Autonomic, endocrine, and psychological stress responses to different forms of blood draw: Results from a preregistered study

Objective: To compare physical and psychological stress responses to fingerstick vs. venipuncture (blood draw using a needle in the arm) within the same person.Methods: We assessed changes in cortisol (a stress hormone), heart rate variability (a marker of autonomic stress), and psychological stress in 40 healthy women who completed both venipuncture and fingerstick.Results: Contrary to our predictions, there was a significant decline in cortisol across conditions, with greater decline from pre- to post-draw in response to venipuncture than fingerstick. There were similar patterns of rise and fall in heart rate variability in both types of blood draw, suggestive of mild vasovagal responses. Psychological measures of stress (such as negative emotion and perceived stress) were generally stronger predictors of participant’s reported pain and blood draw preferences than physical stress measures.Conclusions: These findings challenge the characterization of fingerstick as necessarily “less invasive” than venipuncture, as participant’s stress responses to fingerstick were equivalent to (and for some measures greater than) their response to venipuncture. Heart rate variability response to fingerstick significantly predicted that individual’s vasovagal-like responses to venipuncture, suggesting that measuring heart rate variability during pre-donation hemoglobin testing may identify donors at risk for adverse events during venipuncture.