title: The comparison of heparinized insulin syringes and safety-engineered blood gas syringes used in arterial blood gas sampling in the ED setting (randomized controlled study).
abstract: BACKGROUND
  The arterial blood gas measurement process is a painful and invasive procedure, often uncomfortable for both the patient and the physician. Because the patient-related factors that determine the difficulty of the process cannot be controlled, the physician-related factors and blood gas measurement techniques are a modifiable area of improvement that ought to be considered. Many hospitals use insulin syringes or syringes washed with heparin for the purpose of blood gas measurement because they do not have blood gas-specific syringes. In this prospective cross-sectional study, we aimed to compare safety-engineered blood gas syringes and conventional heparinized syringes used during the arterial blood gas extraction process in terms of ease of operation, the physician-patient satisfaction, laboratory appropriateness, and complications.
  
  
  METHODS
  Our study included patients whose arterial blood gas needed to be measured in the emergency department and who agreed to participate in the study. Patients were randomly divided into 2 groups. The arterial blood gas of the patients from the first group was measured by using conventional heparinized syringes, whereas safety-engineered blood gas syringes were used to measure the arterial blood gas of the patients from the second group. The groups were compared in terms of demographic data, the number of attempts, the physician and patient satisfaction, early and late-term complications, and laboratory appropriateness of the taken sample.
  
  
  RESULTS
  A total of 550 patients were included in our study in a 2-month study period. There were no significant differences between patients in terms of sex, age, weight, height, body mass index, and wrist circumference. In addition, the number of attempts (P=.489), patients' pain level during the procedure (P=.145), and the degree of difficulty of the procedure according to the patient (P=.109) and physician (P=.554) were not significantly different between the groups. After arterial blood gas extraction procedure, 115 patients (20.9%) developed complications. In the conventional heparinized syringe group, the complication rate (n=69; 25.1%) was significantly higher compared with the group that used safety-engineered blood gas syringes (n=46; 16%; P=.0211). Localized pain, which is one of the most common early complications, was more frequent in the conventional heparinized syringe group (19.3%). Complications in women (P=.003) and local pain (P=.01) developed lesser in the second group that used safety-engineered blood gas syringes, and the patient-physician satisfaction was higher in that group, as well. In the evaluation 48 hours after the procedure, the ratios of infection and local hematoma were higher in the conventional heparinized syringe group (P=.0213 and P < .0001).
  
  
  CONCLUSIONS
  In this study, we did not find any significant differences between the conventional heparinized syringes and safety-engineered blood gas syringes in terms of ease of operation, physician and patient satisfaction, and appropriateness of the taken sample. However, patients whose arterial blood gas was extracted by using safety-engineered blood gas syringes felt less pain and experienced fewer infections and hematomas at their puncture site.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Konak, Turkey; Department of Emergency Medicine, Ardahan State Hospital, Ardahan, Turkey. Electronic address: sevcan_sevcan@mynet.com.
authors.forename: Sevcan Baki
authors.initials: SB
authors.lastname: Baskın
authors.affiliation: Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Konak, Turkey. Electronic address: nese.oray@deu.edu.tr.
authors.forename: Neşe Çolak
authors.initials: NÇ
authors.lastname: Oray
authors.affiliation: Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Konak, Turkey. Electronic address: sedat.yanturali@deu.edu.tr.
authors.forename: Sedat
authors.initials: S
authors.lastname: Yanturalı
authors.affiliation: Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Konak, Turkey. Electronic address: basakdr@yahoo.com.
authors.forename: Başak
authors.initials: B
authors.lastname: Bayram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001784:Blood Gas Analysis; D001800:Blood Specimen Collection / Q000295:instrumentation*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007328:Insulin; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013594:Syringes; D014421:Turkey
chemical_list: D000925:Anticoagulants; D007328:Insulin; D006493:Heparin