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Quality Impact on Diagnostic Blood Specimen Collection Using a New Device to Relieve Venipuncture Pain

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Abstract

A new device called Buzzy® has been recently presented that combines a cooling ice pack and a vibrating motor in order to relieve the venipuncture pain. The aim of this study was to evaluate the impact of Buzzy® use during diagnostic blood specimen collection by venipuncture for routine immunochemistry tests. Blood was collected from 100 volunteers by a single, expert phlebotomist. A vein was located on the left forearm without applying tourniquet, in order to prevent any interference from venous stasis, and blood samples were collected using a 20-G straight needle directly into 5 mL vacuum tubes with clot activator and gel separator. In sequence, external cold and vibration by Buzzy® was applied on the right forearm—5 cm above the chosen puncture site—for 1 min before venipuncture and continued until the end of the same procedure already done in the left forearm. The panel of tests included the following: glucose, total cholesterol, HDL-cholesterol, triglycerides, total protein, albumin, c-reactive protein, urea, creatinine, uric acid, alkaline phosphatase, amylase, AST, ALT, g-glutamyltransferase, lactate dehydrogenase, creatine kinase, total bilirubin, phosphorus, calcium, magnesium, iron, sodium, potassium, chloride, lipase, cortisol, insulin, thyroid-stimulating hormone, total triiodothyronine, free triiodothyronine, total thyroxine, free thyroxine and haemolysis index. Clinically significant differences between samples were found only for: total protein, albumin and transferrin. The Buzzy® can be used during diagnostic blood specimens collection by venipuncture for the majority of the routine immunochemistry tests. We only suggest avoiding this device during blood collection when protein, albumin and transferrin determinations should be performed.

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References

  1. Plebani M, Lippi G. To err is human. To misdiagnose might be deadly. Clin Biochem. 2010;43(1–2):1–3.

    Article  PubMed  Google Scholar 

  2. International Organization for Standardization. Medical laboratories: particular requirements for quality and competence ISO document 15189. 2nd ed. Geneva: International Organization for Standardization; 2007.

    Google Scholar 

  3. Lippi G, Guidi GC. Preanalytic indicators of laboratory performances and quality improvement of laboratory testing. Clin Lab. 2006;52(9–10):457–62.

    PubMed  Google Scholar 

  4. Simundic AM, Nikolac N, Vukasovic I, Vrkic N. The prevalence of preanalytical errors in a Croatian ISO 15189 accredited laboratory. Clin Chem Lab Med. 2010;48(7):1009–14.

    Article  PubMed  CAS  Google Scholar 

  5. Simundic AM, Bilic-Zulle L, Nikolac N, Supak-Smolcic V, Honovic L, Avram S, et al. The quality of the extra-analytical phase of laboratory practice in some developing European countries and Mexico: a multicentric study. Clin Chem Lab Med. 2011;49(2):215–28.

    Article  PubMed  CAS  Google Scholar 

  6. Guzel O, Guner EI. ISO 15189 accreditation: requirements for quality and competence of medical laboratories, experience of a laboratory I. Clin Biochem. 2009;42(4–5):274–8.

    Article  PubMed  Google Scholar 

  7. Plebani M, Sciacovelli L, Marinova MM, J Chiozza M. Quality indicators in laboratory medicine: a fundamental tool for quality and patient safety. Clin Biochem. 2012;. doi:10.1016/j.clinbiochem.2012.11.028.

    Google Scholar 

  8. Inal S, Kelleci M. Relief of pain during blood specimen collection in pediatric patients. MNC Am J Matern Child Nurs. 2012;37(5):339–45.

    Google Scholar 

  9. Baxter A, Cohen L, McElvery H, Lawson M, von Baeyer C. An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department. Pediatr Emerg Care. 2011;27(12):1151–6.

    Article  PubMed  Google Scholar 

  10. Baxter A, Leong T, Mathew B. External thermomechanical stimulation versus vapocoolant for adult venipuncture pain: pilot data on a novel device. Clin J Pain. 2009;25(8):705–10.

    Article  PubMed  Google Scholar 

  11. Clinical Laboratory Standards Institute. Procedures for the collection of diagnostic blood specimens by venipuncture. CLSI H3–A6 document. 6th ed. Clinical Laboratory Standards Institute: Wayne; 2007.

    Google Scholar 

  12. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Impact of the phlebotomy training based on CLSI/NCCLS H03–A6: procedures for the collection of diagnostic blood specimens by venipuncture. Biochem Med (Zagreb). 2012;22(3):342–51.

    Article  Google Scholar 

  13. Guder WG, Narayanan S, Wisser H, Zawta B. Diagnostic samples: from the patient to the laboratory: the impact of preanalytical variables on the quality of laboratory results. 4th ed. New York: Wiley-Blackwell; 2009. p. 124.

    Google Scholar 

  14. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Mangueira C, Sumita N, et al. New ways to deal with known preanalytical issues: use of transilluminator instead of tourniquet for easing vein access and eliminating stasis on clinical biochemistry. Biochem Med (Zagreb). 2011;21(2):152–9.

    Article  PubMed  CAS  Google Scholar 

  15. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Scartezini M, Guidi GC, et al. Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing. Int J Lab Hematol. 2011;33(5):457–62.

    PubMed  CAS  Google Scholar 

  16. Lima-Oliveira G, Salvagno GL, Lippi G, Montagnana M, Scartezini M, Picheth G, et al. Elimination of the venous stasis error for routine coagulation testing by transillumination. Clin Chim Acta. 2011;412(15–16):1482–4.

    Article  PubMed  CAS  Google Scholar 

  17. Clinical Laboratory Standards Institute. Procedures for the handling and processing of blood specimens for common laboratory tests. CLSI H18–A4 document. 4th ed. Clinical Laboratory Standards Institute: Wayne; 2010.

    Google Scholar 

  18. Hyltoft Petersen P, Fraser CG. Strategies to set global analytical quality specifications in laboratory medicine: 10 years on from Stockholm consensus conference. Accred Qual Assur. 2010;15:323–330.

  19. Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biological variation: pros, cons and progress. Scand J Clin Lab Invest. 1999;59(7):491–500.

    Article  PubMed  CAS  Google Scholar 

  20. Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem. 2007;53(7):1338–42.

    Article  PubMed  CAS  Google Scholar 

  21. Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem. 1997;43(8 Pt 1):1348–51.

    PubMed  CAS  Google Scholar 

  22. Lippi G, Guidi GC, Mattiuzzi C, Plebani M. Preanalytical variability: the dark side of the moon in laboratory testing. Clin Chem Lab Med. 2006;44(4):358–65.

    Article  PubMed  CAS  Google Scholar 

  23. Bowen RA, Hortin GL, Csako G, Otanez OH, Remaley AT. Impact of blood collection devices on clinical chemistry assays. Clin Biochem. 2010;43(1–2):4–25.

    Article  PubMed  CAS  Google Scholar 

  24. Gren B. Incorrect guidelines for venipuncture affect the analytical results. Scand J Clin Lab Invest. 2009;69(8):815–6.

    Article  PubMed  Google Scholar 

  25. Lippi G, Guidi GC. Risk management in the preanalytical phase of laboratory testing. Clin Chem Lab Med. 2007;45(6):720–7.

    PubMed  CAS  Google Scholar 

  26. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in laboratory medicine. Clin Chem. 2002;48(5):691–8.

    PubMed  CAS  Google Scholar 

  27. Plebani M. Pre-analytical errors and patient safety. J Med Biochem. 2012;31:265–70.

    Article  Google Scholar 

  28. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Different manufacturers of syringes: a new source of variability in blood gas, acid-base balance and related laboratory test? Clin Biochem. 2012;45(9):683–7.

    Article  PubMed  CAS  Google Scholar 

  29. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Pre analytical management: serum vacuum tubes validation for routine clinical chemistry. Biochem Med (Zagreb). 2012;22(2):180–6.

    Article  Google Scholar 

  30. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Poli G, Solero GP, et al. K3EDTA vacuum tubes validation for routine hematological testing. ISRN Hematol. 2012;2012:875357.

    PubMed  Google Scholar 

  31. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Sodium citrate vacuum tubes validation: preventing preanalytical variability in routine coagulation testing. Blood Coagul Fibrinolysis. 2013;24(3):252–5.

    Google Scholar 

  32. Lippi G, Lima-Oliveira G, Nazer SC, Moreira ML, Souza RF, Salvagno GL, et al. Suitability of a transport box for blood sample shipment over a long period. Clin Biochem. 2011;44(12):1028–9.

    Article  PubMed  Google Scholar 

  33. Parenmark A, Landberg E. To mix or not to mix venous blood samples collected in vacuum tubes? Clin Chem Lab Med. 2011;49(12):2061–3.

    Article  PubMed  CAS  Google Scholar 

  34. Lippi G, Plebani M. Primary blood tubes mixing: time for updated recommendations. Clin Chem Lab Med. 2012;50(4):599–600.

    Article  PubMed  CAS  Google Scholar 

  35. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Gelati M, Volanski W, et al. Effects of vigoros mixing of blood vacuum tubes on laboratory test results. Clin Biochem. 2013;46(3):250–4.

    Article  PubMed  CAS  Google Scholar 

  36. Lippi G, Salvagno GL, Montagnana M, Lima-Oliveira G, Guidi GC, Favaloro EJ. Quality standards for sample collection in coagulation testing. Semin Thromb Hemost. 2012;38(6):565–75.

    Article  PubMed  Google Scholar 

  37. Cembrowski GS, Strauss S, Waldeland LJ, Kropp E, Adlis SA. Are phlebotomy services completely satisfying our patient customers? 1995 institute: frontiers in laboratory practice research. 1996:198-208.

  38. Oatey A, Stiller K. An evaluation of the level of satisfaction with a dedicated inpatient service at an rehabilitation centre. Int J Nurs Pract. 2009;15(6):553–9.

    Article  PubMed  Google Scholar 

  39. St Laurent RT. Evaluating agreement with a gold standard in method comparison studies. Biometrics. 1998;54(2):537–45.

    Article  PubMed  CAS  Google Scholar 

  40. Ricos C, Cava F, Garcia-Lario JV, Hernandez A, Iglesias N, Jimenez CV, et al. The reference change value: a proposal to interpret laboratory reports in serial testing based on biological variation. Scand J Clin Lab Invest. 2004;64(3):175–84.

    Article  PubMed  CAS  Google Scholar 

  41. Westgard J. Biological variation database specifications. 2010 January 2012 [cited 2010 11/13]; Available from: http://www.westgard.com/biodatabase1.htm.

  42. Cembrowski GS, Tran DV, Higgins TN. The use of serial patient blood gas, electrolyte and glucose results to derive biologic variation: a new tool to assess the acceptability of intensive care unit testing. Clin Chem Lab Med. 2010;48(10):1447–54. doi:10.1515/CCLM.2010.286.

    Article  PubMed  CAS  Google Scholar 

  43. Plebani M, Lippi G. Biological variation and reference change values: an essential piece of the puzzle of laboratory testing. Clin Chem Lab Med. 2012;50:189–90.

    PubMed  CAS  Google Scholar 

  44. Johnson J. Mechanisms of vasoconstriction with direct skin cooling in humans. Am J Physiol Heart Circ Physiol. 2007;292:H1690–1.

    Article  PubMed  CAS  Google Scholar 

  45. Pergola P, Kellogg D, Johnson J, Kosiba W, Solomon D. Role of sympathetic nerves in the vascular effects of local temperature in human forearm skin. Am J Physiol Heart Circ Physiol. 1993;265:H785–92.

    CAS  Google Scholar 

  46. Austin A, Patterson S, Kanel RV. Hemoconcentration and hemostasis during acute stress: interacting and independent effects. Ann Behav Med. 2011;42:153–73.

    Article  PubMed  Google Scholar 

  47. Risteli J, Winter WE, Kleerekoper M, Risteli L. Bone and mineral metabolism. In: Burtis CA, Edwards RA, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 5th ed. Amsterdam: Elsevier; 2012. p. 1733–801.

    Chapter  Google Scholar 

  48. Fuller J, Thomson R, Howe P, Buckley J. Effect of vibration on muscle perfusion: a systematic review. Clin Physiol Funct Imaging. 2013;33(1):1–10.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge Drs. David Valentim and Sylvio J. C. Romano, respectively technical director and president of Bioanalise (Teresina, Piaui, Brazil) for authorizing to perform this validation in their clinical laboratory. Special thanks to Mss. Marise D. R. Campelo and Katharyne S. A. Tajra for their skilful technical support, and to Mr. Flavio S. Gomes for his dedication in collecting all the diagnostic blood specimens for routine immunochemistry tests presented in this work.

Disclosure

All authors confirmed they have contributed to the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; and (c) final approval of the published article.

Conflicts of interest

No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Ospedale Policlinico, P.le L.A. Scuro, 37134, Verona, Italy

    Gabriel Lima-Oliveira, Gian Luca Salvagno, Martina Montagnana & Gian Cesare Guidi

  2. Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology, Federal University of Parana, Curitiba, Parana, Brazil

    Gabriel Lima-Oliveira, Geraldo Picheth & Gian Cesare Guidi

  3. MERCOSUL, Sector Committee of Clinical Analyses and in vitro Diagnostics, CSM 20, Rio de Janeiro, Brazil

    Gabriel Lima-Oliveira

  4. Brazilian Society of Clinical Analyses on Sao Paulo State, Sao Paulo, Brazil

    Gabriel Lima-Oliveira

  5. Laboratory of Clinical Chemistry and Hematology, Department of Pathology and Laboratory Medicine, Academic Hospital of Parma, Parma, Italy

    Giuseppe Lippi

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  1. Gabriel Lima-Oliveira
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  2. Giuseppe Lippi
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Correspondence to Gabriel Lima-Oliveira.

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Lima-Oliveira, G., Lippi, G., Salvagno, G.L. et al. Quality Impact on Diagnostic Blood Specimen Collection Using a New Device to Relieve Venipuncture Pain. Ind J Clin Biochem 28, 235–241 (2013). https://doi.org/10.1007/s12291-013-0319-y

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  • DOI: https://doi.org/10.1007/s12291-013-0319-y

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