology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Chennai - 600 031, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2]