The Agreement between State-Trait-Anxiety-Inventory (STAI) and Beck Anxiety Inventory (BAI) on Measuring Anxiety Level Among Adult Patients Before Venepuncture Procedure

@#Introduction: Venepuncture procedure is painful and anxiety associated with venepuncture is common. There are many tools for assessing anxiety levels in an outpatient setting. Hence, this study is to compare the degree of agreement between State-Trait-Anxiety-Inventory (STAI) and Beck Anxiety Inventory (BAI) for measuring anxiety levels among adult patients before venepuncture procedure. Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in the Phlebotomy Unit, UiTMMC in April 2020. The Malay-validated version of the State-Trait-Anxiety-Inventory (STAI) and Beck Anxiety Inventory (BAI) were used to assess the anxiety level. Differences between sets of data were plotted as described by Bland-Altman to determine the agreement between these two assessment tools. Results: A total of 330 patients participated in the study with a mean age of 46.34 ± 14.34 years old and gender was equally distributed. The scores of state-anxiety (STAI-S), trait-anxiety (STAI-T) and BAI score were 30.04 ± 20.74; 29.51 ± 19.11; and 40.98 ± 20.45, respectively. The score of anxiety using BAI was higher compared to STAI-S (p<0.001) and STAI-T (p<0.001). The mean difference between the STAI-S and BAI was -10.94 (95%CI: -53.01, 26.87) and between the STAI-T and BAI was -11.47 (95%CI: -42.26, 19.32). However, very few patients’ scores outside the 95% LOA for both differences. Conclusion: The STAI and BAI are concordances in measuring anxiety levels among these patients. However, the anxiety score using BAI was higher than STAI. Thus, both assessment tools can be used in clinical practice in measuring anxiety in the out-patients setting.

Effect of music therapy intervention in pain reduction during venepuncture in neonates

Background: Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behavior?oriented problem in the future. Non?pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief during mild or moderate procedures. The aim of this study was to identify effectiveness of music therapy interventions on pain reduction during venipuncture in neonates.Methods: Total of 60 neonates undergoing venepuncture in the postnatal ward was included in this study. They were divided into the music group (n-30) and control group (n-30) by convenient sampling method. The neonates in music group were exposed to pre-recorded lullaby 5 minutes before starting the venepuncture and during the procedure of venepuncture. The NPASS was done 5 minutes before, during and 5 minutes after the procedure.Results: Compared to the control group neonates, music group neonates showed significantly (P <0.05) less pain perception during intravenous needle puncture. The results showed that music group neonates have significantly less score of NPASS than control group neonates (P<0.001) all five domains.Conclusions: Hence for routine painful procedures like venepuncture, music therapy could be helpful in neonates in reducing the pain perception. Further studies are needed to validate our findings in large sample with proper study design in future.

Eutectic mixture of Prilocaine and Lignocaine (2.5%) versus 5% Lignocaine versus placebo for pain relief in new-borns undergoing venipuncture: a hospital based, double blind randomised case control study

Background: Venipuncture is one of the most common cause of iatrogenic pain in neonates which is equally stressful to the parents as well as to the personnel performing the procedure. Despite an abundance of data that demonstrate the efficacy of local anesthetics for reducing venipuncture pain in neonates their use in day to day practice is not used widely used. Our objective was to evaluate the efficacy of EMLA cream and 5% Lignocaine cream versus placebo for pain relief in newborns undergoing venipuncture.Methods: Present study was a hospital based, double blind randomised, case control study. A 240 eligible new-borns were randomised into EMLA, 5%lignocaine and placebo groups after randomization. The respective creams were applied 1 hour before the procedure and pain scores were assessed using NIPS scoring during venepunture. Data was analysed using SPSS ver. 20.0 statistical package. Student's unpaired t-test and paired t tests was used to compare continuous data, and to compare pain scores one-way ANOVA was used to compare categorical data. A p-value <0.05 was considered statistically significant.Results: Paired t-tests revealed significant lower NIPS scores in EMLA and 5% lignocaine group than the placebo group (p value=0.001).Conclusions: From present study it can be concluded that both EMLA and 5% lignocaine are equally efficacious and cost effective in reducing the pain of venepuncture in neonates.

Anesthetic potential of lidocaine/prilocaine cream versus placebo before venepuncture

Background: Pain associated with venepuncture has long been accepted as an unavoidable consequence. Many studies show reducing pain during venepuncture after application of prilocaine/lignocaine, but there are few studies that has depicted, the depth of anesthesia produced by prilocaine/lignocaine tends to be too superficial for the reducing the pain during venepuncture. These two scenarios were debatable. Therefore, authors planned a study to assess anesthetic potential of lidocaine /prilocaine cream versus placebo before venepuncture with help of VAS in an adult patient who were drawn blood sample for investigation purposes.Methods: Prospective interventional study. All adult patient for blood sampling from surgery OPD to central laboratory were included in study. Site of venepuncture selected in both control and study group was left cubital fossa. 30 patients selected in study group received lignocaine/prilocaine locally, 30min prior to venepuncture which was later covered with occlusive tape, whereas 30 control group patient received normal saline locally as placebo. The extent of pain was assessed by patient on 10cm visual analogue scale (VAS) with end points of 0 cm rated as no pain and the points of 10cm as intolerable pain.Results: A total of 60 patient were randomly selected who were referred from surgery OPD for blood sampling. Other 30 patient were applied normal saline as placebo and 30 patient with lignocaine and prilocaine cream. In the control group there were 30 patients (5 female and 25 male). In the study group there were 30 patients (8 females and 22 males). The level of pain among study group is as follows: mild 22, moderate 7, worst 1 and in control group: no pain 0, mild 5, moderate 14 and worst pain 1. Statistical analysis between outcome of two groups done by calculating chi-square test. Chi- square test was 20.0263. P value is 0.000168. Hence the result is significant at p <0.05.Conclusions: The present study shows that prilocaine-lidocaine cream reduces the pain of needle puncture in adults and facilitates the procedure of venous blood sampling.

Clinical study of Arteriovenous needle used in rescuing patients with hemorrhagic shock / 中国基层医药

Objective To evaluate the clinical value of subclavian vein puncture with 16 G arteriovenous indwelling needle for emergency treatment of hemorrhagic shock,so as to provide a new approach for the rapid establishment of deep venous passage.Methods 80 patients with acute hemorrhagic shock were randomly divided into patients with arteriovenous indwelling needle group (catheter group) and conventional guide wire deep vein puncture group(routine puncture group),40 cases in each group.The two groups were treated with supraclavicular subclavian vein puncture.The operation time,success rate of the first puncture,puncture times and rehydration rate,incidence of complications were observed in the two groups.Results The operation time of indwelling needle group was (62 ±22)s,which was significantly shorter than (672 ± 178)s of the conventional puncture group,there was significant difference between the two groups (t =15.062,P =0.000).The first time success rate of puncture in the indwelling needle group was 70％ (28 cases),which in the conventional group was 80％ (32 cases),the difference was not statistically significant(x2 =1.067,P =0.439),all patients were in 3 attempts in successful puncture.The velocity of infusion of 500 mL hydroxyethyl starch in the indwelling needle group was (198 ± 51)s,which was better than (456 ± 86)s in the conventional puncture group,the difference between the two groups was statistically significant (t =9.318,P =0.000).The two groups had no deep vein puncture related complications.Conclusion Arteriovenous indwelling needle by supraclavicular subclavian vein puncture with conventional guide wire supraclavicular subclavian vein puncture catheter can be used for emergency treatment of hemorrhagic shock,but the indwelling needle group in the operation time and velocity is superior to conventional guide wire group,more suitable for the rescue of patients with acute hemorrhagic shock time is pressing,stay with stable circulation can be through the guide wire inserted catheter indwelling subclavian vein catheter.

Comparison of Pain Response to Venepuncture Versus Heel Lance Blood Sampling in Term Neonates.

Introduction: Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates. Materials and Methods: A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO2) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure. Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001). Conclusion: Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates.

Basic procedure of venepuncture in paediatric and adult patients: a review.

Venepuncture is the preferred method of blood sampling for term neonates and causes less pain than heel-pricks. The choice of site and procedure (venous site, finger-prick or heel-prick – also referred to as “capillary sampling” or “skin puncture”) depends on the volume of blood needed for the procedure and the type of laboratory test to be done. Venepuncture is the method of choice for blood sampling in term neonates; however, it requires an experienced and trained phlebotomist. If a trained phlebotomist is not available, the physician may need to draw the blood sample. The blood from a capillares is similar to an arterial blood in oxygen content, and is suitable for only a limited number of tests because of its higher likelihood of contamination with skin flora and smaller total volume.

Estrés ante la venopunción en niños y adolescentes / Venepuncture distress in children and adolescents

Introducción. Es bien conocido el temor de muchos niños (y no pocos adultos) a las agujas, de ahí su resistencia a asistir a la consulta médica por el miedo a ser víctimas de la venopunción. Los objetivos de este estudio fueron: describir la influencia de los factores propios del paciente en el estrés anticipatorio y el real a la venopunción, describir la influencia de la participación de los padres en el estrés anticipatorio y el real, y determinar la relación entre el estrés anticipatorio y el real ante la venopunción. Material y métodos. Se integró una muestra de 178 niños y adolescentes que acudieron a venopunción al laboratorio. Se utilizaron 2 escalas: del dolor y del estrés. Antes de la punción, los niños determinaron qué tanto suponían les iba a doler el procedimiento (dolor predictivo) y 2 observadores estandarizados calificaron el grado de estrés aparente previo a la punción (estrés anticipatorio). La respuesta observada en el paciente fue considerada estrés real. Finalmente, el niño señaló el grado de dolor sufrido efectivamente (dolor estimado). Resultados. Los primeros 4 tuvieron significancia estadística: 1. A mayor grado de estrés anticipatorio mayor fue el estrés real. 2. Los menores que predijeron que el dolor sería intenso obtuvieron mayores calificaciones de estrés real. 3. Los niños de mayor edad obtuvieron menores calificaciones de estrés real. 4. A mayor escolaridad, menor estrés real. 5. Cuando había el antecedente de venopunción reciente, mayor era el estrés real. 6. Los pacientes de sexo masculino mostraron mayor estrés real que los de sexo femenino. 7. La presencia de los padres durante la realización del procedimiento tendía a aumentar el estrés real. 8. Cuando el menor acostumbraba dormir en la cama de sus padres había una tendencia a experimentar mayor estrés real. Conclusión. Estos resultados dan la pauta para promover que padres y clínicos expliquen al niño este procedimiento, así como la aplicación de técnicas ...

Introduction. The fear of many children (and adults) to needles is well known, it explains their resistance to attend medical consultation because they are afraid of venepuncture. Objective. To describe the influence of patient's factors in children's anticipatory and real distress due to venepuncture; to describe the influence of parents in children's anticipatory and real distress and to determine the relationship among anticipatory and real distress due to venepuncture. Material and methods. One hundred and seventy eight children and adolescents ages 7 to 16, who attended a 3rd level pediatric hospital laboratory for blood sampling were studied. Pain and distress scales were used in order to determine predictive pain (children's presumption of pain induced by venepuncture). Two observers rated their anticipatory distress before venepuncture. They also rated their real distress during the painful proceeding. Finally, children themselves rated the real pain they suffered. Results. The first 4 results were statistically significant. 1. Anticipatory distress was directly related to real distress. 2. Those children who predicted higher pain showed higher rates of real distress. 3. Older children had lower rates of real distress. 4. Higher school grades were related to less real distress. 5. Recent venepuncture was related to higher real distress. 6. Boys showed more real distress than girls. 7. Parents presence during blood sampling was related to real distress. 8. When children used to share bed with parents there was a trend to show more real distress. Conclusion. These results support the idea that parents and clinicians should explain this painful proceeding to children in advance, and the possible usefulness of cognitive behavioral techniques in order to diminish venepuncture distress.