Cerebral Oxygenation and Pain of Heel Blood Sampling Using Manual and Automatic Lancets in Premature Infants.
Heel blood sampling is a common but painful procedure for neonates. Automatic lancets have been shown to be more effective, with reduced pain and tissue damage, than manual lancets, but the effects of lancet type on cortical activation have not yet been compared. The study aimed to compare the effects of manual and automatic lancets on cerebral oxygenation and pain of heel blood sampling in 24 premature infants with respiratory distress syndrome. Effectiveness was measured by assessing numbers of pricks and squeezes and duration of heel blood sampling. Pain responses were measured using the premature infant pain profile score, heart rate, and oxygen saturation (SpO2). Regional cerebral oxygen saturation (rScO2) was measured using near-infrared spectroscopy, and cerebral fractional tissue oxygen extraction was calculated from SpO2 and rScO. Measures of effectiveness were significantly better with automatic than with manual lancing, including fewer heel punctures (P = .009) and squeezes (P < .001) and shorter duration of heel blood sampling (P = .002). rScO2 was significantly higher (P = .013) and cerebral fractional tissue oxygen extraction after puncture significantly lower (P = .040) with automatic lancing. Premature infant pain profile scores during (P = .004) and after (P = .048) puncture were significantly lower in the automatic than in the manual lancet group. Automatic lancets for heel blood sampling in neonates with respiratory distress syndrome significantly reduced pain and enhanced cerebral oxygenation, suggesting that heel blood should be sampled routinely using an automatic lancet.
Department of Neonatal Intensive Care Unit, Korea University Ansan Hospital, Ansan, Republic of Korea (Mr Hwang); and Department of Basic Nursing Science, School of Nursing, Korea University, Seoul, Republic of Korea (Mr Hwang and Seol).
Mi-Jung
MJ
Hwang
Geun Hee
GH
Seol
D001800:Blood Specimen Collection / Q000379:methods; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D057186:Comparative Effectiveness Research; D006365:Heel; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010101:Oxygen Consumption; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods; D018962:Phlebotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis*; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D013525:Surgical Instruments / Q000009:adverse effects / Q000592:standards