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\"Blood carries life, yet the sight of it makes people faint. It is a waste product and a commodity pricier than oil. It can save lives and transmit deadly infections. Each one of us has roughly nine pints of it, yet many don't even know their own blood type ... Rose George ... takes us from ancient practices of bloodletting to the breakthough of the 'liquid biopsy,' which promises to diagnose cancer and other diseases with a simple blood test\"--Publisher marketing.

The epidural blood patch (EBP) requires a syringe that connects to the intravenous and epidural route. Thereby contravening Department of Health guidance, which recommends adoption of equipment that, prevents wrong route drug administration. To comply with these recommendations a non-Luer butterfly needle with one-way valve has been produced by GBUK. The one-way valve and length of tubing has the potential of activating the clotting cascade. This could reduce the time clinicians have to utilise the blood in the syringe. Also any alteration in clotting could affect the therapeutic value of the EBP. The primary objective of this research was to determine if phlebotomy using this new 21G needle altered blood clotting, determined by thromboelastograph analysis, compared to a standard 21G hypodermic needle.We performed paired phlebotomy on 10 healthy volunteers; producing a study capable of revealing a 25% change in R-time (power 80%). Mean R-time was increased with the new needle, however remaining within normal range (7.3 vs 6.6 min (p=0.04)). This would not limit the time to utilise the blood before clot formation in the syringe. With no clinically relevant difference in MA or LY30, it is unlikely to have any impact on the therapeutic value of the EBP.

A hepcidin mimetic, rusfertide, was effective in maintaining hematocrit <45% with minimal or no phlebotomies.

Home blood self-collection devices can enable remote monitoring, but their implementation requires validation. Our objectives were to explore (i) the impact of sampling sites and topical analgesia on capillary blood volume and pain perception and (ii) the safety, acceptability, and failure of capillary self-collection among adults and children using the Tasso-SST device. We conducted a two-phase study. The investigational phase consisted of two on-site cross-sectional studies in healthy adult participants (≥ 12 years) and children (1-17 years) with their accompanying parent. Adults received 4 capillary samplings, where puncture sites and topical analgesia were randomized in a factorial design, and a venipuncture; children (and one parent) had one capillary sampling. The two co-primary outcomes were blood volume and pain. The implementation phase was conducted in two multicentre trials in participants choosing remote visits; blood volume, collection failure, adverse events, and satisfaction were documented. In the investigational phase, 90 participants and 9 children with 7 parents were enrolled; 15 adults and 2 preschoolers participated in the implementation phase. In the adult investigational study, the device collected a median (25%, 75%) of 450 (250, 550) μl of blood with no significant difference between the puncture site, topical analgesia, and its interaction. Using topical analgesia reduced pain perception by 0.61 (95% CI: 0.97, 0.24; P <0.01) points on the 11-point scale; the pain reduction varied by puncture site, with the lower back showing the most significant decrease. Overall, combining all studies and phases, the median volume collected was 425 (250, 500) μl, and the device failure rate was 4.4%; minor adverse effects were reported in 8.9% of the participants, all were willing to use the device again. Capillary blood self-collection, yielding slightly less than 500 μl, proves to be a safe and relatively painless method for adults and children, with high satisfaction and low failure rates. The puncture site and topical analgesia do not affect blood volume, but topical analgesia on the lower back could reduce pain.

Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.

Background We conducted a nationwide questionnaire-based survey to understand the current situation regarding central venous port implantation in order to identify the ideal procedure. Methods Questionnaire sheets concerning the number of implantation procedures and the incidence of complications for all procedures completed in 2012 were sent to 397 nationwide designated cancer care hospitals in Japan in June 2013. Venipuncture sites were categorized as chest, neck, upper arm, forearm, and others. Methods were categorized as landmark, cut-down, ultrasound-mark, real-time ultrasound guided, venography, and other groups. Results We received 374 responses (11,693 procedures) from 153 centers (38.5 %). The overall complication rates were 7.4 % for the chest (598/8,097 cases); 6.8 % for the neck (157/2325); 5.2 % for the upper arm (54/1,033); 7.3 % for the forearm (9/124); and 6.1 % for the other groups (7/114). Compared to the chest group, only the upper arm group showed a significantly lower incidence of complications ( P  = 0.010), and multivariate logistic regression (odds ratio 0.69; 95 % confidence interval 0.51–0.91; P  = 0.008) also showed similar findings. Real-time ultrasound-guided puncture was most commonly used in the upper arm group (83.8 %), followed by the neck (69.8 %), forearm (53.2 %), chest (41.8 %), and other groups (34.2 %). Conclusion Upper arm venipuncture with ultrasound guidance seems the most promising technique to prevent complications of central venous port implantation.

Background Novel devices based on the emission of near-infrared electromagnetic radiation (NIR) have been developed to minimize venous puncture failures. These instruments produce an “augmented reality” image, in which subcutaneous veins are depicted on a LCD display. We compared the new technique with standard venipuncture in a population of elderly patients. Methods Patients admitted in Intensive Care Unit were randomized to standard or to NIR assisted procedure. Results In the 103 enrolled patients (age 74 ± 12 years; standard venipuncture— N  = 56; NIR— N  = 47), no differences were found in procedure length, number of attempts, and referred pain. With NIR there was a lower incidence of hematomas and fewer anxiety and depressive symptoms. Conclusions The use of the novel NIR-based device is safer and more psychologically tolerable, and it is not associated to an increase of procedure length or number of attempts.

Background As many as 90% of patients develop anemia by their third day in an intensive care unit (ICU). We evaluated the efficacy of interventions to reduce phlebotomy-related blood loss on the volume of blood lost, hemoglobin levels, transfusions, and incidence of anemia. Methods We conducted a systematic review and meta-analysis using the Laboratory Medicine Best Practices (LMBP) systematic review methods for rating study quality and assessing the body of evidence. Searches of PubMed, Embase, Cochrane, Web of Science, PsychINFO, and CINAHL identified 2564 published references. We included studies of the impact of interventions to reduce phlebotomy-related blood loss on blood loss, hemoglobin levels, transfusions, or anemia among hospital inpatients. We excluded studies not published in English and studies that did not have a comparison group, did not report an outcome of interest, or were rated as poor quality. Twenty-one studies met these criteria. We conducted a meta-analysis if > 2 homogenous studies reported sufficient information for analysis. Results We found moderate, consistent evidence that devices that return blood from flushing venous or arterial lines to the patient reduced blood loss by approximately 25% in both neonatal ICU (NICU) and adult ICU patients [pooled estimate in adults, 24.7 (95% CI = 12.1–37.3)]. Bundled interventions that included blood conservation devices appeared to reduce blood loss by at least 25% (suggestive evidence). The evidence was insufficient to determine if these devices reduced hemoglobin decline or risk of anemia. The evidence suggested that small volume tubes reduced the risk of anemia, but was insufficient to determine if they affected the volume of blood loss or the rate of hemoglobin decline. Conclusions Moderate, consistent evidence indicated that devices that return blood from testing or flushing lines to the patient reduce the volume of blood loss by approximately 25% among ICU patients. The results of this systematic review support the use of blood conservation systems with arterial or venous catheters to eliminate blood waste when drawing blood for testing. The evidence was insufficient to conclude the devices impacted hemoglobin levels or transfusion rates. The use of small volume tubes may reduce the risk of anemia.

Venepuncture-associated pain is a major source of distress commonly experienced by adult patients in day-to-day clinical practice. Topical lignocaine application before venepuncture may address this issue, but this delivery approach may be suboptimal. Hence, we aim to investigate the safety and efficacy of a novel lignocaine-embedded transdermal microneedle array patch (LEMAP) in facilitating transcutaneous lignocaine delivery to reduce procedural-related pain in adults undergoing venepuncture in a tertiary-care outpatient clinic setting. This is an investigator-initiated, single-centre, active-controlled, double-blind, randomised superiority trial divided into two distinct stages. Twenty (single-group LEMAP recipients) and 144 adult patients (72 per group; randomised to either LEMAP (intervention) or 5% EMLA patch (control) applied on antecubital fossa, near the venepuncture site, for 30 minutes) aged 18 years and above requiring routine venepuncture will be recruited from the Ophthalmology Outpatient Clinic, Hospital Canselor Tuanku Muhriz, for stage I and II of this trial, respectively. For the stage I trial, the safety endpoints are lignocaine’s pharmacokinetic parameters and clinical adverse events. In the stage II trial, the primary endpoints are the venepuncture-associated pain experience, which will be evaluated using the Visual Analogue Scale (VAS) and the skin conductance algesimeter index (SCAI) scores at one-minute post-venepuncture. Non-linear mixed-effect model and multiple linear regression will be used to analyse the stage I and II trial outcomes, respectively. The trial protocol has been registered with the clinicaltrial.gov registry (ID: NCT05694858) and adheres to the SPIRIT 2025 reporting guideline. All trial participants will provide written informed consent, which the trial investigators will obtain before trial enrollment and randomisation. The trial findings will be disseminated via peer-reviewed publications and presentations at international conferences and shared with participants via the web-based trial notification system..