Reducing Pain in Emergency Department by Using Veinous Blood Gas Instead of Arterious Blood Gas

Study Overview
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Brief Summary
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Blood gases are widely used in emergency and resuscitation services and are the key examination for exploring acid-base balance disorders (using pH, PaCO2 and HCO3 ) and gas exchange disorders (using PaO2 and PaCO2). This examination can be taken from both venous and arterial sample and its analysis depends on the type of blood sample. Currently, several studies have already shown the existence of a good correlation of pH and bicarbonates level between a venous and arterial sample. Thus, when this examination is prescribed for the purpose of highlighting and analyzing an acid-base disorder, venous blood gas is theoretically as efficient as arterial blood gas. Due to the lack of evidence of benefit for the patient or the health care team of a venous blood gas rather than an arterial blood gas in the absence of suspicion of hypoxemia, arterial blood gas is currently the standard of care for the analysis of acid-base disorders. Indeed, among the university hospitals affiliated to the Paris Diderot University, the emergency departments carry out in their vast majority (4 of 5 E.D.) arterial blood gases. Demonstration of the superiority of veinous sample over arterial sample regarding pain could substantially modify current practices. The investigator's main hypothesis is that, in the absence of suspicion of hypoxemia (normal oxygen saturation measured by plethysmography), the realization of a venous blood gas for the evaluation of the acid-base balance in the context of emergencies is less painful for patients, simpler for the health care team and provides sufficient biochemical information for the doctor in comparison with an arterial blood gas.

Official Title
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Reducing Pain in Emergency Department by Using Veinous Blood Gas Instead of Arterious Blood Gas

Conditions
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Acid Base Disorder

Intervention / Treatment
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* Diagnostic Test: Arterial blood gas
* Diagnostic Test: Veinous blood gas


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: necessity of blood gas analysis age > 18 yo SpO2>95% without supplemental oxygen no altered level of consciousness: Glasgow Coma Scale=15 Exclusion Criteria: Patient under guardianship or curatorship confusional state or patient unable to understand the protocol no social security

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arterial blood gas<br> | Diagnostic Test: Arterial blood gas<br>* arterial blood sample with puncture of the radial artery<br>|
| Experimental: Veinous blood gas<br> | Diagnostic Test: Veinous blood gas<br>* veinous blood sample using peripheral venepuncture<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain score: Visual Analog Scale | Pain is self-completed by the patient using a Visual Analog Scale. Visual Analog Scale for Pain is a continuous scale comprised of a line of 100 mm grading pain intensity anchored by no pain (score 0) and worst imaginable pain (score 100) | Immediately after blood gas sample | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of attempts needed to obtain a blood gas sample |  | Immediately after blood gas sample | 
| Number of different operators needed to obtain a blood gas sample |  | Immediately after blood gas sample | 
| Ease of blood gas sampling procedure | Ease of blood gas sampling procedure assessed by the operator using a four-levels likert scale (easy,moderate,difficult very difficult) | Immediately after blood gas sample | 
| Failure of the blood gas sampling procedure | Impossibility to obtain a blood gas sample | Immediately after blood gas sample | 
| Quality of information provided by the blood gas analysis: four levels likert scale | Four-levels likert scale assessing doctor's satisfaction regarding the quality of gas information provided by the blood gas analysis (very satisfied,satisfied,slightly satisfied,not satisfied | Immediately after having received blood gas analysis results |