Diagnóstico de enfermería: Dolor, relacionado con la punción en pacientes con terapia anticoagulatoria oral. Comparación entre dos técnicas

• Objectives: To measure the pain caused by two puncture techniques used to draw blood for monitoring anticoagulation. To evaluate differences in the time required to perform each type of puncture, in the international normalised ratio (INR) values, and in puncture-related complications. • Material and Methods: Prospective, randomised, comparative, crossover clinical trial using two blood drawing techniques. The study sample was formed of 70 patients, 36 men and 34 women, aged between the 42 and 81 years. There were 22 study variables. A study intervention protocol was drawn up with randomisation of the intervention sequence. The statistical analysis was performed using the SPSS version 12 statistical package. • Results: The capillary technique was associated with a reduction of 2.6 points on the pain intensity scale (P < 0.0001) and of 35.4 seconds in the time required to draw the blood (P = 0.039). There was good concordance of the INR values between the techniques: intraclass concordance 0.85 with a 95% confidence interval of 0.618-0.925 (P < 0.0001). Complications occurred in 7% of patients after venepuncture compared to 0% after capillary puncture, though this result did not reach statistical significance due to the small sample size (P = 0.1). • Conclusions: The capillary technique is associated with less pain and a shorter time required to perform the extraction. There was a tendency to fewer complications with the capillary technique. Significant differences in the INR values were found between the two techniques. Patients prefer the capillary technique and our practice can make them aware of the two possibilities. • Introducción y objetivos: Objetivo principal: Medir el dolor en pacientes ingresados en nuestra unidad, sometidos a terapia anticoagulatoria oral mediante dos técnicas de punción (capilar y venosa) Objetivos secundarios: Valorar las diferencias en la utilización de las dos técnicas en cuanto a tiempo empleado por las enfermeras, valores del índice normalizado ratio (INR), complicaciones derivadas. • Metodología: Estudio prospectivo, aleatorizado, cruzado y comparativo entre dos técnicas de punción. Se estableció un protocolo de actuación consensuado, que incluye: Criterios de selección (inclusión, exclusión y retirada del estudio), identificación de los pacientes, confidencialidad de los datos, hoja informativa para cada paciente, consentimiento informado, cuaderno de recogida de datos, protocolo para la extracción de las muestras (cap