This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Larsson, B. A.
Right arrow Articles by Olsson, G. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Larsson, B. A.
Right arrow Articles by Olsson, G. L.
Related Collections
Right arrow Therapeutics & Toxicology

PEDIATRICS Vol. 101 No. 5 May 1998, pp. 882-886

Venipuncture Is More Effective and Less Painful Than Heel Lancing for Blood Tests in Neonates

Received Apr 7, 1997; accepted Sep 10, 1997.

Björn A. Larsson*, Gunnilla Tannfeldt*, Hugo LagercrantzDagger , and Gunnar L. Olsson*

From the * Department of Pediatric Anesthesia and Intensive Care, Pain Treatment Service; and the Dagger  Department of Neonatology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.

Objective.  Heel lancing has hitherto been the method of choice for screening tests of inborn errors of metabolism in neonates. Eutectic mixture of local anesthetic has little, if any, analgesic effect when applied to the heel of pre- and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by heel lancing. The aim of this study was to investigate whether other methods, such as venipuncture of the dorsal side of the hand, are less painful and more efficient than heel lancing in neonates.

Methods.  One hundred twenty healthy, full-term infants who underwent testing for phenylketonuria (PKU) were included in the study. They were randomized into three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). Pain reactions were assessed by the Neonatal Facial Coding System (NFCS). The latency and duration of the first cry as well as the total screaming time was analyzed. The efficacy of the method was assessed by the time taken to complete the PKU test and number of times the skin had to be punctured.

Results.  Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjected to heel lancing. During the first 60 seconds after skin puncture, 44% of the infants cried in the VP group, compared with 72% and 85% in the SL and LL groups, respectively.

Efficacy.  A successful PKU test with only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time needed to obtain the PKU blood sample was 191 seconds (median) in the VP group, 419 seconds in the SL group, and 279 seconds in the LL group.

Conclusion.  Venipuncture is more effective and less painful than heel lancing for blood tests in neonates.

Key words: analgesia, topical, anesthesia, venipuncture, heel lancing, neonates, phenylketonuria test.




This article has been cited by other articles:


Home page
 PediatricsHome page
P. J. Sharek, R. Powers, A. Koehn, and K. J.S. Anand
Evaluation and Development of Potentially Better Practices to Improve Pain Management of Neonates
Pediatrics, November 1, 2006; 118(Supplement_2): S78 - S86.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
S Ogawa, T Ogihara, E Fujiwara, K Ito, M Nakano, S Nakayama, T Hachiya, N Fujimoto, H Abe, S Ban, et al.
Venepuncture is preferable to heel lance for blood sampling in term neonates
Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2005; 90(5): F432 - F436.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
W. T. Zempsky, J. P. Cravero, and Committee on Pediatric Emergency Medicine, and Sec
Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems
Pediatrics, November 1, 2004; 114(5): 1348 - 1356.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
A. R. Valentine and S. A. Tanumihardjo
Adjustments to the Modified Relative Dose Response (MRDR) Test for Assessment of Vitamin A Status Minimize the Blood Volume Used in Piglets
J. Nutr., May 1, 2004; 134(5): 1186 - 1192.
[Abstract] [Full Text] [PDF]

Home page
 Pediatr. Rev.Home page
W. T. Zempsky and N. L. Schechter
What's New in the Management of Pain in Children
Pediatr. Rev., October 1, 2003; 24(10): 337 - 348.
[Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
P J Mathew and J L Mathew
Assessment and management of pain in infants
Postgrad. Med. J., August 1, 2003; 79(934): 438 - 443.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. Gradin, M. Eriksson, G. Holmqvist, A. Holstein, and J. Schollin
Pain Reduction at Venipuncture in Newborns: Oral Glucose Compared With Local Anesthetic Cream
Pediatrics, December 1, 2002; 110(6): 1053 - 1057.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
K. J. S. Anand and and the International Evidence-Based Group for Neo
Consensus Statement for the Prevention and Management of Pain in the Newborn
Arch Pediatr Adolesc Med, February 1, 2001; 155(2): 173 - 180.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
H Vertanen, V Fellman, M Brommels, and L Viinikka
An automatic incision device for obtaining blood samples from the heels of preterm infants causes less damage than a conventional manual lancet
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2001; 84(1): 53F - 55.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A Jain, N Rutter, and M Ratnayaka
Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2001; 84(1): 56F - 59.
[Abstract] [Full Text]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A Jain and N Rutter
Topical amethocaine gel in the newborn infant: how soon does it work and how long does it last?
Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2000; 83(3): 211F - 214.
[Abstract] [Full Text]

Home page
 PediatricsHome page
Committee on Fetus and Newborn, Committee on Drugs and Canadian Paediatric Society, Fetus and Newborn Com
Prevention and Management of Pain and Stress in the Neonate
Pediatrics, February 1, 2000; 105(2): 454 - 461.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A. Jain and N. Rutter
Local anaesthetic effect of topical amethocaine gel in neonates: randomised controlled trial
Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2000; 82(1): 42F - 45.
[Abstract] [Full Text]

Home page
 BMJHome page
I. Choonara
Why do babies cry?
BMJ, November 27, 1999; 319(7222): 1381 - 1381.
[Full Text]

Home page
 Evid. Based Nurs.Home page
R. O Mainous
Venipuncture was less painful and more efficient than heel lance for blood testing in newborns
Evid. Based Nurs., January 1, 1999; 2(1): 10 - 10.
[Full Text] [PDF]