Fever glove hand-shake method safe blood collection from children's fingertips in COVID-19 fever clinic

Abstract

BACKGROUND

During the coronavirus disease 2019 (COVID-19) epidemic, the fever clinic is an important link for screening and diagnosing whether a patient is infected with the novel coronavirus. Blood collection from children’s fingertips is a commonly used detection method; however, in children, the blood collection process may cause discomfort and resistance. To address this problem, the use of heating gloves combined with hand swinging can be considered for fingertip blood collection in children.

AIM

To explore the application of fever gloves with the handshaking method for fingertip blood collection from children in fever clinics during the COVID-19 epidemic.

METHODS

A total of 100 children were selected for fingertip blood collection at the fever clinic of our hospital from June 2022 to June 2023 and were divided into two groups using a randomized numerical table method, with 50 cases in each group, including the control and observation groups. The patients in the control group followed the doctor's instructions to cooperate with the routine fingertip blood collection method, and the patients in the observation group followed the doctor's instructions to cooperate with the static fever gloves with the shaking hands method of children's fingertip blood collection. The level of the six blood routine and collection indexes, and the satisfaction of the examination of the patients in the peripheral blood group and the fever gloves with the shaking hands method of the children's fingertip blood collection group were compared.

RESULTS

The red and white blood cell count, hemoglobin, and red blood cell pressure volume in the observation group were higher than those in the control group (P < 0.05); the platelet count in the control group was lower than that in the observation group (P < 0.05); the number of times of squeezing the fingertip, the average time of blood collection, and the score of puncture pain in the observation group were significantly better than those in the control group (P < 0.05); and satisfaction with the routine blood examination in the observation group was greater than that in the control group.

CONCLUSION

The application value of the fever gloves with shaking hands method for children's fingertip blood collection was better, the accuracy of examination indexes was higher, and patient satisfaction with the examination was greater.

Key Words: Fever gloves; Shaking hands method; Peripheral blood; Index; Puncture; Satisfaction

Core Tip: The research results can evaluate the application effect of heating gloves combined with the hand-swinging method for fingertip blood collection in children. If fever gloves combined with flicking can reduce children's discomfort and resistance and improve the effect of blood collection, they can be applied to fever clinics during the coronavirus disease 2019 epidemic to improve the success rate of children’s fingertip blood collection and patient experience.

INTRODUCTION

Fever clinics play an important role in the diagnosis and screening of patients during the coronavirus disease 2019 (COVID-19) pandemic. Fingertip blood collection is a common but difficult procedure in pediatric patients. Traditional fingertip blood collection methods require the use of a needle to puncture the patient’s fingertip, which can be painful and frustrating for children. Therefore, a new method is required to improve the efficiency of blood collection and minimize patient suffering[1-3]. In this study, we proposed a new method for fingertip blood collection in children using a heated glove in conjunction with the hand-shaking method. Heated gloves can be heated to increase the patient’s blood circulation and dilate the blood vessels in the fingertips, thus facilitating blood collection. The flutter method increases blood flow by fluttering the arm, which can further improve the efficiency of blood collection. In practice, we found that the use of heated gloves in conjunction with the flap method for fingertip blood collection in children significantly improved the efficiency of blood collection. Compared with the traditional fingertip blood collection method, the use of a heated glove can dilate the blood vessels at the fingertip, making it easier to locate the vessels and collect sufficient blood samples. Simultaneously, the flap method increases blood flow, further improving the efficiency of blood collection.

Shaking fever gloves is a simple but effective method that can be applied to fingertip blood collection from children in fever clinics during the COVID-19 outbreak. This method not only improves the efficiency of blood collection and reduces patient suffering but also reduces the contact time of healthcare workers and decreases the risk of infection[4]. However, further studies are required to evaluate the safety and feasibility of the proposed method. Shaking fever gloves is a promising method that can be applied to fingertip blood collection from children in fever clinics during the COVID-19 outbreak. This method may improve the efficiency of blood collection, reduce patient distress, and reduce the risk of infection. Further studies are needed to validate the safety and feasibility of this method and promote its use in clinical practice.

MATERIALS AND METHODS

General information

Case selection: Between June 2022 and June 2023, 100 children underwent fingertip blood collection at our hospital’s fever clinic. Inclusion criteria: (1) Fever clinic selection of children with fingertip blood collection routine, body temperature of 36 ℃–39 ℃ or less; (2) children aged 7 mo to 6 years; and (3) parents know about the research program and voluntary participation in this study; exclusion criteria: (1) Children with a temperature of 39 ℃ or more and their condition of them being critically ill; and (2) family members of the communication barriers. The children were randomly divided into the control and observation groups according to the single or double serial number of consultations.

Methodology

(1) Control group: 50 patients, routine fingertip blood collection. The family fixes the root of the child’s palm with their fingers and places it on the operating table; the blood collector fixes the child’s finger, pinches the finger, and disinfects the child’s left ring finger with a skin disinfectant (Maokang brand), then takes the disposable peripheral blood collection needle (Huahong) and quickly inserts it to a depth of approximately 2 mm, pulls out the needle, squeezes the child’s finger to see the blood flows out, wipes away the first drop of blood with a sterile dry cotton ball, and sucks out the blood with a disposable micro blood collection pipette (Laixu), by repeatedly squeezing. The first drop of blood was dried with a sterile dry cotton ball, and the blood was aspirated using a disposable micro blood collection pipette (Laixu) by repeatedly squeezing the child’s finger until the blood reached the area of the blue fine marking line; the micro-blood collection pipette was put into a disposable anticoagulation test tube, the family of the patient was instructed to use a sterile dry cotton ball to hold down the puncture hole, and the pressure was held down for 2–3 min. The nurse immediately pushed all the blood into a disposable anticoagulation test tube by using the red cap, the stopper was tightened on the test tube, and the test tube was placed in a vortex oscillator to mix the blood; and (2) Observation group: 50 cases - Fever gloves with the hand shaking method for fingertip blood collection.

Fever gloves with the hand method of children’s fingertip blood collection method: (1) Heat the disposable baby warmer into the cotton half-finger finger gloves in the compartment, the cotton gloves through the baby warmer heated; (2) Warm baby heated to the appropriate temperature, with a digital thermometer to measure the temperature of the heated gloves (37 ± 1) ℃, to the child’s hands on the homemade heated gloves. After 5 min, the nurse guided/assisted the child in implementing the hand shaking method. Specific operation of the hand-shaking method: The family members of infants and toddlers hold the child from behind and sit on the lap of the family members; older children take the seated position; the child’s arm is naturally lowered to the wrist as the pivot point, and the nurse gently shakes the hand by holding the child's arm 10–15 times. The nurse held the child’s arm and gently shakes it 10–15 times; (3) Same as the conventional fingertip blood collection method; and (4) Take off the cotton gloves when there is no bleeding from the finger at the puncture site of the child and put the cotton gloves into the recycling box.

The baby was uniformly sent to the supply room for autoclave sterilization and disinfection, and the warm baby was disposed of in medical waste garbage.

Routine blood specimens from both groups were examined using an XN-350 automatic five-category hematology analyzer, and the reagents, quality control products, and calibration products were imported. The instruments were calibrated, and performance was verified with reference to the “Quality Requirements for Analysis of Routine Clinical Hematology Tests.”

Observation indicators

Observe and record the number of times the fingertip is squeezed during blood collection and the aspiration time required to memorize the volume of blood collected (100 UL) using a micro-blood collection pipette. The pass rate of the blood specimen and whether the blood specimen was returned for recollection. Satisfaction with the child’s family was assessed using a questionnaire.

Statistical methods

The SPSS19.0 statistical software was used to analyze the data. Measurement data were expressed as mean ± standard deviation using the t-test; count data were expressed as rate (%) using the χ² test. P < 0.05 was considered statistically significant.

RESULTS

Comparison of the levels of blood routine testing indexes between the two groups

There was no difference in the average hemoglobin concentration in red blood cells between the control and observation groups (P > 0.05), whereas the red blood cell count, white blood cell count, hemoglobin, and erythrocyte pressure volume were higher in the observation group than in the control group (P < 0.05), and the platelet count was lower in the observation group than in the control group (P < 0.05) (Table 1).

Table 1 Comparison of the levels of blood routine testing indexes between the two groups (mean ± SD).

Groups	Erythrocyte count (× 1012/l)	White blood cell count (× 109/l)	Hemoglobin (g/L)	Erythrocyte pressure (%)	Average hemoglobin of red blood cells; white concentration (g/L)	Platelet count (× 109/L)
Control group (n = 50)	3.95 ± 0.76	6.19 ± 1.57	110.03 ± 19.73	31.19 ± 10.89	301.76 ± 39.72	238.97 ± 47.89
Observation group (n = 50)	4.32 ± 0.85	7.03 ± 1.65	119.42 ± 20.65	40.39 ± 12.13	304.23 ± 39.76	207.65 ± 47.86
t	7.865	3.681	3.423	5.865	0.761	4.365
P value	0.001	0.001	0.001	0.001	0.267	0.001

Comparison of blood collection indexes between the two groups

The number of times the fingertip was squeezed, average blood collection time, and puncture pain score in the observation group were significantly better than those in the control group (P < 0.05), as shown in Table 2.

Table 2 Comparison of blood collection indexes between the two groups (mean ± SD).

Groups	Number of fingertip squeezes (times)	Average blood collection time (min)	Puncture pain score (points)
Control group (n = 50)	4.19 ± 0.68	5.00 ± 0.33	0.79 ± 0.10
Observation group (n = 50)	1.36 ± 0.50b	2.01 ± 0.28b	0.48 ± 0.13a
t	8.732	6.281	2.139
P value	0.000	0.000	0.041

^aP < 0.05 compared with control group.

^bP < 0.01 compared with control group.

Comparison of satisfaction with routine blood tests between the two groups

Satisfaction with routine blood tests in the observation group was greater than in the control group (P < 0.05) (Table 3).

Table 3 Satisfaction with routine blood tests in both groups [n (%)].

Groups	Unsatisfactory	Partially satisfactory	Extremely satisfied	Satisfaction with routine blood tests
Control group (n = 50)	16 (32.00)	25 (50.00)	9 (18.00)	34 (68.00)
Observation group (n = 50)	5 (10.00)	30 (60.00)	15 (30.00)	45 (90.00)
χ2	-	-	-	6.873
P value	-	-	-	0.001

DISCUSSION

Routine blood tests are the most basic clinical examination. After collecting human blood samples, it identifies and analyzes the substances in the blood, assesses the patient’s health, detects the presence of diseases in time, and guides the clinic in carrying out effective treatment. Human blood consists of various types of blood cells and plasma, including white blood cells, red blood cells, and platelets, which have different functions and are used for various purposes in disease diagnosis. Red blood cells are the main component of blood, which bear the important responsibility of transporting oxygen to all parts of the body and can reflect the body’s physical strength and mental state. White blood cells are human immune cells that can protect the human body from foreign pathogens and effectively remove cancer cells from the human body, assuming an important defense function[5]. Platelets are an important part of the blood and have a coagulation effect. After the body is damaged, platelets work quickly to promote wound healing. If platelets exceed the standard, they cause damage to the human body, leading to thrombosis, and thrombus dislodgement to form emboli can lead to the death of the host. From the clinical application of routine blood tests, a variety of white blood cell counts, human inflammatory responses, and viral infections, there is a close relationship between hemoglobin, the number of red blood cells, a variety of anemic diseases, and anemia severity. In the early stages of some diseases, abnormalities in routine blood tests are almost invisible. With the prolongation of the course of the disease, the patient’s condition gradually worsens, and the abnormalities of routine blood tests become increasingly obvious. Active routine blood tests can assess the number of cells in the blood as well as morphological changes, which can detect disease abnormalities in a timely manner and provide important test data support for clinicians to effectively diagnose, target intervention, and evaluate disease regression. Routine blood tests for a variety of diseases can also play a strong role in assisting the timely clinical detection of the presence of disease and targeted intervention.

Since the outbreak of COVID-19 in Wuhan, Hubei, China, it has rapidly spread to all provinces of the country and is highly contagious and generally susceptible to the population[6]. Children’s fever clinics are the first line of defense for virus prevention and control in hospitals, and they are also a high-risk area for cross-infection. Therefore, medical staff should not neglect their own protection when contacting patients, especially blood collection nurses in fever clinics. Intravenous blood collection is a nursing operation project with close contact with patients, and children generally have a poorer ability to cooperate; peripheral blood vessels are finer than adults. Nurses in the blood collection are very likely due to coughing, sneezing, crying, or swinging too large, resulting in increased difficulty in puncture and prolonged close contact with the child, increasing the risk of contact transmission. Thus, improving the success rate and shortening the time of blood collection are key to reducing the rate of nosocomial infection among nurses and preventing the nosocomial transmission of the virus. Fingertip blood collection for routine blood tests in children is a commonly used clinical blood collection method; it is easier to perform fingertip blood collection, which is also a more adherent blood collection method for children.

Several studies have shown[7-9] that routine blood collection is performed using fever gloves with a shaking hand method of performing fingertip blood collection in children for routine blood tests.

The examination revealed some differences in the levels of these indicators. The results of this study are consistent with the above viewpoints, and the results show that there are sharp differences in the red blood cell count, white blood cell count, hemoglobin, red blood cell pressure volume, and platelet count of the patients in the peripheral blood group and the group of children's fingertip blood collection with fever gloves with the shaking hand method; however, there was no difference in the average hemoglobin concentration of red blood cells and the three puncture indices of the two groups. In addition, the patients in the group of children’s fingertip blood collection with the fever gloves with the shaking hand method are more likely to have a greater degree of examination. The degree of intention is greater. From the perspective of blood collection, the peripheral blood source is the capillary, the site of blood flow velocity is relatively slow, platelets are attached to the puncture site and then form clots, and the results of routine blood tests have a direct impact.

CONCLUSION

The blood content of the peripheral site is low, and blood collection alone often fails to collect an adequate blood sample. Therefore, it is necessary to rub the fingertip to engorge it with blood and repeatedly press the puncture site to obtain an adequate blood sample[10]. However, this behavior can lead to other blood components entering the blood specimen, diluting the blood specimen, and ultimately affecting the examination results[11]. From the perspective of blood collection time, the heating gloves with the shaking hands method of children’s fingertip blood collection site utilizes the elbow vein of the upper limb; the patient’s blood vessels are thicker, more blood is collected, and blood collection speed and stability are higher; therefore, the routine blood examination is more accurate.

ARTICLE HIGHLIGHTS

Research background

During the coronavirus disease 2019 (COVID-19) pandemic, fever clinics have become an important link for screening and diagnosing patients infected with the novel coronavirus. Children’s fingertip blood collection is a commonly used detection method, and the use of heated gloves combined with hand swinging can be considered for fingertip blood collection.

Research motivation

Fever gloves can generate heat, which can improve blood circulation in children’s fingers, thereby increasing blood flow and blood collection. The hand-swinging method increases blood flow by quickly swinging the arm, which can further promote blood collection.

Research objectives

In applied research, a certain number of pediatric patients can be recruited and were randomly divided into two groups. One group used the traditional fingertip blood collection method, whereas the other group used heating gloves combined with the fingertip blood collection method.

Research methods

The effects of blood collection, discomfort, and resistance were compared between the two groups.

Research results

The research results can be used to evaluate the application of heating gloves combined with the hand-wagging method for fingertip blood collection in children.

Research conclusions

Combining fever gloves with flicking can reduce discomfort and resistance in children.

Research perspectives

It can be applied in fever clinics during the COVID-19 pandemic to improve the success rate of children’s fingertip blood collection and patient experience.