Do HIV Patients Prefer Fingersticks Over Venipuncture?

Venipuncture is a painful and messy method of collecting small volumes of blood because patients tend to bleed slightly after testing, which exposes health care workers and close contacts to blood-borne pathogens. On the other hand, clinicians use fingersticks in a wide variety of small blood volume tests because they believe fingersticks are less painful and less prone to bleeding afterwards.

Past research in diabetes patients suggests fingersticks are indeed less painful, but this population is more likely to have callouses and peripheral neuropathy-induced numbness that confound these subjective findings. Additionally, CD4-positive cell count point-of-care (POC) blood tests need larger volumes of blood than glucose testing, so clinicians widely use venipuncture for HIV patients.

A recent study compared patient preference for fingerstick-based blood collection with that of venipuncture. HIV clinic nurses collected blood for CD4 count testing from 499 patients either by fingerstick or venipuncture and asked about perceived pain from the procedure immediately after and 2 days later. The nurses used 2 mm by 1.5 mm metal lancet blades for the fingersticks, while the needles used for venipuncture were 2.25 mm 23 gauge (“large”) and 1.7 mm 28 gauge (“small”).

Half of fingerstick patients reported soreness after testing, but 91% reported minimal or no pain at the time of testing. One in 4 patients reported worse pain with fingerstick tests than venipuncture, while half perceived less pain with fingersticks. Only 28 patients preferred venipuncture over fingersticks at the time of testing.

Perceived pain was more severe in patients needing only one POC test at their visit than those needing multiple POC tests. Patients undergoing one POC test were also less willing to undergo multiple failed fingerstick blood draws before requesting venipuncture.

Patients perceived the CD4 testing lancet as more painful than the needles used for hemoglobin (large), alanine aminotransferase (small), or creatinine (small) testing. Meanwhile, larger fingerstick tool size (needle or lancet) was associated with increased perceived pain.

The questionnaire 2 days after testing showed more patients preferred fingersticks over venipuncture, but almost half had no preference. The most common reason for method preference was relative perceived pain. The largest drivers of change in preference were continued bleeding (favoring fingerstick preference) and soreness (favoring venipuncture).

Soreness lasted longer and delayed wound bleeding was more common after fingersticks than venipuncture. Most fingerstick patients who provided the duration of bleeding reported at least 5 minutes of wound bleeding. Wound reopening during manual labor in the day following testing may have caused the delayed bleeding experienced by fingerstick patients.

The nurses in the study believed that fingerstick testing exposed them to more blood, posed a greater risk of casual transmission, and took longer to complete. The nurses preferred venipuncture if multiple POC tests were needed because it took less time and needed less adhesive bandages than multiple fingersticks. Fingersticks are advantageous at care settings that lack employees trained in phlebotomy skills, but clear employee training on the variable techniques of different POC fingerstick blood needs is critical.

Overall, patients prefer fingersticks over venipuncture for their POC testing needs, although they report worse soreness and ongoing bleeding after fingersticks. Clinicians may prefer venipuncture if multiple fingersticks are necessary.

Reference

Daneau G, et al. Human immunodeficiency virus (HIV)-infected patients accept finger stick blood collection for point-of-care CD4 testing. PLoS One. 2016;11(8):e0161891.