Clinical Application of 'Flying Needle' Painless Phlebotomy Technology

Clinical Application of 'Flying Needle' Painless Phlebotomy Technology | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical Application of 'Flying Needle' Painless Phlebotomy Technology Rongfang Zhang, Yuning Lin, Songping Chen, Kaili Zhang, Peijie Xu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6275587/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Scientific Reports → Version 1 posted 16 You are reading this latest preprint version Abstract "Flying Needle" painless phlebotomy was explored in a comparative study on 600 outpatients in Xiamen Humanity Hospital from September to December The patients were randomly divided into experimental and control groups. The experimental group used the "Flying Needle" method while the control group used the conventional method. Pain, fear, adverse events, satisfaction, hemolysis, and success rate were compared. There was no significant gender, age, or BMI difference between the groups. The experimental group had a lower pain score (1.96 ± 1.42 vs 2.87 ± 1.42, p < 0.001), fewer adverse events (0.25 ± 0.59 vs 0.52 ± 0.87, p < 0.001), a lower fear score after sampling (1.49 ± 0.90 vs 1.67 ± 0.85, p = 0.025; vs 1.75 ± 0.91 before sampling in the experimental group, p < 0.001), and a higher satisfaction rate (97.33% vs 87.33%, p < 0.001). The "Flying Needle" technique has rapid insertion, a short process, minimal damage, reduces pain, adverse reactions, and fear, and improves satisfaction. It has good potential and is worthy of promotion. Biological sciences/Neuroscience/Emotion Biological sciences/Neuroscience/Motivation Health sciences/Health care Health sciences/Health occupations Health sciences/Medical research needles phlebotomy personal satisfaction fear hemolysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Phlebotomy refers to a method of using a blood collection needle to puncture a disinfected superficial vein in the arm to collect blood. It is a fundamental and important skill in medical diagnostics and treatment. Although guidelines are already in place to standardize phlebotomy practices[ 1 , 2 ].Many patients experience fainting during blood collection, or even refuse it, due to fear of pain and anxiety, which can affect subsequent diagnosis and treatment. Therefore, it is necessary to improve phlebotomy techniques to better serve patients. Our hospital has developed the "Flying Needle Blood Collection Technique" based on traditional phlebotomy skills. We have trained nearly a hundred nurses and technicians to master this technique.In practice, the "Flying Needle Blood Collection Technique" has been observed to effectively reduce patient pain, alleviate anxiety, and improve patient comfort and personal satisfaction during medical procedures. This technique is a specialized skill that requires specific training and is considered more challenging. There are no related literature reports or even a formal definition for it. Professor Zhang, based on the key movements of the "Flying Needle Blood Collection," defined the technique as "a method of accurately, quickly, and painlessly inserting a needle into a vein by using the thumb and index finger to precisely flick the needle into the blood vessel."During the procedure, the technician holds the needle's butterfly wings with the thumb and index finger, aims at the blood vessel, and flicks the needle, ensuring accurate insertion into the vessel. Since the needle is no longer in contact with the operator's fingers at the moment it pierces the skin, the term "Flying Needle" is used. Studies suggest that the duration of applying a tourniquet can influence test results to some extent[ 3 ].Moreover, the "Flying Needle" blood collection technique allows for rapid needle insertion, reducing the time the tourniquet is applied. This may help prevent the bias in test results caused by prolonged tourniquet application. The aim of this study is to explore the effectiveness of the "Flying Needle" blood collection technique Materials and Methods Participants A randomized sampling method was used to select 600 outpatient blood collection patients at our hospital from September 1, 2022 to November 30, 2022 as study subjects. Among them, 312 were male and 286 were female, aged 4 to 79 years, with an average age of 41.09 years. The patients were randomly divided into an experimental group and a control group, with 300 patients in each group. The experimental group was subjected to the "Flying Needle" phlebotomy technique, while the control group underwent the conventional phlebotomy method. Informed Consent Prior to enrollment in the study, all participants or their legal guardians were informed about the purpose of the study, the procedures involved, and the potential benefits and risks associated with participation. Informed consent was obtained through a questionnaire survey that included detailed information about the study and an explicit consent section. Participants were required to sign the consent form to indicate their willingness to participate in the study. The consent process ensured that all participants were fully aware of their rights and the nature of the study. Study Materials Both groups used No. 7 disposable blood collection needles (manufactured by Weihai Weigao Blood Collection Consumables Co., Ltd.) and vacuum negative pressure blood collection tubes (manufactured by Guangdong Kindell Medical Devices Group Co., Ltd.) for phlebotomy. Study Methods Strict adherence to the standardized venous blood specimen collection procedure was followed during blood collection:The phlebotomist reviewed the medical orders, confirmed the information on the blood collection tubes, and prepared the tubes accordingly.In both groups, the order of blood collection tubes containing different anticoagulants was determined following the EFLM WG-PRE guidelines[4].Before blood collection, the "Three Checks and Seven Verifications" process was followed to confirm patient information. Once verified, blood was drawn from the elbow vein using the assigned phlebotomy method for each group.After determining the collection time and verifying the quality of the blood specimens, the samples were promptly transported to the laboratory for testing (Figure 1). 'Flying Needle' Painless Phlebotomy Technology Needle-holding Method: The needle is held by pinching the butterfly wings with the thumb and index finger of the right hand.Blood Collection Technique: The needle is aimed at the vein and flicked into the arm’s venous blood vessel with swift speed (Figure 2 A). Normal Phlebotomy Technology Pinch the butterfly wing part of the needle with the thumb and index finger, support the other end of the needle with the middle finger, and make the needle shaft form an angle of 30°-45° with the skin. With the bevel of the needle pointing upward, aim at the vein, and accurately puncture into the venous blood vessel in the arm for blood collection (Figure 2 B). Conventional Phlebotomy Method Needle-holding Method: The needle is held by pinching the butterfly wings with the thumb and index finger of the right hand. Blood Collection Technique: During phlebotomy, the thumb and index finger of the right hand hold the needle handle. The needle is aligned with the vein and pushed into the arm’s venous blood vessel. During insertion, the needle’s direction is adjusted as necessary. Survey and Statistical Analysis After blood collection, a questionnaire survey was conducted by staff. The survey included questions on gender, age, height, weight, pain level, personal satisfaction, and fear level. Observations were recorded regarding redness, swelling, bruising, pain, and other discomfort reactions. The study results were statistically analyzed using SPSS 22.0. Observation Indicators and Evaluation Criteria First Attempt Success Rate: This refers to the percentage of successful phlebotomys on the first attempt, where blood collection is smoothly achieved. The calculation for each group's first attempt success rate is as follows: First Attempt Success Rate= (Total number of cases in the group/Number of successful first punctures in the group)×100%. Pain Score:The surveyed patients used the Visual Analog Scale (VAS) method for scoring[5, 6]. Patients were asked to rate their pain after blood collection on a scale from 0 to 10, with 0 representing no pain at all and 10 representing the most severe, unbearable pain. Incidence of Adverse Events: According to literature reports[7-9] and combined with actual circumstances, adverse events are divided into 5 levels according to severity, and scores are assigned based on the levels. 0 level: No adverse events. 1 level: Small bruising or hematoma at the puncture site. 2 level: Larger hematoma or bruising. 3 level: Significant persistent pain, local infection, or prolonged fainting. 4 level: Extensive infection, nerve pain requiring treatment, or severe phlebitis. Comparison of Hemolysis Incidence: To achieve standardized and high-quality service, we referred to the conclusions of the study by Makhumula-Nkhoma N[10]. We enhanced the training on pre-analytical knowledge of sample hemolysis for the blood collection personnel in both the experimental and control groups, aiming to prevent hemolysis caused by other factors. The hemolysis incidence rate for each group is calculated as follows: Hemolysis Incidence Rate= ( Total number of cases in each group/ Number of hemolysis cases in each group )× 100%. Fear Score: Each patient in both groups rated their level of fear based on their personal fear of the phlebotomy situation[11], both before and after the blood collection. Ethical Statement: We confirm that all experiments involving human subjects and/or the use of human tissue samples in this study were conducted in accordance with relevant guidelines and regulations. This study was approved by the Ethics Committee of Xiamen Humanity Hospital(No: HAXM-MEC-20250320-019-01) and was performed in accordance with the ethical standards laid down in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Confirmation has been obtained of the informed consent of all participants and/or their legal guardians. Results Baseline Data Table of the Two Groups There was no statistically significant difference in gender, age, or BMI index between the two groups of patients (Table 1). Comparison of First Attempt Success Rate and Hemolysis Incidence Between the Two Groups There was no statistically significant difference in the first attempt success rate of phlebotomy between the experimental group and the control group (p =0.501). Additionally, there was no statistically significant difference in the incidence of hemolysis between the two groups (p =0.202) (Table 2). Comparison of Blood Collection Pain Scores Between the Two Groups The Visual Analog Scale (VAS) was used to assess the pain experienced during blood collection for both the experimental and control groups. According to the results of the Wilcoxon rank sum test, the pain score in the experimental group (2.87±1.42) was significantly lower than that in the control group (1.96±1.42), with p <.001 (Figure 3). Comparison of Adverse Event Scores Between the Two Groups Based on the adverse event scoring system, the adverse events in the experimental and control groups were evaluated. The results of the Wilcoxon rank sum test showed that the adverse event score in the experimental group (0.25 ± 0.59) was significantly lower than that in the control group (0.52 ± 0.87), with p <.001. This indicates that the use of the "Flying Needle" technique can reduce the severity of adverse events (Figure 4). Comparison of Fear Scores Before and After Blood Collection Between the Two Groups Both the experimental and control group members rated their fear of the phlebotomy situation. The results of the Wilcoxon rank sum test showed that the fear level after blood collection in the experimental group (1.49 ± 0.90) was significantly lower than that in the control group (1.67 ± 0.85), with p =0.025. Additionally, the fear level in the experimental group after blood collection was significantly lower than before blood collection (1.75 ± 0.91), with p <.001 (Figure 5). Personal satisfaction with Blood Collection Technique in the Experimental and Control Groups The personal satisfaction rate with the blood collection technique in the experimental group was 97.00%, which was significantly higher than the control group's 83.00% (χ2=33.75, p <0.001)(Table 3). Discussion Blood tests provide objective and accurate references for diagnosing, treating, and evaluating the prognosis of diseases, and their clinical significance is substantial. Phlebotomy for blood collection is an essential step in this process. Achieving a "one-stick success" is the hope of patients and a measure of the phlebotomist’s skill level.Based on experience, applying local heat or lightly tapping the vein before puncture to make the veins more visible and full can help improve the success rate of blood collection and reduce patient discomfort. However, while these techniques—such as heat application, light tapping, and using a tourniquet—can enhance vein visibility and increase the success rate, they may also significantly alter coagulation parameters like APTT, fibrinogen, and D-dimer levels[12, 13], potentially leading to inaccurate test results.The "Flying Needle" phlebotomy technique is a new method of blood collection. As can be seen from the video we shot, it only takes about 0.02 seconds to insert the needle into the blood vessel for blood collection, while it takes about 0.8 second for ordinary blood collection. Through the highly refined skill of the phlebotomist, the needle is inserted at a very high speed, piercing the skin and entering the vein quickly. This minimizes stimulation to the skin and the vessel wall, reduces the leakage of tissue fluid, prevents the activation of the coagulation response, and decreases interference with coagulation test results. Additionally, this technique is suitable for sample collection in all types of blood tests.In clinical practice, the focus is often solely on successful blood collection, with little attention given to the patient’s experience. As a result, slow needle insertion often causes intense pain, which leads to a lack of cooperation from patients who fear pain or experience anxiety, thus making the blood collection process more difficult. The "Flying Needle" phlebotomy technique, with its rapid needle insertion, quickly penetrates the skin and minimizes stimulation to the free nerve endings in the epidermis, avoiding a peripheral sensory response. Since the puncture time is so short that it does not reach the pain threshold, patients experience little to no pain. In many cases, the puncture is completed before the patient even realizes it, effectively reducing their anxiety and increasing their cooperation, which in turn improves the success rate of the puncture.In this study, both groups used the same blood collection needles and vacuum tubes, and the experimental group achieved a first attempt success rate of 99.33%. Hemolysis in blood samples can interfere with biochemical tests that rely on colorimetric principles, such as AST, LDH, and TP[14-16]. Additionally, hemolysis can affect plasma miRNA levels due to contamination from erythrocyte miRNA[17]. However, some reports suggest that hemolysis does not affect the quality of plasma RNA as long as leukocytes remain intact[18]. According to Davide's research, the release of intracellular enzymes into plasma following erythrocyte lysis interferes with certain enzyme-catalyzed tests, thereby affecting the accuracy of the results[19]. The International Council for Standardization in Haematology (ICSH) recommends that APTT testing should not be performed on hemolyzed samples[20].Thus, preventing hemolysis is a critical measure for improving the accuracy of laboratory results. Among the various internal and external factors that can cause hemolysis, unsuccessful or improper phlebotomy is one of the primary causes. The "Flying Needle" vacuum phlebotomy technique helps to reduce the incidence of hemolysis in venous blood samples, thus improving sample quality and minimizing the negative impact on test results. Lippi's study recommends that medical institutions provide thorough training to doctors or nurses performing phlebotomy[21]. At the Humanity Hospital Medical Laboratory Center, the "Flying Needle" phlebotomy technique was introduced early on in the hospital's operation for routine blood sample collection. Continuous efforts were made to explore training methods and develop innovative training materials and tools. As of now, over a hundred nurses and technicians have mastered the "Flying Needle" phlebotomy technique.The phlebotomists who participated in this study were all personnel who had successfully passed the training and assessment, demonstrating proficiency in both conventional and "Flying Needle" vacuum blood collection techniques. The results of this study show that the pain score in the experimental group (1.96±1.42) was significantly lower than that in the control group (2.87±1.42), P<0.001, indicating that the use of the "Flying Needle" technique can greatly reduce patient pain. The adverse event score in the experimental group ( 0.25 ± 0.59) was also significantly lower than that in the control group ( 0.52 ± 0.87), p <0.001, suggesting that the "Flying Needle" technique reduces the severity of adverse events. Anxiety and fear related to phlebotomy largely stem from the pain and discomfort, such as redness and bruising, experienced during the procedure. The "Flying Needle" technique, with its rapid needle insertion and shortened blood collection process, causes minimal discomfort. Many patients reported that the puncture was completed "without even noticing," alleviating anxiety and fear.The fear level after blood collection in the experimental group (1.49 ± 0.90) was significantly lower than in the control group (1.67 ± 0.85), p =0.025, and the fear level in the experimental group was significantly lower after blood collection compared to before (1.75 ± 0.91), p <.001. This demonstrates that the "Flying Needle" technique can reduce patients' anxiety and fear about phlebotomy, as well as minimize discomfort reactions such as redness and bruising.The questionnaire results show that the personal satisfaction rate in the "Flying Needle" group was 97.33%, compared to 84.33% in the control group, with the personal satisfaction rate being significantly higher in the "Flying Needle" group, p <0.001. This indicates that the use of the "Flying Needle" technique can improve personal satisfaction. Conclusion In summary, the "Flying Needle" blood collection technique, with its rapid needle insertion, short blood collection process, and minimal damage to the skin and blood vessels, reduces patient pain, lowers the incidence of adverse reactions, decreases fear related to the blood collection process, and improves patient personal satisfaction. It has promising application potential and is worth promoting in clinical practice. Declarations Declaration of Interest Statement All authors disclosed no relevant relationships. Funding This research received no external funding Patient consent statement not applicable Data Availability Statement The dataset generated and/or analyzed during the current study is not publicly available due to the laboratory's policies and confidentiality agreements. We have fully described the experimental design, analysis, and results, as well as the processes of data analysis and processing. However, it can be obtained from the corresponding author upon reasonable request. RELEVANCE FOR CLINICAL PRACTICE Based on the results of this study, blood collection departments in hospitals could promote "flying needle" painless blood collection as a priority blood collection technique. The promotion of this technology in community health service centers can reduce the pain, adverse reactions and fear of residents during blood collection, and improve satisfaction, which helps to improve the overall medical service experience in the community. For elderly care institutions, this technology can be used to provide more comfortable blood collection services for the elderly, reduce their pain, but also reduce the work pressure of medical staff. In addition, in remote areas with relatively scarce medical resources, training medical staff to master the "flying needle" technology can improve the success rate of blood collection, reduce the occurrence of adverse events, and help improve the quality of local medical services. References Simundic, A. M. et al. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. Clin. Chem. Lab. Med. 56 (12), 2015–2038. 10.1515/cclm-2018-0602 (2018). PubMed PMID: 30004902. GP41: Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Seventh Edition. Clinical and Laboratory Standards Institute. ;GP41–A7. (2017). Freitas, F. & Alves, M. Improving the Quality of Venous Blood Sampling Procedure (Phlebotomy): Avoiding Tourniquet Use. J Lab Physicians. ;14(2):218 – 22. Epub 20210922. doi: 10.1055/s-0041-1735584. PubMed PMID: 35982876; PubMed Central PMCID: PMCPMC9381316. (2022). Cornes, M. et al. 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Tables Table 1 Comparison of two groups of basic Information Experiment Group Control Group χ2 P Number of cases 300 300 Gender Male 156 153 0.060 0.806 Female 144 147 Age 13-19 11 13 0.319 0.572 20-39 139 136 40-59 107 105 ≥60 43 46 BMI classification Thin BMI≤18.4 25 23 0.244 0.621 Normal weight 18.5≤BMI≤23.9 175 176 Overweight 24.0≤BMI≤27.9 66 64 Obesity BMI≥28 34 37 Table 2 Comparison of the number of successful first puncture cases and the incidence of hemolysis between the two groups Experimental Group Control Group χ2 P Success rate Number of successful puncture cases at one time 297(99.00%) 294(98.00%) 0.451 0.501 Number of failed puncture cases 3(1.00%) 6(2.00%) Hemolysis No hemolysis 297（99.00%） 293（97.67%） 1.627 0.202 Hemolysis 3（1.00%） 7（2.33%） Total 300 300 Table 3 Blood collection satisfaction of Experimental group and Control group on blood collection technology Experimental group Control group χ2 P Number of subjects 300 300 Patient satisfaction Satisfied 291 (97.00%) 253 (84.33%) 26.96 0.000 Average 6 (2.00%) 44 (14.67%) 29.87 0.000 Dissatisfied 3 (1.00%) 7 (2.33%) 0.92 0.339 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 29 Oct, 2025 Reviews received at journal 29 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviews received at journal 23 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 03 Aug, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviews received at journal 25 Jul, 2025 Reviewers agreed at journal 13 Jul, 2025 Reviewers invited by journal 11 Jul, 2025 Editor assigned by journal 08 Jul, 2025 Editor invited by journal 02 Apr, 2025 Submission checks completed at journal 01 Apr, 2025 First submitted to journal 21 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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08:23:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6275587/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6275587/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-40294-z","type":"published","date":"2026-02-20T15:59:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87030555,"identity":"d619b5ca-3127-4cd5-8253-8c31a9b5bc05","added_by":"auto","created_at":"2025-07-18 12:45:09","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37159,"visible":true,"origin":"","legend":"\u003cp\u003eSequence Of Blood Vessel Collection\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/40ebfe0a8b32d11bb32c650e.jpeg"},{"id":87030558,"identity":"0cc61791-bfee-453f-b259-2f600a225733","added_by":"auto","created_at":"2025-07-18 12:45:09","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":224938,"visible":true,"origin":"","legend":"\u003cp\u003eA. Blood is collected using the 'Flying Needle' Painless Phlebotomy Technology, and it takes approximately 0.02 seconds to insert the needle. B. Blood collection is carried out using the common venipuncture blood collection technique, and it takes approximately 0.8 seconds to insert the needle.\u003c/p\u003e","description":"","filename":"groupimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/49319ba80fd67c5f739c5fe1.jpeg"},{"id":87030557,"identity":"350f5c57-d71f-4966-8aee-4e65adc4272e","added_by":"auto","created_at":"2025-07-18 12:45:09","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14173,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of VAS pain scores between experimental group and control group.\u003c/p\u003e","description":"","filename":"groupimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/af2480bd1227041f44df07b0.jpeg"},{"id":87031462,"identity":"c39b7bf2-8b94-4ed8-a1af-c215f3e74176","added_by":"auto","created_at":"2025-07-18 12:53:09","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":16161,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of adverse event scores between experimental group and control group.\u003c/p\u003e","description":"","filename":"groupimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/36772f247a1729e9ae8b8000.jpeg"},{"id":87030563,"identity":"adbafd48-b154-419b-b91e-27523d0f7d70","added_by":"auto","created_at":"2025-07-18 12:45:09","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":12603,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of fear ratings. A:Control group before blood collection; B:Control group after blood collection; C:Experimental group before blood collection; D:Experimental group after blood collection.\u003c/p\u003e","description":"","filename":"groupimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/07f77186597efd9856fd3759.jpeg"},{"id":103251267,"identity":"eeb76766-9be4-4679-a485-65f1ae7645b8","added_by":"auto","created_at":"2026-02-23 16:07:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1065254,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6275587/v1/d1ca0cb1-954b-4f3e-8038-420269e96d2b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Application of 'Flying Needle' Painless Phlebotomy Technology","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhlebotomy refers to a method of using a blood collection needle to puncture a disinfected superficial vein in the arm to collect blood. It is a fundamental and important skill in medical diagnostics and treatment. Although guidelines are already in place to standardize phlebotomy practices[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].Many patients experience fainting during blood collection, or even refuse it, due to fear of pain and anxiety, which can affect subsequent diagnosis and treatment. Therefore, it is necessary to improve phlebotomy techniques to better serve patients. Our hospital has developed the \"Flying Needle Blood Collection Technique\" based on traditional phlebotomy skills. We have trained nearly a hundred nurses and technicians to master this technique.In practice, the \"Flying Needle Blood Collection Technique\" has been observed to effectively reduce patient pain, alleviate anxiety, and improve patient comfort and personal satisfaction during medical procedures. This technique is a specialized skill that requires specific training and is considered more challenging. There are no related literature reports or even a formal definition for it. Professor Zhang, based on the key movements of the \"Flying Needle Blood Collection,\" defined the technique as \"a method of accurately, quickly, and painlessly inserting a needle into a vein by using the thumb and index finger to precisely flick the needle into the blood vessel.\"During the procedure, the technician holds the needle's butterfly wings with the thumb and index finger, aims at the blood vessel, and flicks the needle, ensuring accurate insertion into the vessel. Since the needle is no longer in contact with the operator's fingers at the moment it pierces the skin, the term \"Flying Needle\" is used. Studies suggest that the duration of applying a tourniquet can influence test results to some extent[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Moreover, the \"Flying Needle\" blood collection technique allows for rapid needle insertion, reducing the time the tourniquet is applied. This may help prevent the bias in test results caused by prolonged tourniquet application. The aim of this study is to explore the effectiveness of the \"Flying Needle\" blood collection technique\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003eA randomized sampling method was used to select 600 outpatient blood collection patients at our hospital from September 1, 2022 to November 30, 2022 as study subjects. Among them, 312 were male and 286 were female, aged 4 to 79 years, with an average age of 41.09 years. The patients were randomly divided into an experimental group and a control group, with 300 patients in each group. The experimental group was subjected to the \u0026quot;Flying Needle\u0026quot; phlebotomy technique, while the control group underwent the conventional phlebotomy method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u0026nbsp;\u003c/strong\u003ePrior to enrollment in the study, all participants or their legal guardians were informed about the purpose of the study, the procedures involved, and the potential benefits and risks associated with participation. \u0026nbsp;Informed consent was obtained through a questionnaire survey that included detailed information about the study and an explicit consent section. \u0026nbsp;Participants were required to sign the consent form to indicate their willingness to participate in the study. The consent process ensured that all participants were fully aware of their rights and the nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Materials\u0026nbsp;\u003c/strong\u003eBoth groups used No. 7 disposable blood collection needles (manufactured by Weihai Weigao Blood Collection Consumables Co., Ltd.) and vacuum negative pressure blood collection tubes (manufactured by Guangdong Kindell Medical Devices Group Co., Ltd.) for phlebotomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Methods\u0026nbsp;\u003c/strong\u003eStrict adherence to the standardized venous blood specimen collection procedure was followed during blood collection:The phlebotomist reviewed the medical orders, confirmed the information on the blood collection tubes, and prepared the tubes accordingly.In both groups, the order of blood collection tubes containing different anticoagulants was determined following the EFLM WG-PRE guidelines[4].Before blood collection, the \u0026quot;Three Checks and Seven Verifications\u0026quot; process was followed to confirm patient information. Once verified, blood was drawn from the elbow vein using the assigned phlebotomy method for each group.After determining the collection time and verifying the quality of the blood specimens, the samples were promptly transported to the laboratory for testing (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026apos;Flying Needle\u0026apos; Painless Phlebotomy Technology\u0026nbsp;\u003c/strong\u003eNeedle-holding Method: The needle is held by pinching the butterfly wings with the thumb and index finger of the right hand.Blood Collection Technique: The needle is aimed at the vein and flicked into the arm\u0026rsquo;s venous blood vessel with swift speed (Figure 2 A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNormal Phlebotomy Technology\u0026nbsp;\u003c/strong\u003ePinch the butterfly wing part of the needle with the thumb and index finger, support the other end of the needle with the middle finger, and make the needle shaft form an angle of 30\u0026deg;-45\u0026deg; with the skin. With the bevel of the needle pointing upward, aim at the vein, and accurately puncture into the venous blood vessel in the arm for blood collection (Figure 2 B).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConventional Phlebotomy Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNeedle-holding Method: The needle is held by pinching the butterfly wings with the thumb and index finger of the right hand. Blood Collection Technique: During phlebotomy, the thumb and index finger of the right hand hold the needle handle. The needle is aligned with the vein and pushed into the arm\u0026rsquo;s venous blood vessel. During insertion, the needle\u0026rsquo;s direction is adjusted as necessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvey and Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter blood collection, a questionnaire survey was conducted by staff. The survey included questions on gender, age, height, weight, pain level, personal satisfaction, and fear level. Observations were recorded regarding redness, swelling, bruising, pain, and other discomfort reactions. The study results were statistically analyzed using SPSS 22.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservation Indicators and Evaluation Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirst Attempt Success Rate: This refers to the percentage of successful phlebotomys on the first attempt, where blood collection is smoothly achieved. The calculation for each group\u0026apos;s first attempt success rate is as follows: First\u0026nbsp;Attempt\u0026nbsp;Success\u0026nbsp;Rate= (Total\u0026nbsp;number\u0026nbsp;of\u0026nbsp;cases\u0026nbsp;in\u0026nbsp;the\u0026nbsp;group/Number\u0026nbsp;of\u0026nbsp;successful\u0026nbsp;first\u0026nbsp;punctures\u0026nbsp;in\u0026nbsp;the\u0026nbsp;group)\u0026times;100%.\u003c/p\u003e\n\u003cp\u003ePain Score:The surveyed patients used the Visual Analog Scale (VAS) method for scoring[5, 6]. Patients were asked to rate their pain after blood collection on a scale from 0 to 10, with 0 representing no pain at all and 10 representing the most severe, unbearable pain.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIncidence of Adverse Events: According to literature reports[7-9] and combined with actual circumstances, adverse events are divided into 5 levels according to severity, and scores are assigned based on the levels. 0 level: No adverse events. 1 level: Small bruising or hematoma at the puncture site. 2 level: Larger hematoma or bruising. 3 level: Significant persistent pain, local infection, or prolonged fainting. 4 level: Extensive infection, nerve pain requiring treatment, or severe phlebitis.\u003c/p\u003e\n\u003cp\u003eComparison of Hemolysis Incidence: To achieve standardized and high-quality service, we referred to the conclusions of the study by Makhumula-Nkhoma N[10]. We enhanced the training on pre-analytical knowledge of sample hemolysis for the blood collection personnel in both the experimental and control groups, aiming to prevent hemolysis caused by other factors. The hemolysis incidence rate for each group is calculated as follows: Hemolysis\u0026nbsp;Incidence\u0026nbsp;Rate= ( Total\u0026nbsp;number\u0026nbsp;of\u0026nbsp;cases\u0026nbsp;in\u0026nbsp;each\u0026nbsp;group/ Number\u0026nbsp;of\u0026nbsp;hemolysis\u0026nbsp;cases\u0026nbsp;in\u0026nbsp;each\u0026nbsp;group )\u0026times; 100%.\u003c/p\u003e\n\u003cp\u003eFear Score: Each patient in both groups rated their level of fear based on their personal fear of the phlebotomy situation[11], both before and after the blood collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that all experiments involving human subjects and/or the use of human tissue samples in this study were conducted in accordance with relevant guidelines and regulations. This study was approved by the Ethics Committee of Xiamen Humanity Hospital(No: HAXM-MEC-20250320-019-01) and was performed in accordance with the ethical standards laid down in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003eConfirmation has been obtained of the informed consent of all participants and/or their legal guardians.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline Data Table of the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in gender, age, or BMI index between the two groups of patients (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of First Attempt Success Rate and Hemolysis Incidence Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in the first attempt success rate of phlebotomy between the experimental group and the control group (p =0.501). Additionally, there was no statistically significant difference in the incidence of hemolysis between the two groups (p =0.202) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Blood Collection Pain Scores Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Visual Analog Scale (VAS) was used to assess the pain experienced during blood collection for both the experimental and control groups. According to the results of the Wilcoxon rank sum test, the pain score in the experimental group (2.87\u0026plusmn;1.42) was significantly lower than that in the control group (1.96\u0026plusmn;1.42), with p \u0026lt;.001 (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Adverse Event Scores Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the adverse event scoring system, the adverse events in the experimental and control groups were evaluated. The results of the Wilcoxon rank sum test showed that the adverse event score in the experimental group (0.25 \u0026plusmn; 0.59) was significantly lower than that in the control group (0.52 \u0026plusmn; 0.87), with p \u0026lt;.001. This indicates that the use of the \u0026quot;Flying Needle\u0026quot; technique can reduce the severity of adverse events (Figure 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Fear Scores Before and After Blood Collection Between the Two Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth the experimental and control group members rated their fear of the phlebotomy situation. The results of the Wilcoxon rank sum test showed that the fear level after blood collection in the experimental group (1.49 \u0026plusmn; 0.90) was significantly lower than that in the control group (1.67 \u0026plusmn; 0.85), with p =0.025. Additionally, the fear level in the experimental group after blood collection was significantly lower than before blood collection (1.75 \u0026plusmn; 0.91), with p \u0026lt;.001 (Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePersonal satisfaction with Blood Collection Technique in the Experimental and Control Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe personal satisfaction rate with the blood collection technique in the experimental group was 97.00%, which was significantly higher than the control group\u0026apos;s 83.00% (\u0026chi;2=33.75, p \u0026lt;0.001)(Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBlood tests provide objective and accurate references for diagnosing, treating, and evaluating the prognosis of diseases, and their clinical significance is substantial. Phlebotomy for blood collection is an essential step in this process. Achieving a \u0026quot;one-stick success\u0026quot; is the hope of patients and a measure of the phlebotomist\u0026rsquo;s skill level.Based on experience, applying local heat or lightly tapping the vein before puncture to make the veins more visible and full can help improve the success rate of blood collection and reduce patient discomfort. However, while these techniques\u0026mdash;such as heat application, light tapping, and using a tourniquet\u0026mdash;can enhance vein visibility and increase the success rate, they may also significantly alter coagulation parameters like APTT, fibrinogen, and D-dimer levels[12, 13], potentially leading to inaccurate test results.The \u0026quot;Flying Needle\u0026quot; phlebotomy technique is a new method of blood collection. As can be seen from the video we shot, it only takes about 0.02 seconds to insert the needle into the blood vessel for blood collection, while it takes about 0.8 second for ordinary blood collection. Through the highly refined skill of the phlebotomist, the needle is inserted at a very high speed, piercing the skin and entering the vein quickly. This minimizes stimulation to the skin and the vessel wall, reduces the leakage of tissue fluid, prevents the activation of the coagulation response, and decreases interference with coagulation test results. Additionally, this technique is suitable for sample collection in all types of blood tests.In clinical practice, the focus is often solely on successful blood collection, with little attention given to the patient\u0026rsquo;s experience. As a result, slow needle insertion often causes intense pain, which leads to a lack of cooperation from patients who fear pain or experience anxiety, thus making the blood collection process more difficult. The \u0026quot;Flying Needle\u0026quot; phlebotomy technique, with its rapid needle insertion, quickly penetrates the skin and minimizes stimulation to the free nerve endings in the epidermis, avoiding a peripheral sensory response. Since the puncture time is so short that it does not reach the pain threshold, patients experience little to no pain. In many cases, the puncture is completed before the patient even realizes it, effectively reducing their anxiety and increasing their cooperation, which in turn improves the success rate of the puncture.In this study, both groups used the same blood collection needles and vacuum tubes, and the experimental group achieved a first attempt success rate of 99.33%.\u003c/p\u003e\n\u003cp\u003eHemolysis in blood samples can interfere with biochemical tests that rely on colorimetric principles, such as AST, LDH, and TP[14-16]. Additionally, hemolysis can affect plasma miRNA levels due to contamination from erythrocyte miRNA[17]. However, some reports suggest that hemolysis does not affect the quality of plasma RNA as long as leukocytes remain intact[18]. According to Davide\u0026apos;s research, the release of intracellular enzymes into plasma following erythrocyte lysis interferes with certain enzyme-catalyzed tests, thereby affecting the accuracy of the results[19]. The International Council for Standardization in Haematology (ICSH) recommends that APTT testing should not be performed on hemolyzed samples[20].Thus, preventing hemolysis is a critical measure for improving the accuracy of laboratory results. Among the various internal and external factors that can cause hemolysis, unsuccessful or improper phlebotomy is one of the primary causes. The \u0026quot;Flying Needle\u0026quot; vacuum phlebotomy technique helps to reduce the incidence of hemolysis in venous blood samples, thus improving sample quality and minimizing the negative impact on test results.\u003c/p\u003e\n\u003cp\u003eLippi\u0026apos;s study recommends that medical institutions provide thorough training to doctors or nurses performing phlebotomy[21]. At the Humanity Hospital Medical Laboratory Center, the \u0026quot;Flying Needle\u0026quot; phlebotomy technique was introduced early on in the hospital\u0026apos;s operation for routine blood sample collection. Continuous efforts were made to explore training methods and develop innovative training materials and tools. As of now, over a hundred nurses and technicians have mastered the \u0026quot;Flying Needle\u0026quot; phlebotomy technique.The phlebotomists who participated in this study were all personnel who had successfully passed the training and assessment, demonstrating proficiency in both conventional and \u0026quot;Flying Needle\u0026quot; vacuum blood collection techniques.\u003c/p\u003e\n\u003cp\u003eThe results of this study show that the pain score in the experimental group (1.96\u0026plusmn;1.42) was significantly lower than that in the control group (2.87\u0026plusmn;1.42), P\u0026lt;0.001, indicating that the use of the \u0026quot;Flying Needle\u0026quot; technique can greatly reduce patient pain. The adverse event score in the experimental group ( 0.25 \u0026plusmn; 0.59) was also significantly lower than that in the control group ( 0.52 \u0026plusmn; 0.87), p \u0026lt;0.001, suggesting that the \u0026quot;Flying Needle\u0026quot; technique reduces the severity of adverse events. Anxiety and fear related to phlebotomy largely stem from the pain and discomfort, such as redness and bruising, experienced during the procedure. The \u0026quot;Flying Needle\u0026quot; technique, with its rapid needle insertion and shortened blood collection process, causes minimal discomfort. Many patients reported that the puncture was completed \u0026quot;without even noticing,\u0026quot; alleviating anxiety and fear.The fear level after blood collection in the experimental group (1.49 \u0026plusmn; 0.90) was significantly lower than in the control group (1.67 \u0026plusmn; 0.85), p =0.025, and the fear level in the experimental group was significantly lower after blood collection compared to before (1.75 \u0026plusmn; 0.91), p \u0026lt;.001. This demonstrates that the \u0026quot;Flying Needle\u0026quot; technique can reduce patients\u0026apos; anxiety and fear about phlebotomy, as well as minimize discomfort reactions such as redness and bruising.The questionnaire results show that the personal satisfaction rate in the \u0026quot;Flying Needle\u0026quot; group was 97.33%, compared to 84.33% in the control group, with the personal satisfaction rate being significantly higher in the \u0026quot;Flying Needle\u0026quot; group, p \u0026lt;0.001. This indicates that the use of the \u0026quot;Flying Needle\u0026quot; technique can improve personal satisfaction.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the \"Flying Needle\" blood collection technique, with its rapid needle insertion, short blood collection process, and minimal damage to the skin and blood vessels, reduces patient pain, lowers the incidence of adverse reactions, decreases fear related to the blood collection process, and improves patient personal satisfaction. It has promising application potential and is worth promoting in clinical practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors disclosed no relevant relationships.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and/or analyzed during the current study is not publicly available due to the laboratory\u0026apos;s policies and confidentiality agreements. We have fully described the experimental design, analysis, and results, as well as the processes of data analysis and processing. However, it can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRELEVANCE FOR CLINICAL PRACTICE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the results of this study, blood collection departments in hospitals could promote \u0026quot;flying needle\u0026quot; painless blood collection as a priority blood collection technique. The promotion of this technology in community health service centers can reduce the pain, adverse reactions and fear of residents during blood collection, and improve satisfaction, which helps to improve the overall medical service experience in the community. For elderly care institutions, this technology can be used to provide more comfortable blood collection services for the elderly, reduce their pain, but also reduce the work pressure of medical staff. In addition, in remote areas with relatively scarce medical resources, training medical staff to master the \u0026quot;flying needle\u0026quot; technology can improve the success rate of blood collection, reduce the occurrence of adverse events, and help improve the quality of local medical services.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSimundic, A. M. et al. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. \u003cem\u003eClin. Chem. Lab. Med.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e (12), 2015\u0026ndash;2038. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1515/cclm-2018-0602\u003c/span\u003e\u003cspan address=\"10.1515/cclm-2018-0602\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018). 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Epub 20120605.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 653px;\"\u003e\n \u003cp\u003eTable 1 Comparison of two groups of basic Information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003eExperiment Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNumber of cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e13-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.572\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e20-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e40-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 224px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eBMI classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eThin BMI\u0026le;18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.621\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eNormal weight 18.5\u0026le;BMI\u0026le;23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eOverweight 24.0\u0026le;BMI\u0026le;27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 224px;\"\u003e\n \u003cp\u003eObesity BMI\u0026ge;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 111px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"115%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Comparison of the number of successful first puncture cases and the incidence of hemolysis between the two groups\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eExperimental Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eControl Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eSuccess rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eNumber of successful puncture cases at one time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e297(99.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e294(98.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eNumber of failed puncture cases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3(1.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6(2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eHemolysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eNo hemolysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e297（99.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e293（97.67%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eHemolysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3（1.00%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7（2.33%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 587px;\"\u003e\n \u003cp\u003eTable 3 Blood collection satisfaction of Experimental group and Control group on blood collection technology\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eNumber of subjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePatient satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e291 (97.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e253 (84.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e26.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e6 (2.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e44 (14.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e3 (1.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (2.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"needles, phlebotomy, personal satisfaction, fear, hemolysis","lastPublishedDoi":"10.21203/rs.3.rs-6275587/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6275587/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\"Flying Needle\" painless phlebotomy was explored in a comparative study on 600 outpatients in Xiamen Humanity Hospital from September to December The patients were randomly divided into experimental and control groups. The experimental group used the \"Flying Needle\" method while the control group used the conventional method. Pain, fear, adverse events, satisfaction, hemolysis, and success rate were compared. There was no significant gender, age, or BMI difference between the groups. The experimental group had a lower pain score (1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 vs 2.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fewer adverse events (0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59 vs 0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a lower fear score after sampling (1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90 vs 1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85, p\u0026thinsp;=\u0026thinsp;0.025; vs 1.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 before sampling in the experimental group, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a higher satisfaction rate (97.33% vs 87.33%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The \"Flying Needle\" technique has rapid insertion, a short process, minimal damage, reduces pain, adverse reactions, and fear, and improves satisfaction. It has good potential and is worthy of promotion.\u003c/p\u003e","manuscriptTitle":"Clinical Application of 'Flying Needle' Painless Phlebotomy Technology","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 12:45:04","doi":"10.21203/rs.3.rs-6275587/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-29T10:32:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T10:05:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"215775040046765749100757323903784630434","date":"2025-10-11T03:24:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210472534517130513239706665314150643544","date":"2025-10-10T11:57:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-23T10:24:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17667123839320227412244463993864979453","date":"2025-09-13T09:44:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-12T10:30:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148990128605308410799325271454677065703","date":"2025-08-03T20:09:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327618127111000406392209787876607343451","date":"2025-07-28T06:48:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T06:51:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10578850964231593573298707275758423923","date":"2025-07-13T09:42:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-11T16:39:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T09:11:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-02T06:13:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-01T09:25:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-21T08:18:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"94ad65d7-adc0-4835-9e9c-71e5a4949f10","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":51456268,"name":"Biological sciences/Neuroscience/Emotion"},{"id":51456269,"name":"Biological sciences/Neuroscience/Motivation"},{"id":51456270,"name":"Health sciences/Health care"},{"id":51456271,"name":"Health sciences/Health occupations"},{"id":51456272,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-23T16:04:23+00:00","versionOfRecord":{"articleIdentity":"rs-6275587","link":"https://doi.org/10.1038/s41598-026-40294-z","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-02-20 15:59:30","publishedOnDateReadable":"February 20th, 2026"},"versionCreatedAt":"2025-07-18 12:45:04","video":"","vorDoi":"10.1038/s41598-026-40294-z","vorDoiUrl":"https://doi.org/10.1038/s41598-026-40294-z","workflowStages":[]},"version":"v1","identity":"rs-6275587","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6275587","identity":"rs-6275587","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}