Background and Objectives: Two of the authors, one heterosexual and one homosexual, both voluntarily donated blood to a well-known health institution in the Philippines. As they were filling out the paperwork, one of the authors' attention was called by one of the questions in the form: “Nakipagtalik ka na ba sa iyong kauri?,” which can be literally translated as “Have you had sex with your own kind?”. This erroneously phrased question was the sole question interrogated and problematized in the study. Methodology: Reviews of Standpoint Theory and the methodology associated with it and, in effect, used in the study, formed part of the critique, divided into individual narrations and interpretations by each author. A third co-author, a hematologist, lent her insight on the logistics and issues of phlebotomy. Institutional ethnography was brought to bear on the narratives Results and Conclusion This three-author collaboration is presented as a claim that an interdisciplinary approach may open new vistas to a phenomenon that has long existed but been ignored. Reviews of Standpoint Theory and curriculum planning for health professionals are recommended.
Phlebotomy ; Communication ; Homosexuality ; Blood Donation

OBJECTIVE: To prospectively investigate the feasibility of using 2 small intravenous catheters for high-rate computed tomography (CT) contrast injection in patients lacking superficial veins capable of accommodating ≤ 20-gauge catheters. MATERIALS AND METHODS: Sixty-eight consecutive eligible adults referred for dynamic liver CT were enrolled; 58 had previously undergone liver CT, including 8 that experienced extravasation. Two 22- or 24-gauge catheters were placed in all patients after 2–5 venipunctures, and 2 mL/kg of contrast agent (370 mg I/mL) was split-administered through both catheters to achieve total flow rate of 4 mL/s. Patients' experience and examination success rate, defined as uneventful scans completed at 4 mL/s or at < 4 mL/s achieving standard image quality in all phases, were analyzed. Quantitative hepatic signal-to-noise and hepatic vascular contrast-to-noise ratios (CNRs) were compared with 30 control examinations scanned at 4 mL/s using an 18-gauge catheter. RESULTS: One case each of extravasation and severe injection pain caused the examination to be aborted. Success rate was 88.2% (60/68; 54 patients scanned at 4 mL/s, 6 at 3.5–3.9 mL/s). Fifty-five of 58 patients (94.8%) that had past CT regarded the venipuncture as more tolerable than (n = 36) or similar to (n = 19) past experiences; 45 of 58 patients (77.6%) found contrast injection less painful than (n = 35) or similar to (n = 10) past experiences. When compared with control examinations, signal-to-noise ratio was similar in all phases (p ≥ 0.502), but the hepatic arterial CNR in arterial phase was slightly inferior (p ≤ 0.047). CONCLUSION: Using 2 small intravenous catheters can effectively achieve high-rate CT contrast injection in patients lacking adequate superficial veins.
Adult ; Catheters* ; Contrast Media ; Humans ; Liver ; Multidetector Computed Tomography ; Patient Satisfaction ; Phlebotomy ; Prospective Studies ; Quality Assurance, Health Care ; Signal-To-Noise Ratio ; Veins*

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.
Autopsy ; Child ; Child Development ; Death, Sudden ; Diagnosis ; Forensic Pathology ; Humans ; Infant ; Infant Death ; Needles ; Phlebotomy ; Phobic Disorders ; Reflex ; Seizures

BACKGROUND: Venipuncture pain is an uncomfortable suffering to the patient. It creates anxiety, fear and dissatisfaction. The ketoprofen transdermal patch is a proven treatment for musculoskeletal and arthritic pain. We planned this study to evaluate the efficacy of the ketoprofen patch to reduce venipuncture pain. METHODS: Two hundred adult patients, aged 18–60 years, of either sex, ASA grade I or II, were enrolled. Presuming that therapy would decrease venipuncture pain by 30%, a power calculation with α = 0.05 and β = 0.80 required enrollment of at least 24 patients into each group. However, 100 patients in each group were recruited. Group I (Control) received a placebo patch; Group II (Ketoprofen) received a 20 mg ketoprofen patch. A selected vein on the dorsum of the patient's non-dominant hand was cannulated with 18 g intravenous cannula 1 h after the application of the respective patch. Assessment of pain was done by a 10 cm visual analogue scale (VAS) of 0–10, where 0 depicts “no pain” and 10 is “the worst imaginable pain”. The venipuncture site was assessed for the presence of skin erythema, swelling and rashes at 12 h, 24 h and at the time of decannulation. RESULTS: Incidence of pain was 100% (94/94) in the control group as compared to 93% (85/91) in the ketoprofen group. The severity of the venipuncture pain was 6 (2) and 2 (2) for control and ketoprofen groups respectively (P < 0.05). CONCLUSIONS: Application of a ketoprofen patch at the proposed site of venipuncture one hour before the attempt is effective and safe for attenuating venipuncture pain.
Adult ; Anxiety ; Catheterization ; Catheters ; Erythema ; Exanthema ; Hand ; Humans ; Incidence ; Ketoprofen ; Phlebotomy ; Skin ; Transdermal Patch ; Veins ; Visual Analog Scale

Clinical interpretation of the test results for cortisol based on continuous reference intervals with appropriate partitions improves pediatric diagnosis; however, these values are available only for Caucasians. To develop the pediatric reference intervals for Chinese population, we examined the serum cortisol levels in 1,143 healthy Chinese children aged 4–18 years (566 boys and 577 girls), using an IMMULITE 2000 Immunoassay System (Siemens Healthcare GmbH). Phlebotomy was performed at 7–9 a.m. for 284 boys and 287 girls and at 1–3 p.m. for the others. They were divided into four age groups according to the Clinical and Laboratory Standards Institute guideline EP28-A3c, with the last group further stratified according to sampling time. Separate reference intervals of 49.6–323.7, 70.9–395.3, and 90.1–448.7 nmol/L were established for children aged 4–8, 9–12, and 13–15 years, respectively. Further, reference intervals of 118.2–464.7 and 71.4–446.7 nmol/L were established for morning and afternoon cortisol levels, respectively, in children aged 16–18 years. Further studies are necessary to transfer and validate these reference intervals in other analytical systems and pediatric populations, and to allow for broader applications.
Asian Continental Ancestry Group ; Child ; Delivery of Health Care ; Diagnosis ; Female ; Humans ; Hydrocortisone ; Immunoassay ; Pediatrics ; Phlebotomy

BACKGROUND: The returning time of inpatient specimen analysis is usually slow because phlebotomists deliver all the collected specimens at the end of their work cycle. In addition, manual specimen reception further delays the reporting time and imposes a heavy workload on the technical staff, thus compromising effectiveness. Therefore, we have created an automated specimen reception system to tackle testing delays and enhance the efficiency and quality of specimen collection and handling. METHODS: In May 2015, the pre-analytical processing of inpatient samples was renovated. We automated the specimen reception in parallel with barcode printing and introduced pneumatic tubes to deliver samples for routine chemistry tests. We compared the reporting time of the automated system with that of the manual system and analyzed the distribution pattern of the specimens according to handling time. RESULTS: The median reporting time was advanced by 41 minutes, from 09:33 AM to 08:52 AM for the manual and automated reception, respectively. Moreover, with the reduction in hands-on time, the blood specimens reached the laboratory immediately after phlebotomy, thereby improving the processing efficiency by spreading out the interval during which the specimens arrived in the laboratory. Additionally, the new system allowed the identification of the phlebotomist who collected the specimens and tracking the specimens from collection to test result. CONCLUSIONS: With the introduction of our automatic reception system, the reporting time was considerably reduced. Therefore, the satisfaction of the clinician and the technical staff was improved.
Chemistry* ; Humans ; Inpatients* ; Phlebotomy ; Specimen Handling

PURPOSE: This study aimed to investigate the clinical and socioenvironmental characteristics of sudden cardiorespiratory arrest after venipuncture in children. METHODS: We conducted a retrospective email-based survey of all members of the Korean Pediatric Society. The questionnaire included items on patient demographics, socioenvironmental circumstances of the venipuncture, type of cardiorespiratory arrest, symptoms and signs, treatment, prognosis, and presumed cause of the arrest. RESULTS: Fourteen patients were identified. Of these, 13 were young children (< 2 years old), and 1 was 14 years old. All patients had been previously healthy and had no specific risk factors for sudden cardiorespiratory arrest. Most cases (n=11, 79%) were defined as cardiac or cardiorespiratory arrest, while the remaining cases (n=3, 21%) were defined as respiratory arrest. Aspiration (n=3), acute myocarditis (n=2), and laryngeal chemoreflex (n=1) were presumed as the causes; however, the exact causes were unclear. The overall prognosis was poor (death, n=7; morbidity, n=5; full recovery, n=2). The medical institutions faced severe backlash because of these incidents (out-of-court settlement, n=5; medical lawsuit, n=5; continuous harassment, n=3). CONCLUSION: Cardiorespiratory arrest after venipuncture is unpredictable and the probable cause of most cases is a vasovagal reaction. Medical personnel must be aware of the risk of unexpected cardiorespiratory arrest during routine intravenous procedures.
Cardiopulmonary Resuscitation ; Child* ; Demography ; Heart Arrest ; Humans ; Myocarditis ; Phlebotomy* ; Prognosis ; Retrospective Studies ; Risk Factors

BACKGROUND: Phlebotomy performed for laboratory testing has the potential to cause anemia in newborns and infants. This study investigated the minimum specimen volume required for an automated immunohematology analyzer DAYmate S. METHODS: Three combinations of tubes were evaluated: I. 6 mL EDTA tube, II. 0.5 mL microtainer (on top of 3 mL EDTA tube), and III. 1 mL sample cup (on top of 6 mL EDTA tube). ABO/RhD cell typing was done using centrifuged red cells; unexpected antibody screening was carried out using plasma, and Type & Screening was conducted using whole blood samples. The lowest specimen volume capable of performing 10 repetitive tests without errors was investigated. RESULTS: ABO/RhD cell typing could be performed from I. 30 μL, II. 25 μL, and III. 25 μL. Unexpected antibody screening could be performed from I. 170 μL, II. 150 μL, and III. 140 μL. According to the hematocrit levels, Type & Screening could be performed from 30%, I&III 650 μL, II. 800 μL; 40%, I&III 650 μL, II. 900 μL; and 50%, I&III 1,000 μL, II. Testing using specimen volumes below 1,000 μL was difficult. CONCLUSION: By separating red cells and plasma, pre-transfusion testing of ABO/RhD cell typing and unexpected antibody screening could be conducted with very small specimen volumes using DAYmate S compared to Type & Screening using whole blood. The application of small-sized sample tubes was more competitive and this is expected to be very useful for preventing iatrogenic anemia in neonates and infants less than 4 months old.
Anemia ; Edetic Acid ; Hematocrit ; Humans ; Infant ; Infant, Newborn ; Mass Screening* ; Phlebotomy ; Plasma

PURPOSE: This study was done to assess the influence of application time of Lidocaine patch on pain intensity following venipuncture in hospital. METHODS: The participants were 31 adult patients admitted to J hospital in G city. Patients' anxiety, blood pressure and pulse were measured when no patch was applied and when a patch was applied. To evaluate the pain intensity and physiological index caused by venipuncture, blood pressure, pulse and pain intensity were checked for patients in the no patch group, and for a 5 minutes of application and 30 minutes application patch. Pain was evaluated using a visual analogue scale, anxiety using the Profile of Mood states developed McNair et al. and modified by Lee. Data were analyzed using one-way repeated measures ANOVA with the SPSS 21.0 program. RESULTS: Anxiety and pain were significantly reduced when a lidocaine patch was applied following venipuncture. There was no significant difference in pain intensity whether the lidocaine patch application is for 30 minutes or application for 5 minutes. CONCLUSION: Results of this study show that application of lidocaine patch can be used as a nursing intervention for pain reduction by showing that there is no need to wait a long time for pain to be reduced.
Adult ; Anxiety ; Blood Pressure ; Humans ; Lidocaine* ; Nursing ; Phlebotomy*

The circulatory system is closely related to the inter-relationship between the anatomy of the heart and blood vessels, and the fluid dynamic properties of blood. The physical properties of blood, which affect blood flow, are called hemorheologic factors. Hemorheologic factors, such as blood viscosity and erythrocyte aggregation, are influenced mainly by hematocrit. A higher hematocrit level results in an increase in blood viscosity, erythrocyte aggregation, which impedes the circulation itself, and tissue oxygenation. An excess of serum ferritin causes injury to vascular endothelial cells and erythrocytes via oxygen free radicals. In addition, an excess of blood can aggravatee the adverse effects of the hemorheologic parameters and induce atherogenesis, microcirculatory disturbances, and major cardiovascular events. A preventive and therapeutic approach with a phlebotomy or blood donation has been stimulated by the knowledge that blood loss, such as regular donations, is associated with significant decreases in key hemorheologic variables, including blood viscosity, erythrocyte aggregation, hematocrit, and fibrinogen. Major cardiovascular events have been improved in regular blood donors by improving blood flow and microcirculation by decreasing the level of oxidative stress, improving the hemorheologic parameters, and reducing the serum ferritin level. Confirmation of the positive preventive and therapeutic effects of blood donations on cardiovascular disease by a well-designed and well-controlled Cohort study may be good news to patients with cardiovascular disease or at risk of these diseases, as well as patients who require a transfusion.
Atherosclerosis ; Blood Donors* ; Blood Vessels ; Blood Viscosity ; Cardiovascular Diseases ; Cohort Studies ; Endothelial Cells ; Erythrocyte Aggregation ; Erythrocytes ; Ferritins ; Fibrinogen ; Free Radicals ; Heart ; Hematocrit ; Humans ; Hydrodynamics ; Microcirculation ; Oxidative Stress ; Oxygen ; Phlebotomy ; Therapeutic Uses