Effect of Tourniquet Abstention on Pain Reduction in Venous Sampling in the Elderly People

Hôpital NOVO240 enrolled

Overview

This prospective study evaluates the effect of abstaining from tourniquets on pain reduction during the venous puncture of the elderly people.

Almost 3 million people aged 70 and over are hospitalized once or more each year. The implementation of multiple treatments in these fragile patients, often poly-pathological requires a regular biological monitoring. For these patients, samples must be taken on average every two days. This population often has a fragile venous capital due to reduced skin elasticity, undernutrition more or less associated with dehydration, the use of certain venous-toxic treatments and / or repetition of the gesture taking into account the monitoring biological closely related to long-term therapies. With the aim of well-treatment and well-being, the reduction of patient pain is one of the major concerns of caregivers and in particular pain induced by treatment. In children, the practice of harvesting without tourniquet is already frequent (18) and our preliminary study has confirmed us on the tourniquet as one of the acts responsible for the pain that the caregiver can possibly abstain. No study had been conducted on this subject in the adult population and more particularly the elderly population. This prospective study evaluates the effect of abstaining from tourniquets on pain reduction during the venous puncture of the elderly people.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

240

Conditions

Venous Puncture

Interventions

Rubber tourniquetPROCEDURE

The blood sample is taken with a rubber tourniquet

Fabric tourniquetPROCEDURE

The blood sample is taken with a fabric tourniquet

Without tourniquetPROCEDURE

The blood sample is taken without tourniquet

Eligibility

Sex: ALLMin age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * ≥ 75 years and over, * Hospitalized in internal medicine or geriatric department, * For which the 2 upper limbs are accessible to venous puncture (due to the multiple attempts that may be necessary to take a sample during the hospitalization), * For which at least one vein is visible or palpable on an upper limb, * Without venous puncture since admission in the department, * Patient who did not receive a topical anesthetic before the venous puncture (Emla type) * Communicating patient, able to assess their pain on a digital scale, * Patients with affiliation to a social security system or beneficiary , * Written informed consent (IC) obtained. Exclusion Criteria: * Patient already included, * Previous pain localized to the upper limbs, * Hematoma at the planned site of skin-vascular breakage, * Hemiplegic or quadriplegic patient, * Patient with lymphedema in the upper limbs, * Patient with behavioral disorders that may interfere with the proper functioning of the sampling, * Patient with cognitive impairment preventing understanding of the study and adequate assessment pain (CODEX cognitive score of category C or D), * Patient placed under legal protection (guardianship).

Locations (5)

Geriatric Department - CHRU Brest

Brest, France

Geriatric Department - CH Cholet

Cholet, France

Geriatric Department - Hospital Louis Mourier - Colombes

Colombes, France

Geriatric Department - Intercommunal hospital center - Créteil

Créteil, France

Outcomes

Primary Outcomes

Comparison of the maximum pain associated with venous puncture, in elderly patients with a visible or palpable vein depending on the method of sampling.

Assessment of maximum pain on examination (including pain from skin-vascular invasion and tourniquet pain)by the patient using a verbal numerical scale (EN) rated from 0 to 10. This measure concerns the 1st sampling as a whole, regardless of the number of attempts necessary to obtain it and their terms

Time frame: At the end of the study, an average of 12 month

Secondary Outcomes

Proportion of elderly patients with a visible or palpable vein

Estimate of the proportion of patients corresponding to phlebological prerequisites of the study (vein visible or palpable on at least one of the two upper limbs) on all elderly people meeting the other selection criteria upon admission to the service for the duration of the research

Time frame: At the end of the study, an average of 12 month

Comparison of the number of cutaneous-vascular breaks necessary for obtain a blood sample, according to the venous sampling procedure

Compilation of the number of cutaneous-vascular ruptures performed until obtention of a sample sent to laboratory

Time frame: At the end of the study, an average of 12 month

Comparison of the time taken to obtain a blood sample by caregivers, according to the venous sampling procedures

Measurement of the time required for this sample using timing from the moment the nurse is ready and until the end of the filling of the first tube sampled. This timing is performed by the caregiver himself and not by the third party who will collect the patient's pain and who is not present, in order to avoid any external influence linked to the performance of the gesture during the evaluation of the main criterion

Time frame: At the end of the study, an average of 12 month

Comparison of the ease of taking the sample by caregivers, according to the venous sampling procedure

Data from ClinicalTrials.gov

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