자동화천자기구와 레이저천자기구 사용 발뒤꿈치 천자 후 신생아의 통증 및 생리적 반응 비교

Abstract

Comparison of pain and physiology in newborns after heel puncture using an automated puncture device and a laser puncture device

Hea Jin, Lee Department of Nursing, The Graduate School, Pukyong National University Directed by Professor Myoung Soo, Kim, PhD

Abstract

Purpose This study aimed to compare the differences in pain responses (behavioral and physiological response), skin injury, hemostasis, and the number of punctures with an automatic puncture device and a laser puncture device during heel blood sampling in newborns.

Method This was a prospective observational study targeting newborns admitted to the neonatal intensive care unit(NICU) of University Hospital I. A total of 53 newborns were included and 71 puncture records were obtained. The tools and markers used were the neonatal infant pain scale (NIPS), heart rate, oxygen saturation, skin injury(erythema, bruise, scar), hemostasis, number of punctures, and facial analysis mobile app. The skin injury evaluation time points were before the puncture, immediately after the puncture, 3 minutes after the puncture, and 24 hours after the puncture. Repeated measures ANOVA was used to determine the differences in pain response(behavioral and physiological response) with time according to the puncture method.

Result The results verified the differences in the percentage of skin injury(erythema, edema, bruise, scar) according to the puncture method used. Significantly different scars were observed in one case(2.9%) with the laser puncture device and seven case(18.9%) with the automated puncture device at 3 minutes after the puncture(χ²=4.52, p=.033). One case(2.9%) with the laser puncture device and 31 cases(83.78%) with the automated puncture device were significantly different(χ²=46.77, p< .001) 24 hours after the puncture. The number of punctures showed a significant difference according to the puncture method(t=7.94, p<.001). The laser puncture device(2.41±1.05) showed a higher number of punctures than the automatic puncture device(1.03±0.16). Hemostasis with the laser puncture device(1.12±0.03) was significantly lower(t= 8.61, p<.001) than that with the automated puncture device(1.84 ±0.37). Correlations between anger, contempt, disgust, fear, happiness, neutral, sadness, and surprise in pain behavioral response and facial expression analysis were also conducted. Significant positive correlations were observed between pain behavioral responses and anger(r=.24, p=.045), disgust (r=.27, p=.023), fear(r=.29, p=.015), and sadness(r=.25, p=.017) in facial expression analysis. In addition, facial expression in the subcategory of pain behavioral response showed a significant positive correlation with anger(r=.12, p=.031). Crying a subcategory of pain behavioral response showed significant positive correlations with fear(r=.28, p=.019) and sadness(r=.26, p=.031) in facial expression analysis. Finally, no significant differences in pain behavioral responses(F=2.09, p= .153), heart rate(F=0.09, p=.760), and oxygen saturation(F= 0.15, p=.705) were observed according to the puncture method.

Conclusion There were no significant differences among pain responses according to the puncture method. Significant differences were observed in skin injury, hemostasis, and the number of punctures, according to the puncture methods used. In addition, positive correlations were observed between pain behavioral responses and the facial expressions of anger, disgust, fear, and sadness. Hence, when performing painful punctures in clinical practice, an instrument that considers the conditions and characteristics of a newborn should be selected.