Palm Prick Vs.

Fingerstick Sampling for Routine Capillary Blood Glucose Testing:

Its Effect on Pain Perception

Chapter 1

Introduction

Statement of the Problem

This is an unblinded randomized controlled trial which seeks to determine the effect on pain perception
during routine capillary blood glucose sampling when utilizing the fingertips and the palmar surface of
the hand. It aims to compare the two sites in relation to pain perception. Ultimately, this study seeks to
know if there is a significant difference on the degree of pain experienced by these patients.

Objectives:
The purpose of this study is to determine the degree of pain experienced during routine capillary blood
glucose testing. Specifically this study aims to:

1. To determine the degree of pain perceived during routine capillary blood glucose sampling
utilizing the fingerstick method.
2. To determine the degree of pain perceived during routine capillary blood glucose sampling
when utilizing the palm as an alternative site.
3. To determine if there is a significant difference in pain perception between fingerstick and palm
prick method of sampling for blood glucose level determination.

Scope and Delimitation

The study focuses on the determination of the degree of pain perceived during sampling for routine
blood glucose using the traditional (“main”) site which is the fingertips and an alternate site, the palmar
dorsum.

The study delimits itself to the determination of pain when utilizing the two sampling techniques. It
shall not tackle on the degree of difference between the readings obtained from the sampling methods
 Chapter 3:
Methodology

.Design of the Study

The study shall utilize an unblinded randomized controlled trial.

Venue of the Study

The study will be conducted at the Philippine Heart Center Out-Patient Department for a 3-month
period during the People's Day. The People's Day is a monthy outreach program conducted by the
Philippine Heart Center. The primary objective of this program is to promote awareness and campaign
for the modifications of risk factors associated with the development of cardiovascular disorder. Free
blood cholesterol and sugar determination and EKG is given to a hundred recipients monthly along
with medical consult, nutritional assessment and counseling.

Sample Size
to be determined

Study Population

Patients will be recruited to the trial during the People's Day. Patients with the following conditions
will be excluded from the study includes: aged less than 18, dysphasic, less than alert on the AVPU
scale, has a bleeding disorder, has altered sensation (including pain), or a lesion at any of the test sites.

Sampling Scheme

Eligible consenting patients will be randomised to one of two intervention groups: 1) fingerstick
sampling; 2) palm prick sampling. Randomization shall utilize the odd-even scheme where consenting
patients registered with on an odd number shall fall on the fingerstick group while the those registered
on an even number shall be placed into the palm prick group.
 Instruments
The Visual Analog Scale (VAS) shall be utilized to determine the degree of pain experienced during the
sampling procedure. The Optium Xceed Meter kit by Abott shall be utilized as the glucometer and
lancet of choice as it is currently the standard machine utilized by this institution.

.Procedures in Data Gathering

The skin at the site of sampling shall be cleaned, then wiped with a sterile dry swab to reduce potential
interference with the sample. Lancet skin puncture was performed on the lateral aspect of the thumb or
on the fingertips. The Optium Xceed Meter device was used (Abott). The area surrounding the test site
will be squeezed to express a drop of blood.

If the proscribed sampling method failed to provide an adequate sample for successful glucometry the
failure will be recorded, and the test will be repeated using lancet puncture on the other testing site.

Pain perception will be assessed using a 100mm visual analogue scale (VAS). The number of
successful 1st attempts will recorded for each technique. Additional outcomes such as adverse events
and withdrawal from the trial shall also be recorded.

Statistical Treatment of the Data

Analysis will be by intention to test. Non-parametric data will be analyzed using using Mann-Whitney
U tests. Categorical variables will be compared using Chi-squared analysis with Yates correction.