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Fulltext Tunnelled peripherally inserted central Catherer- how we do them

Vijaynanthan, A., Nawawi, O., Abdullah, B.J.J.

JUMMEC, 2017;20(2):8-12.
MyJurnal

In the current study, we report a new technique to place a tunnelled peripherally inserted central catheter
(PICC) at the upper arm of patient under real-time ultrasound-guided venipuncture using disposal equipment
provided within a standard PICC set. The tunnelling of the PICC required an extra time of 5 minutes but was
well tolerated by all patients involved in the study. The tunnelled PICC was applied on 50 patients and the
infection rate as well its catheter dwell time were compared to another 50 patients with conventional PICC.
The rate of patients who developed infection decreased from 34% for conventional PICC to 16% in tunnelled
PICC patients. The central line-associated blood stream infections rate was also decreased from 4.4 per 1000
catheter-days for conventional PICC to 1.3 per 1000 catheter-days for tunnelled PICC. The mean time to infection
development for tunnelled PICC (24 days) was longer than those observed with conventional PICC (19 days).
Tunnelled PICC has also increased the mean catheter dwell time from 27 days (for conventional PICC) to 47
days. Tunnelling a PICC has the potential to reduce the infection rate while increase the catheter dwell time.

Matched MeSH terms: Phlebotomy
Fulltext Self-inflicted and iatrogenic peripheral intravenous cannula fracture: A case report

Khoo PJ, Tay KL, Jamaluddin AA, Gunasaker D

Ann Med Surg (Lond), 2018 Sep;33:44-46.
PMID: 30167303 DOI: 10.1016/j.amsu.2018.08.004

Introduction: We present a case of broken peripheral intravenous catheter/cannula (PIVC), a well-known, underreported complication of PIVC placement. The fractured cannula could have resulted in intravascular foreign body retention, which is usually iatrogenic.
Presentation of case: In this case, we conceded that both iatrogenic and self-infliction were culpable. The intoxicated, aggressive patient forcefully removed the inserted cannula after repeated attempts by medical personnel to place it. The same cannula was used for multiple attempts. After the location of the fractured catheter was reconfirmed with radiological imaging, venotomy and removal of the foreign body were performed.
Conclusion: Due to potentially devastating consequences, early detection, adherence to standard operating procedures for peripheral venous access, management of aggressive patients, and meticulous teamwork must be upheld.

Matched MeSH terms: Phlebotomy
Feels Not Right Stabbing a Child

Goh ZNL, Khoo EJ

Acad Pediatr, 2018 07;18(5):481-482.
PMID: 29331344 DOI: 10.1016/j.acap.2018.01.001
Matched MeSH terms: Phlebotomy/methods; Phlebotomy/psychology*
Fulltext Venipuncture versus heel prick for blood glucose monitoring in neonates

Saththasivam P, Umadevan D, Ramli N, Voralu K, Naing NN, Ilias MI, et al.

Singapore Med J, 2009 Oct;50(10):1004-7.
PMID: 19907892

The aim of this study was to determine whether there was a difference in the pain indicators and effectiveness between venipuncture (VP) and heel prick (HP) for blood glucose monitoring in term neonates (recently, venipuncture was shown superior for the Guthrie test).

Matched MeSH terms: Phlebotomy/adverse effects*; Phlebotomy/methods*
Fulltext Concentration of serum amyloid a in clinically normal endurance horses in Malaysia

Rajendren, S.K., Khairuddin, N.H., Sumita, S.

Jurnal Veterinar Malaysia, 2019;31(1):28-33.
MyJurnal

Endurance horses continuously undergoing training. This will cause inflammation which leads to acute phase reaction with the production of acute phase protein, especially serum amyloid A (SAA). The purpose of this study was to establish concentration of SAA in normal endurance horses in the blood serum using two-site enzyme linked immunoassay (ELISA) technique. Horse sera were aliquoted from blood taken from jugular venipuncture. The highest concentration of SAA was observed in horses rested between 12 months and 24 months. The lowest concentration of SAA was noticed in horses rested more than 24 months. All the horses between 6 and 11 years old have high SAA concentration. When resting intervals were compared against gender of the horses, it was noted that all mares have high SAA concentration compared to gelding and stallion. Whereas SAA concentration in Thoroughbred horses were high compared to Arabian horses in all rest intervals. The SAA concentration in horses rested more than 24 months was low most probably because the horses recovered well from the inflammatory process happened during the endurance race.

Matched MeSH terms: Phlebotomy
Neonatal buccal cell collection: a non-invasive strategy to provide a reliable source of DNA for high resolution melting analysis

Cheung, Tian Pei, Rostenberghe, Hans Van, Narazah Mohd Yusoff, Noraida Ramli, Nor Rosidah Ibrahim, Nishio, Hisahide, et al.

Malaysian Journal of Paediatrics and Child Health, 2019;25(2):14-22.
MyJurnal

Background: The low yield and quality of buccal-derived genomic DNA have reduced its applicability in various genetic research. The aim of this study was to assess the quantity, purity and genotyping efficiency of genomic DNA isolated from neonatal buccal swabs. Methods: Paired buccal swabs and whole blood samples were collected from 60 neonates with the mean age 5 days (SD=1.57). The genomic DNA quantity and purity were measured by using Infinite® 200 PRO NanoQuant reader and agarose gel electrophoresis. High-resolution melting (HRM) analysis was used to analyse the sequence variants present in uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1 c.211G>A) and nuclear receptor subfamily 1, group I, member 3 (NR1I3 IVS8+116T>G) genes. Results: Buccal swabs provided lower mean genomic DNA concentration (18.78 ± 8.39 ng/μl versus 40.02 ± 13.03 ng/μl), yield (2.63 ± 1.17 μgversus8.00 ± 2.61 μg). The purity of buccal samples however were inconsistent with 16 samples (26.7%) having A260/280 ratios below 1.8 which indicated protein contamination. Genomic DNA purity for all blood samples were within the ideal range with average absorbance ratios of 1.8−2.0. However, all buccal genomic DNA demonstrated 100% genotype call rates for all variants. A complete genotype concordance was also observed between paired genomic DNA samples. Conclusion: Despite related to a reduced quantity and purity, neonatal buccal genomic DNA could generate reliable HRM genotyping results. Therefore, buccal swab collection is a promising alternative to the invasive blood sampling to provide genomic DNA for genetic analysis involving paediatric population.

Matched MeSH terms: Phlebotomy
In vitro and in vivo Evaluation of New Topical Anaesthetic Cream Formulated with Palm Oil Base

Khodari SNK, Noordin MI, Chan L, Chik Z

Curr Drug Deliv, 2017;14(5):690-695.
PMID: 27480118 DOI: 10.2174/1567201813666160801113302

BACKGROUND: Topical local anaesthetic cream was reported to be useful for pain relief for cutaneous procedures such as minor surgery and venipuncture.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of new formulation of lidocaine topical anaesthetic using palm oil base, HAMIN® and to determine how fast this new formulation produces adequate numbness compared to the currently used EMLA cream, in the University of Malaya Medical Centre (UMMC) set-up.
METHOD: The skin permeation test was conducted by using Franz type diffusion cell and pain assessment was carried out in healthy subject by using Verbal Rating Score (VRS) and Visual Analogue Score (VAS) evaluation.
RESULT: Result of permeation test demonstrated that the cumulative amount of lidocaine released from HAMIN® cream was increased with time and slightly higher than EMLA cream. The clinical study showed that HAMIN® single lidocaine cream can produces numbness through venepuncture procedure and comparable with EMLA cream which is a combination therapy for local anaesthetic (lidocaine and prilocaine).
CONCLUSION: It can be concluded that HAMIN® Lidocaine cream is suitable for cream preparation especially for topical application and it can be regarded as an achievement in palm oil and medical industries.

Matched MeSH terms: Phlebotomy
The effect of facilitated tucking on procedural pain control among premature babies

Lopez O, Subramanian P, Rahmat N, Theam LC, Chinna K, Rosli R

J Clin Nurs, 2015 Jan;24(1-2):183-91.
PMID: 25060423 DOI: 10.1111/jocn.12657

To determine the effectiveness of facilitated tucking in reducing pain when venepuncture is being performed on preterm infants.

Matched MeSH terms: Phlebotomy/adverse effects*
Fulltext The safety and efficacy of oral dextrose for relieving pain following venepuncture in neonates

Ling JM, Quah BS, Van Rostenberghe H

Med J Malaysia, 2005 Jun;60(2):140-5.
PMID: 16114153

The objective of this study was to assess the efficacy and safety of oral 30% dextrose during venepuncture in neonates. Neonates admitted in the Special Care Nursery for jaundice from September 200 to January 2001 were recruited for this double-blind randomised controlled trial. The intervention consisted of administration of either 2 ml of oral 30% dextrose or 2 ml of sterile water 2 minutes before venepuncture. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score at 3 minutes after venepuncture and the duration of cry assessed from a videotaped recording. Twenty-six neonates received 30% dextrose and 26 neonates received sterile water. The cumulative NIPS score at 3 minutes (median, IQR) after venepuncture for neonates given 30% dextrose (13, 6.8-21) was significantly (p = 0.03) lower than that for neonates given sterile water (21, 13.8-21). The duration of cry in neonates given 30% dextrose (median 45 sec IQR 1.5-180.8 sec) was significantly (p = 0.03) shorter than that in neonates given sterile water (median 191 sec IQR 52.3-250 sec). No neonates developed diarrhoea, fever or rash during the 24 hour observation period. Both the intra-rater (ICC 0.993 95% CI 0.988-0.996) and inter rater (ICC 0.988 95% CI 0.980-0.993) agreement on the 3-minute NIPS score were good. In conclusion oral 30% dextrose given 2 minutes before venepuncture was effective in reducing neonatal pain following venepuncture. It is a simple, safe and fast acting analgesic and should be considered for minor invasive procedure in term neonates.

Matched MeSH terms: Phlebotomy*
Fulltext Buccal swab as a suitable source of genomic DNA for screening of selected human leukocyte antigen (HLA) alleles

Vivek Prasad, Lam Yan Shim, Sethu Thakachy Subha, Fazlina Nordin, Maha Abdullah

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):46-46.
MyJurnal

Introduction: Human leukocyte antigens (HLA) are a group of unique transmembrane glycoproteins that are ex-pressed on the surface of virtually all types of cells within the human body. These molecules are encoded by a set of highly polymorphic gene sequences known also as the major histocompatibility complex (MHC) and play an essential role in the presentation of antigenic peptides to immune cells for recognition and response. In recent years, various HLA alleles have been found to be associated with different autoimmune and inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus (SLE) and allergic rhinitis. Identification of these alleles via HLA typing is necessary for initial screening and diagnosis purposes. Besides that, HLA typing is also used to determine compatibility matching between a donor and a recipient for tissue/organ transplantations in order to prevent graft rejection. Therefore, good quality and quantity of genomic DNA is required. In most scenarios, peripheral blood is chosen as the most reliable source of DNA for analysis, however this approach is seen as invasive and may cause pain and anxiety among the patients, particularly young children and weak subjects. Hence, derivation of genomic DNA from buccal cells as an alternative source material is becoming increasingly popular, especially in PCR-based genetic assays. Some of the most commonly described methods to collect buccal cells include using oral swabs, cytological brushes, mouthwashes and treated cards. Each technique yields varying quantities of DNA with diverse purity levels. In this study, we aim to evaluate the amount and purity of genomic DNA extracted from buccal swabs and brushes as well as blood for screening of selected HLA class II alleles. Methods: Cheek cell samples were col-lected using sterile foam tipped buccal swabs (Whatman) and buccal collection brushes (Gentra Puregene) whereas peripheral blood samples were withdrawn following routine venipuncture techniques. All samples were subjected to DNA extraction according to modified commercial kit protocols. Screening of selected HLA-DRB1 alleles was con-ducted via PCR with sequence-specific primers as established by Bunce et al. 1995. Results: There was no significant difference (p > 0.05) in the total DNA yield obtained from blood and buccal swab samples, which were 17.57μg (± 8.66) and 13.28μg (± 4.81), respectively. All samples exhibited similar 260/280 ratios of about ~1.80 (p > 0.05). However, buccal brush samples contributed the least amount of DNA (0.29μg, ± 0.12) compared to other sources (p < 0.05). The pure genomic DNA isolated from both blood and buccal swab samples were successfully typed for low resolution HLA-DRB1 alleles. Conclusion: Buccal swabs provide good quantity and quality of DNA for screening of HLA alleles with high accuracy and thus can be utilized as a non-invasive substitute for venipuncture.

Matched MeSH terms: Phlebotomy
A report on needle stick injuries for the year 2000

Lim JF

Journal of Occupational Safety and Health, 2004;1(2):82-88.
MyJurnal

Workers in the health care industry and related occupations are at risk of occupational exposure to blood borne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other potentially infectious agents. The primary route of occupational exposure to blood borne pathogens is accidental percutaneous (through the skin) injury. Health care workers handle sharp devices and equipment such as hypodermic and suture needles, intravenous blood collection devices, phlebotomy devices, and scalpels. Health care workers with the most involvement in direct patient care e.g., nursing staff, sustain the highest proportion of reported NSIs (needle stick injuries).

Matched MeSH terms: Phlebotomy