Nurse leads research study to reduce needle sticks

Bedside nurse Nicoletta Constantin’s empathy for her patients has her leading a first-of-its-kind, nursing led research study to investigate a potential means to decrease the number of needle sticks cystic fibrosis patients endure with each inpatient admission.

Taylor has to have blood drawn several times during each inpatient admission. Here, her favorite nurse, Allyson, checks her PICC line.Taylor is no stranger to needles. Since her diagnosis with cystic fibrosis at 18 months old, the 16-year-old high school junior from Kenly, N.C., has been hospitalized at UNC Hospitals dozens of times and been, as she describes it, “poked and prodded” more instances than she can count.

Next to the hospital food (which she insists is “just not greasy enough”), the needle sticks are her least favorite thing about being inpatient at North Carolina Children’s Hospital.

“My veins are very fragile and pop easily, so it usually takes some digging to find one that works,” explains Taylor. “It can take three different sticks for one draw. After a while, your arm bruises up.”

Anxiety-inducing needle sticks aren’t just hard on the patient. They take a toll on the care team, too.

“We are the ones who see the pain in their faces,” Nicoletta Constantin, PhD, RN, says of herself and the other frontline caregivers who experience the patients’ fears and worries firsthand. “It’s especially difficult with the little ones.”

Constantin’s empathy for her patients has her paving a somewhat unconventional path for a bedside nurse, leading a research study to investigate a potential means to decrease the number of sticks cystic fibrosis patients like Taylor must endure: drawing blood from patients’ implanted ports (IPs) and peripherally-inserted central catheters (PICCs) instead of by needle stick.

Why so many needle sticks?

Nicoletta Constantin, PhD, RN, hopes her research will reduce the number of needle sticks that CF patients endure during hospitalization.

Cystic fibrosis (CF) is a chronic, genetic disease. The condition causes the body to produce thick, sticky mucus that can clog the lungs and be a breeding ground for harmful bacteria. As such, it is common for people with cystic fibrosis to develop serious lung infections that require in-hospital treatment with high-dose, intravenous (IV) antibiotics like tobramycin.

The therapeutic range for these antibiotics is very narrow: too little renders them ineffective; too much can lead to hearing loss and kidney damage. Striking the correct balance requires multiple blood draws. Current national standards of care for CF patients require that antibiotic levels be tested with a blood sample drawn directly from a vein, even if the patient has a central line in place. That can translate into several sticks per admission.

“Central lines are used for all other blood tests, so patients and families have a hard time understanding why they can’t also be used to test antibiotic levels,” says Constantin, who was determined to find an explanation. “While looking at the (research) literature, we realized there are some missing pieces.” The idea of a research study was born.

Funded by the Becton-Dickinson Nursing Research Fellowship, Constantin’s study aims to determine the accuracy of tobramycin levels drawn from central lines as they compare with samples drawn via needle stick. She and her multidisciplinary team will collect 40 IP samples and 40 PICC samples for the comparison, a process that will take more than two years to complete.

To date, the team has collected 27 samples and is encouraged by the preliminary results, which consistently demonstrate central line levels within 10 percent of those drawn by needle.

If the results hold true, it could signal a change in national standards of care and eliminate some of the pain and discomfort felt by CF patients during their inpatient stays. If not, Constantin has, at the very least, trail blazed new opportunities for bedside nurses to engage in research. Hers is the first research study at UNC to be designed, written, supported and carried out by bedside registered nurses not associated with academia.

“We can do it,” says an enthusiastic Constantin. “We can actually bring new knowledge to the table that will improve nursing practice at our hospital and everywhere else.”

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Listen and watch as Nicoleta Constantin describes the research project and her aspirations for helping patients in this year's UNC Nursing Annual Report >>