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collection centres, the primary response to VVRs among phlebotomists is to raise the donor’s legs above their head (i.e. the Trendelenburg position) to increase central blood volume and cardiac output. However, a formal evaluation of this technique by Wieling and colleagues (2011b) suggested that it may only result in minimal increases in blood pressure. An alternative This article is protected by copyright. All rights reserved. 17 management strategy is therefore to use physical manoeuvres (e.g., dynamic tension, lower-body muscle tension) to increase the heart rate and blood pressure. These exercises more rapidly resolve symptoms in those experiencing prolonged VVRs (Wieling et al. 2004; Wieling et al. 2011a; Wieling et al. 2011b). Although, BCAs sometimes use these techniques to speed up recovery once the donor is deemed fit to sit in an upright position, their use is not routine (Thijsen et al. 2016). Phlebotomists often supplement these physical manoeuvres by providing the donor with cold water, something to eat, or by placing a cool cloth on the donor’s forehead (Wieling et al. 2011b; Thijsen et al. 2016). While these techniques are not documented to have a physiological impact (Wieling et al. 2011b), for some donors the distraction or the perception that something is being done to manage their reaction may be beneficial. Finally, the phlebotomist may provide social support during the event and interactions with the attending phlebotomist can positively influence the overall donation experience and increase future donation intentions (Stewart et al. 2006). Donors rely on staff, as the perceived experts in the donation context, for the prevention and management of all aspects of their donation experience including if a VVR results (Thijsen et al. 2016). It is therefore necessary to increase our evidence-base of what support phlebotomists provide to donors and how to optimise this to manage the impact of VVRs. In addition to the physical effects, VVRs have a psychological impact on the donor with some experiencing stress, anxiety and/or discomfort as a result of their VVR symptoms (van Dongen et al. 2013; Thijsen et al. 2016). In a study examining coping strategies and VVRs, Kaloupek and colleagues (1985) found that those who experienced VVRs practised suppression strategies (that This article is protected by copyright. All rights reserved. 18 is, trying to reduce tension by not thinking about the situation) more frequently during their donation compared to those with no reaction. In a similar study, donors employing problemfocused strategies during their donation reported lower levels of distress compared to those using emotion-focused strategies (Kaloupek and Stoupakis 1985). Consistent with this, Gilchrist and colleagues (2015) examined the role of perceived control in reducing vasovagal symptoms. In a controlled research environment, those assigned to the intervention condition were able to control the breaks they took from the stimulus-video. As a result of this, participants in this group reported lower VVR symptoms compared to those in the control condition who had predetermined breaks. While heightening donors’ perceptions of control has previously been found to be useful in improving the donation experience of those approaching their donation (France et al. 2008b), the current findings suggest that increasing donors’ perceptions of control may also serve to mitigate the severity of their VVR experience. Impact of VVR on donor return Whilst VVRs have an immediate negative impact on the donor’s health and emotional wellbeing, these reactions also have a longer-term negative impact for BCAs as they reduce donor return rates. Research shows that, among WB donors, VVRs have the strongest deterrent effect of all forms of phlebotomy trauma (Veldhuizen et al. 2012; Wiersum-Osselton et al. 2013), with even the subjective experience of mild VVRs reducing return rates by 20% for first-time donors and by 33% for repeat donors (France et al. 2004). Rates of donor return after the experience of a VVR are not constant across demographic categories. Specifically, even though male donors typically This article is protected by copyright. All rights reserved. 19 experience fewer VVRs, they are less likely to return following a reaction compared to female donors (van Dongen et al. 2013; Wiersum-Osselton et al. 2013). Due to its strong influence on donor retention, it is important to increase our understanding of what factors associated with VVRs impact on donor retention and why certain donors do not come back.

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