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BD® PIVO™ Pro Needle-free Blood Collection Device 

BD Peripheral Line Draw Solution

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The BD Peripheral Line Draw Solution

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Transformative Solution

Transform the care experience with longer-lasting peripheral IV catheters that enable needle-free blood draws1,2

The PIVO™ Pro Needle-free Blood Collection Device is designed to achieve the first and only compatibility with integrated and long peripheral IV catheters, including the new Nexiva™ Closed IV Catheter System with NearPort™ IV Access in addition to traditional short IV catheters.

BD is transforming clinical workflows and their outcomes1,2 by combining the proprietary technologies of closed IV catheter systems that have shown to improve dwell times and reduce complications with a needle-free blood collection device to overcome traditional IV and blood collection challenges.2

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Cost of Status Quo

IV access and blood draws are invasive, costly procedures

Inefficiencies in IV access and blood draws impact clinical quality, workflows and experience, hindering your bottom line.

These common invasive procedures are associated with a variety of complications that can extend hospital stays, increase your costs, and negatively impact care experiences for both clinicians and patients.3,4

Challenges
IV complications IV complications
IV complications
Specimen errors Specimen errors
Specimen errors
Risk of injuries Risk of injuries
Risk of injuries
The problem


Avoidable IV replacements are costly to patients, caregivers, and the health care system3


The cost


Up to $980,000 per year in an average 200 bed hospital from IV restarts alone*#3


The problem


Preanalytical specimen errors lead to sample rejection and redraws, delaying time to treatment


The cost


Up to $2.4M in a 200 bed hospital with a $200M operating expense+,5


The problem


Needlestick injuries are associated with bloodborne pathogen exposure and infection and can require costly interventions6


The cost


$935 median of direct and indirect costs for accidental needlestick injuries7

Up to $4,838 for post blood exposure management costs per reported exposure8

*Costs are estimated for a 200 bed U.S. hospital. #Annual estimate for 100,000 catheters, with a 35% failure rate and a $28 average cost per IV insertion. +Math: $200M operating expense x 1.2% = $2.4M

 

Solution Components

Powering dual utility of PIVCs for infusion and high-quality blood draws

See how BD is optimizing IVs to make needle-free blood collection possible

The PIVO™ Pro Needle-free Blood Collection Device optimizes IV performance by advancing a flexible internal flow tube through the patient's PIVC to access optimal draw conditions beyond the catheter tip.2

 

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    How it Works

    See how the BD Peripheral Line Draw Solution makes blood draws easier11,12

    Help preserve vessel health4 and overcome traditional peripheral IV line draw challenges by using existing access for high-quality blood draws.2,11

    During the BD peripheral line draw procedure with the PIVO™ Pro Blood Collection Device, a flexible internal flow tube advances through the PIVC and into the vessel. This enables clinicians to go beyond suboptimal draw conditions to collect a high-quality, reliable blood sample.

    The Peripheral Line Draw Solution in Action

    See what people are saying about the PIVO™ Pro Blood Collection Device

    Trust in the only company with a complete peripheral vascular access solution designed to deliver longer lasting IVs1 and high-quality blood samples11 to elevate clinical outcomes, while improving patient experience and clinical workflow.2,11,13

    Alleviate anxiety associated with repetitive needlesticks.13

    quote-icon
    Create lasting value for your hospital.

    The thing that tells me about the potential of this device is to see the reaction of the patient.

    —

    Patrick Charmel,
    CEO Griffin Hospital

    Improve Clinical Quality and Experiences

    Support the vision of a “One-Stick
    Hospital Stay” for your patients

    Together we can transform care that touches patients every day. By enabling the right device to be placed successfully the first time, lasting throughout a patient’s stay, and used for therapy and labs. 

    Gain high-quality, reliable blood samples that reduce the risk of preanalytical lab errors2 that may result in redraws and delays in patient care,4 while helping to reduce complications3 that lead to unnecessary procedures and IV replacements.1,2 

    56% decrease in pre-analytical errors*,2
    19%     reduction in IV replacement rates2

    Optimize IV performance to use existing access for blood draws,2,5 and reduce unnecessary procedures associated with poor sample quality and IV failures,5 helping alleviate patient’s fear and anxiety from repetitive needlesticks that may disrupt the sleep and healing process.2,13-16


    9.1 out of 10 patients preferred the PIVO™ Needle-free Blood Collection Device13
    Overall clinician satisfaction was significantly higher with all in one PIVC17

    Reduce the risk of needlestick injuries and associated bloodborne pathogen exposure that may create stress for clinicians,2,6,7 while preserving your patient’s vessel health4 by maximizing first stick success,18 minimizing IV replacements, and using existing access for blood draws.2,11

    94% demonstrated success rate on the first draw2
    91%     first attempt insertion success*,18

    Minimize unnecessary costs associated with IV complications, IV replacements, and sample recollections that may delay patient care, prolong discharge, and create dissatisfaction for both clinicians and patients.3,5 

    Up to 1.2% of total operating costs associated with preanalytical specimen errors5
    $980K     annually from IV restarts alone in a 200 bed hospital3

    Comprehensive and Flexible Portfolio

    Learn about our portfolio of transformative line draw solutions

    Elevate patient outcomes and experiences with this powerful combination including straight and closed IV catheter systems that support PIVO™ Pro Needle-free Blood Collection Device compatibility. 

    Learn more

    References

    1. Gonzàlez Lòpez J, Arribi Vilela A, Fernàndez Del Palacio E, et al. Indwell times. complications ond costs of open vs closed safety peripheral intravenous catheters: a randomized study. J Hosp Infect. 2014;86(2):117-126
    2. Pendleton B, LaFaye R. Multicenter study of needle·free blood collection system for reducing specimen error and intravenous catheter replacement. J Healthc Qual. 2022;-44;(2):e24·e30. doi:10.1097/JHQ.0000000000000331
    3. Helm RE, Klausner JD, Klemperer JO, et al. Accepted but unacceptable; peripheral IV catheter failure: Infus Nurs Society. 2015;38(3):189-203.
    4. Twibell KR, Hofstetter P, Siela D, Brown D, Jones HM. A comparative study of blood sampling from venipuncture and short peripheral catheters in pediatric inpatients. J Infus Nurs. 2019;42(5):239. doi:10.1097/NAN.0000000000000338
    5. Green SF. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem. 2013;46:1175-1179. doi: 10.1016/j.clmbiochem.2013.06.001
    6. Mengistu, DA, Tolera ST, Demmu YM. Worldwide prevalence of occupational exposure to needle stick injury among healthcare workers: a systematic review and meta·analysis. Canadian Joumal of Infectious Diseases and Medical Microbiology, 2021.
    7. Mannocci A, De Carli G. Di Bari V et al, How much do needlestick injuries cost? A systematic review of the economic evaluations of needlestick and sharps injuries among healthcare personnel. Infect Control Hosp Epidemiol. 2016;37(6):635-646. Doi:10.1017/ice.2016.48
    8. O'Molley C. The frequency and reasons for central line accesses in cntical core units. Canadian Journal of Infection Control. 2018:33(3):165-167.
    9. Adams S, Toroni B, Lele M. Effect of the PIVO device on the procedure of phlebotomy from peripheral JV catheters. Nurs Res Pract. 2018:7380527. doi:10.1155/2018/7380527
    10. Goel D, Smitthimedhin A, Yadav B, et al. Ultrasound-detected venous changes associated with peripheral intravenous placement m children. JAVA. 2020;25(1)36-42.
    11. Natali R, Wand C, Doyle K, Noguez JH. Evaluation of a new venous catheter blood draw device and its impact on specimen hemolysis rates. Pract Lab Med. 2018;10:38-43. doi:10.1016/j.plabm.2018.01.002
    12. Cadacio C, Nachamkin I. A novel needle-free blood draw device for sample collection from short peripheral catheters. JIN. 2017:40(3):156-162.
    13. Mulloy DF, Lee SM, Gregas M, Hoffman KE, Ashley SW. Effect of peripheral IV based blood collection on catheter dwell time, blood collection, and patient response. Appl Nurs Res. 2018;40:76-79. doi:10.1016/j.apnr.2017.12.006
    14. Matthews EE. Sleep disturbances and fatigue in critically ill patients. AACN Adv Cnt Care. 2011:22(3):204-224. doi:10.1097/NCI.Ob013e31822052cb
    15. Psaila J, Parson TF, Hahn SA, Fichera L Standard penpheral intravenous catheters can be used for blood collection throughout hospital stay. JIN.2023;46(1):1-5.
    16. DuBose JR, Hadi K. Improving inpatient environments to support patient sleep. Int J Qual Health Care, 2016. 28(5):p.540-553.
    17. Rickard CM, Larsen E, Walker Rachel M, et al. Integrated versus nonintegrated peripheral intravenous catheter in hospitalized adults (OPTIMUM): A randomized controlled trial. J Hosp Med. 2022;1-12.
    18. Bausone-Gazda D. Lefaiver CA, Walters SA. A randomized controlled trial to compare the complications of 2 peripheral intravenous catheter-stabilization systems. J Infus Nurs. 2010;33(6):371-384

     

    BD-66490 (04/24)

    MY PIVO™ STORY

    Read what patients and clinicians are saying

    The PIVO™ Pro Needle-free Blood Collection Device is helping to reduce unneccesary and repeat needlesticks in the hospital. This helps to elevate clinical outcomes, improve workflow, and create a better experience for both clinicians and patients.

    "I'm kind of a hard poke, and this saves the anxiety and stress around the draw."

    Ryan is what his medical care team calls a 'frequent flyer.' After a serious automobile accident as a teenager resulted in the amputation of his left leg below the knee, he has had to endure years of surgeries. "A lot of times, people look at that as a pretty significant disability, but it hasn't slowed me down," Ryan said.

    Now, as a father to three rambunctious boys, Ryan still stays active—skiing, hunting and going on long hikes. But years of hospitalization and vascular access problems make blood draws one of the challenging parts of his hospital stays. "I'm kind of a hard poke to start with, and you can see my arms and hands are bruised--and that is from the last couple of days."

    Ryan was the first patient at his hospital to receive a needle-free blood draw with the PIVO™ Needle-free Blood Collection Device. "I was a little concerned that I might be able to feel it, but I didn't feel it at all--it was phenomenal."

    For him, and two of three patients who are difficult venous access, technologies like the PIVO™ Device can make hospital stays a little less challenging and "save the anxiety and stress around hospital blood draws."

     

    “The patient didn't experience any discomfort...he didn't even know what I was doing."

    Victoria has been a pediatric nurse for 10 years. “Pediatric nursing was always the way to go for me,” she said.

    The floor Victoria works on at the hospital has a mix of some very sick patients and some more stable patients who can leave the hospital after only a few days. No matter what the patient’s condition, one procedure that remains tough across pediatric patients is blood draws. 

    “Sometimes the parents fear for their child, makes their child more anxious,” she said. “Holding them [the children] down is the worst part and is usually what scares the parents initially—and then you add the needle on top of that. Kids hate needles.”

    Using the PIVO™ Needle-free Blood Collection Device for the first time on 5-year-old patient Wyatt “was super easy.”  She was surprised with how well it went—both from a practitioner perspective and equally for her patient. Wyatt was distracted with a game on his iPad® throughout the entire draw, and his mother was able to relax too. “The patient didn’t experience any discomfort,” she said. “He didn’t even know what I was doing.”

    “It’s truly a life-changing game changer for patients like me.”

    Traci was diagnosed with ulcerative colitis as a child. Since then, she has experienced repeated vascular access for blood draws and IVs causing her arms, wrists and hands to become painful and bruised. Over the course of two, 30-day hospital stays, her veins collapsed and clinicians had to go under her knuckles to access her veins. This made blood draws so painful that she was prescribed a powerful pain medication to make them more bearable and had to have a central venous catheter (CVC) placed in her neck, which ended up getting clogged and becoming unusable. 

    When she was recently admitted to the hospital with a pulmonary embolism, she experienced the PIVO™ Needle-free Blood Collection Device for the first time. “The only way I can describe this product is to say it’s truly a life-changing game changer for patients like me,” Traci said. “It helped eliminate needlestick pain and the need for additional medication and unnecessary line escalations.”

    In addition to making blood draws virtually pain free, this device makes it possible for patients to experience what’s called a “one-stick hospital stay vision," by using an IV catheter line already in place instead of having to be poked and prodded countless times for blood collection.

    “Many patients like me experience so much trauma, pain and anxiety from past needlestick experiences, they’ll avoid seeking medical care if they think it means having blood drawn,” Traci said. “The PIVO™ Device can be truly life-changing, because I believe it can make patients who have to receive frequent blood draws far less anxious and hesitant when having to seek medical care.”

    “I know for a fact that the PIVO™ Blood Collection Device is good for the patient, because I was one.”

    Like many people, blood draws during hospital stays have always caused added anxiety for Joan. At 82, she dreaded the constant poking and the resulting pain and bruises up and down her arms. During a hospital stay, she was bracing herself for that “painful pinch” when the nurse let her know she already had collected her blood sample.

    “While my overall hospital experience was good…the best part was not having to be stuck anymore when they needed to collect my blood,” Joan said.

    As a practicing pharmacist for over 40 years, Joan has seen many significant advances in medicine. For her, the PIVO™ Needle-free Blood Collection Device is a breakthrough innovation that will “help transform how we experience blood collection in the hospital.”

    “The gamechanger is when someone enters the room at 3 a.m. to get a blood sample and they don’t have to wake you up.”

    After a routine checkup, Rachelle found out she required surgery and a hospital stay. She also needed multiple blood draws daily—which are more challenging for her as she has a blood condition where it takes several hours for her blood to clot after needlesticks. However, during this stay, the PIVO™ Needle-free Blood Collection Device was used for her lab draws.

    “It was fantastic for a few reasons,” she said. “It didn’t require me to get stuck, it didn’t require me to have someone hold pressure for 15–20 minutes then bandage my arm, and I could even rest when blood was being drawn because they didn’t need to turn on the lights to poke me. It was wonderful!”

    The nurse was excited to have this innovative technology to help ease her experience, and the process was quick and efficient. Rachelle’s family didn’t even realize they were drawing blood because it was integrated into the care delivery process. The ability to receive an IV and use that to deliver medications and draw blood was very convenient.

    “I would say the gamechanger is when someone enters the room at 3 a.m. to get a blood sample, and they don’t have to wake you up,” Rachel shared. “The PIVO™ procedure was quick and allowed me to stay in a restful state with no additional pokes or a drawn-out experience.”

    “She wasn’t scared during her blood draw.”

    Christine is a nurse in the medical intensive care unit (ICU) and often cares for patients who are in drug withdrawal, delirious or suffering from dementia. These patients are difficult to care for because their symptoms can cause them to become easily agitated, confused or combative, which is dangerous for both the patient and staff. A patient was actively delirious and required the assistance of Christine and several other staff members to calm down. “If we came at her with a needle again, she could easily pull back, get scared and become combative,” Christine said. The blood draw process for patients who are easily irritable or combative can be especially dangerous, as it entails approaching the patient with a needle, sometimes repeatedly. The pain of a needlestick often escalates the patient’s agitation, increasing the risk for needlestick injuries.

    Needlestick injuries expose nurses and healthcare workers to bloodborne pathogens—a serious health and safety hazard. The CDC estimates that 385,000 sharps-related injuries occur every year among healthcare workers in hospitals.

    Fortunately, with this particular patient, Christine was able to use the PIVO™ Needle-free Blood Collection Device to perform a needle-free blood draw. The patient didn’t see a sharp device approaching her or feel a painful poke, resulting in a smooth, simple draw, free of the anxiety that can surround repetitive needlesticks.

    “She wasn’t scared during her blood draw, the process wasn’t at all traumatic,” Christine said.

    Experience more patient portraits at www.bd.com/pivo.

    “When you can see one less opportunity to stick your child and lessen their fears...it’s amazing.”

    Jack has been in and out of the hospital since birth. His mom Kelli says “the needles are scary enough, but Jack has difficult veins making every stick a challenge. She heartbreakingly has tallied the poke marks after a collection, and sometimes even asks for a 30-minute break between attempts to calm Jack down before they try again.

    Technologies like PIVO™ make hospital stays a little less challenging for Jack and his family. Now an outspoken advocate for other patients, Kelli believes this innovation is a game changer that can “save another child from ever having to overcome the pain and fear Jack has experienced.”

    Experience more #PatientPortraits at www.bd.com/pivo.

    “PIVO™ completely changed my experience.” 

    Katie is a charge nurse in the Operating Room (OR) and surgical services department, so she’s used to seeing plenty of needles. But it wasn’t until she was a patient in the same hospital she works at that she started to view needles, specifically blood draw needles, differently.

    After experiencing a medical emergency, Katie was placed in the neuro trauma Intensive Care Unit (ICU). For three days, she required blood draws every four hours. In typical circumstances that would mean Katie would have been poked 18 times just for blood draws. Katie’s hospital had recently adopted the PIVO™ Needle-free Blood Collection Device to use existing IV access for blood draws. “It worked flawlessly,” Katie said. “I couldn’t have imagined being poked that many times – it completely changed my experience.”

    While Katie doesn’t routinely perform blood draws, there are times in the Post-Anesthesia Care Unit (PACU) where a patient blood sample is needed urgently. “By the time we get patients in the PACU, they’re dehydrated and may have lost a lot of blood, making it really difficult to access their veins. I’m excited to have this alternative for those patients.” 

    Experience more patient and clinician portraits at www.bd.com/pivo.

    “It truly transformed my hospital experience…I absolutely adored this thing.”

    Just before her senior year of high school, Skyler faced a sudden and severe health crisis. One day she woke up feeling extremely ill, and within days, her condition worsened to the point where she couldn't get out of bed. A trip to the emergency room revealed her hemoglobin levels were dangerously low, leading to a diagnosis of Evan's syndrome, a rare autoimmune disorder where antibodies destroy red blood cells.

    During Skyler’s 30-day hospital stay, she dreaded being stuck repeatedly for blood draws, and her arms were filled with painful bruises. Skyler participated in a trial for the BD® PIVO™ Pro Needle-free Blood Collection Device. Skyler shared that she was “so happy” when she learned this device could use her existing IV and reduce the number of daily needlesticks. This transformed her hospital experience allowing her to focus on getting better without the added stress of painful blood draws. At the end of her stay, Skyler was proud to share that “PIVO™ worked great for me…I absolutely adored this thing.”

    Experience more #PatientPortraits at www.bd.com/pivo.

    Video Gallery

    Streamline clinical efficiency with high-quality samples

    Create lasting value and boost hospital reputation

    Alleviate patient anxiety and fear from repetitive needlesticks

    See how the PIVO™ Blood Collection Device is advancing practice for hospitals

    Streamline clinical efficiency with high-quality samples
    Create lasting value and boost hospital reputation
    Alleviate patient anxiety and fear from repetitive needlesticks
    See how the PIVO™ Blood Collection Device is advancing practice for hospitals

    Together, we can transform vascular care. Our experts are here to help. Let's get started.

    The BD Peripheral Line Draw Solution
    Ready to learn more? Let’s have a conversation.

    References

    1. Natali R, Wand C, Doyle K, Noguez JH. Evaluation of a new venous catheter blood draw device and its impact on specimen hemolysis rates. Pract Lab Med. 2018;10:38-43. doi:10.1016/j.plabm.2018.01.002
    2. Betts A, DeCarli G, DiBari V, et al. How much do needlestick injuries cost? A systematic review of the economic evaluations of needlestick and sharps injuries among healthcare personnel. Infect Control Hsp Epidemiol. 2016;37(6):635-646. doi: 10.1017/ice.2016.48
    3. Mulloy DF, Lee SM, Gregas M, Hoffman KE, Ashley SW. Effect of peripheral IV based blood collection on catheter dwell time, blood collection, and patient response. Appl Nurs Res. 2018;40:76-79. doi:10.1016/j.apnr.2017.12.006

    Frequently Asked Questions

    The PIVO™ Pro Needle-free Blood Collection Device advances a flexible flow tube through the IV catheter to access optimal blood draw conditions, overcoming traditional hurdles to collect high-quality, reliable blood samples.11

    The PIVO™ Pro Blood Collection Device has been shown in clinical and healthy human studies to provide reliable, high-quality blood draws from peripheral IV catheter lines.*,2 In addition to providing high-quality blood draws with low rates of hemolysis, the PIVO™ Pro Blood Collection Device may have a positive impact on patient experience by reducing repetitive needlesticks and redraws that may result in care delays.12

    The BD Peripheral Line Draw Solution is fully compatible with the BD portfolio of blood collection products and peripheral IV catheters, including BD Vacutainer® Luer-Lok™ Access Device, BD Vacutainer® Blood Collection Tubes, Nexiva™ Closed Catheter System with NearPortTM IV Access, AccuCath Ace™ Intravascular Catheter as well as the BD Insyte™ Autoguard™ Safety IV Catheter and BD Cathena™ Safety IV Catheter portfolio of products.

    The PIVO™ Pro  Blood Collection Device provides compassionate care that alleviates fear and anxiety associated with repetitive needlesticks by reducing IV replacement2,13 and using existing access for blood draws11 with minimal disruption to a patient's sleep and healing process.14-16

    Compared with venipuncture, patients who received daily phlebotomy collections rated their overall experience a 9.1 out of 10 using the PIVO™ Blood Collection Device.13

    The BD Peripheral Line Draw Solution includes the PIVO™ Pro Blood Collection Device and Nexiva™ Closed IV Catheter System with NearPort™ IV Access. Together these products help to reduce the number of sticks associated with venipuncture and IV replacement2 helping to preserve vessel health for future access.4 Reliable peripheral line draws may also provide an alternative to the reliance and associated risks of central line draws.19

    Streamline clinical workflow with a innovative line draw solution that optimizes IV performance to effectively perform reliable blood draws and reduce IV replacements, empowering clinician confidence at each patient encounter.2,5

    Performing a needle-free blood draw and reducing the number of sticks associated with sample recollections and IV replacements reduces the potential risk of an accidental needlestick injury.2

    It preserves your patient’s vessel health4 by maximizing first stick success,18 minimizing IV replacements, and using existing access for blood draws.2,11

    Needle phobia terminology differs throughout literature and includes terms that are often used interchangeably: scared of needles, fear of needles, needle fear, Blood-Injection Injury (BII) phobia, fear of injections, and needle anxiety.

    If your patients have needle phobia, it could lead to avoidance behavior. This includes exacerbated avoidance of treatment, blood donations, and vaccinations – all which can negatively impact patient care.20,21

    The most common device-related approach for addressing needle phobia is utilizing innovations that include smaller/thinner needles, followed by needle-free options.22,23

    *Clinical studies were done on previous generations of the PIVO™ Blood Collection Device and Nexiva™ Catheter System. PIVO™ Pro and Nexiva™ with NearPort™ IV Access are the next generations of their respective product families.

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    References

    1. Natali R, Wand C, Doyle K, Noguez JH. Evaluation of a new venous catheter blood draw device and its impact on specimen hemolysis rates. Pract Lab Med. 2018;10:38-43. doi:10.1016/j.plabm.2018.01.002
    2. Pendleton B, LaFaye R. Multicenter study of needle·free blood collection system for reducing specimen error and intravenous catheter replacement. J Healthc Qual. 2022;-44;(2):e24·e30. doi:10.1097/JHQ.0000000000000331
    3. Cadacio C, Nachamkin I. A novel needle-free blood draw device for sample collection from short peripheral catheters. JIN. 2017:40(3):156-162.
    4. Mulloy DF, Lee SM, Gregas M, Hoffman KE, Ashley SW. Effect of peripheral IV based blood collection on catheter dwell time, blood collection, and patient response. Appl Nurs Res. 2018;40:76-79. doi:10.1016/j.apnr.2017.12.006
    5. Matthews EE. Sleep disturbances and fatigue in critically ill patients. AACN Adv Cnt Care. 2011:22(3):204-224. doi:10.1097/NCI.Ob013e31822052cb
    6. DuBose JR, Hadi K. Improving inpatient environments to support patient sleep. Int J Qual Health Care, 2016. 28(5):p.540-553.
    7. Psaila J, Parson TF, Hahn SA, Fichera L Standard penpheral intravenous catheters can be used for blood collection throughout hospital stay. JIN.2023;46(1):1-5.
    8. Twibell KR, Hofstetter P, Siela D, Brown D, Jones HM. A comparative study of blood sampling from venipuncture and short peripheral catheters in pediatric inpatients. J Infus Nurs. 2019;42(5):239. doi:10.1097/NAN.0000000000000338
    9. Kuriakose L. Decreasing central line associated bloodstream infection through limiting the use of central venous catheters for routine blood draws. J Dr Nurs Pract. 2020:139(2):173-183.doi:10.1891/JDNP-D-19-00071
    10. Green SF. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem. 2013;46:1175-1179. doi: 10.1016/j.clmbiochem.2013.06.001
    11. Bausone-Gazda D. Lefaiver CA, Walters SA. A randomized controlled trial to compare the complications of 2 peripheral intravenous catheter-stabilization systems. J Infus Nurs. 2010;33(6):371-384
    12. McLenon J, Rogers MAM. The fear of needles: a systematic review and meta-analysis. J Adv. Nurs. 2019;75:30-42
    13. Sharma SK, Kant R, Kalra S, Bishnoi R. Prevalence of pnmory non-adherence with insulin and barriers to insulin initiation in patients with type 2 diabetes mellitus -- An exploratory study in a tertiary core teaching public hospital. Eur Endocrinol. 2020:16(2):143-1-47. doi:10.17925/EE.2020.16.2.143 
    14. Ibrahim I, Yau YW, Ong L., Chan YH, Kuan WS. Arterial puncture using insulin needle is less painful than with standard needle: a randomized crossover study. Acad Emerg Med. 2015:22(3):315-320. doi:10.1111/acern.12601
    15. Gill H, Prousnitz M. Does needle size matter? J Diabetes Sciences Technol 2007;1(5):725·729

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