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Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a
Zhuowen Yu1, Yiwen Zhou1, Xiaofeng Xu1
1Children's Hospital of Fudan University, No. 399, Wanyuan Rd, Minhang District, Shanghai, China.
Insights
EMLA, distraction, and combined interventions effectively reduced pain during pediatric venipuncture. The distraction group showed lower salivary cortisol levels, indicating reduced physiological stress in children undergoing blood collection.
Area of Science:
- Pediatric Nursing
- Pain Management
- Clinical Trials
Background:
- Venipuncture is a common pediatric nursing procedure for blood collection and transfusions.
- Inadequate pain management during venipuncture can cause significant distress in children.
Purpose of the Study:
- To compare the effectiveness of EMLA, distraction techniques, and a combined approach in managing pain during pediatric venipuncture.
- To evaluate the impact of these interventions on children's self-reported pain, parent-reported pain, observer-reported pain, and physiological stress markers.
Main Methods:
- A randomized controlled trial involving 299 children aged 3-16 years.
- Participants were assigned to EMLA, distraction, or combined intervention groups.
- Pain was assessed using the Wong-Baker FACES® Pain Rating Scale and the Revised Face, Legs, Activity, Cry and Consolability Scale. Salivary cortisol, heart rate, and oxygen saturation were also measured.
Main Results:
- No statistically significant differences in self-reported, parent-reported, or observer-reported pain were found among the three groups.
- All interventions demonstrated an ability to decrease children's pain during IV cannulations.
- The distraction group exhibited lower salivary cortisol levels compared to the combined group (P=0.013).
Conclusions:
- EMLA, distraction, and combined interventions are effective in managing pain during pediatric venipuncture.
- Healthcare providers can select interventions based on available resources and patient preferences.
- While all methods reduce perceived pain, distraction may offer additional benefits in reducing physiological stress.
Background:
Venipuncture is a routine nursing procedure in the pediatric ward for blood collection and transfusion. However, this procedure can cause severe pain and distress if not adequately managed.
Methods:
Children aged 3-16 years old were randomized into three groups: EMLA group, distraction group, and combined group. The primary outcome was children's self-reported pain scored using the Wong-Baker FACES® Pain Rating Scale. The parents-reported and observer-reported pain were scored using the Revised Face, Legs, Activity, Cry and Consolability Scale, and children's salivary cortisol levels, heart rate, percutaneous oxygen saturation, venipuncture duration and retaining time of IV cannulas were the secondary outcomes.
Results:
A total of 299 children (167 male, 55.8%, median age 8.5) were enrolled: EMLA group (n = 103), distraction group(n = 96) and combined group(n = 100). There was no statistical difference in self-reported pain (P = 0.051), parent-reported pain (P = 0.072), and observer-reported pain (P = 0.906) among the three groups. All three interventions can decrease children's pain during IV cannulations. Additionally, the distraction group's salivary cortisol levels were lower than the combined group(P = 0.013). Furthermore, no significant difference was observed in the heart rate(P = 0.844), percutaneous oxygen saturation (P = 0.438), venipuncture duration (p = 0.440) and retaining time of IV cannulas (p = 0.843) among the three groups.
Conclusions:
All three groups responded with slight pain during the peripheral venipuncture procedure. Therefore, medical workers in pediatric settings can use the interventions appropriate for their medical resources and availability while involving parents and children's preferences whenever possible.
Trial Registration:
This trial was registered on https://register.
Clinicaltrials:
gov/ (Gov.ID NCT04275336).
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