Strategy for the precaution of vasovagal reactions (VVRs) during blood sampling in our healthcare center

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  • 採血による血管迷走神経反応の実態調査ならびにその対応について

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 BACKGROUND: Vasovagal reaction (VVR) is an adverse event such as drop in blood pressure, bradycardia, and nausea occurring during or after blood sampling. VVR is one of the well-known reactions during blood sampling, and it could lead to faintness, convulsion, and incontinence. In serious cases; however, few papers have been published regarding VVRs at medical examination. We aimed to investigate the characteristics of VVRs and propose a precaution manual during blood sampling.<br> METHODS: We extracted 144 cases with VVRs out of 55,150 examinees seen in Osaka Central Hospital Healthcare Center from November 2012 until October 2013. We retrospectively analyzed age, sex, severity of VVRs, posture during blood sampling and recovery time. A questionnaire survey about VVR was performed among 20 nurses and their opinions were reflected in the precaution manual during blood sampling.<br> RESULTS: Female showed the higher rate of VVRs (male:0.25% v.s. female:0.27%) among 55,150 examinees. From 144 cases with VVRs, the younger generation showed high tendency (age ≦40 yrs: 87.5% v.s. age ≧41 yrs: 12.5%). Regarding the severity of VVRs, 128 cases were mild (88.9%: Grade I); 9 cases were moderate (6.3%: Grade II), and 7 were severe (4.9%: Grade III). All 20 examinees collected in supine position remained Grade I, suggesting the usefulness of supine position. Of note, 106 examinees (73.6%) recovered within five minutes, which could be a criterion for recovery of VVRs. From the questionnaire survey, most nurses agreed that more than 15 minutes of supine posture is needed to relieve Grade II and III VVRs. A precaution manual for blood sampling to avoid VVR is proposed, which includes a questionnaire for examinees and routine checking of vitals every five minutes to alert medical staff.<br> CONCLUSION: At medical examination, VVRs are not frequent side effects during blood sampling, but examinees, especially who are young and female, should be treated more carefully using our precaution manual.

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