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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Factors Associated With High Pain Scores During Paediatric Peripherous Intravenous Cannulation Insertion: A Secondary
Amy L Sweeny1,2,3, Shane George1,2,4, Clayton Lam1,2
1School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.
Insights
High pain during peripheral intravenous catheter (PIVC) insertion is common in children, especially with repeated attempts. Younger age, combative behavior, and prior negative experiences increase pain scores, highlighting the need for optimized first attempts.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Clinical Nursing
Background:
- Peripheral intravenous catheter (PIVC) insertion is a frequent and often painful procedure in pediatric care.
- Limited research exists on factors contributing to or alleviating pain during PIVC insertion in children.
Purpose of the Study:
- To identify participant, proceduralist, and situational factors associated with high pain scores during PIVC insertion in children.
- To inform strategies for pain reduction in this vulnerable population.
Main Methods:
- Secondary analysis of a prospective observational study involving 198 PIVC insertion attempts in children under 16.
- Pain scores (0-10) were assessed using the Faces Pain Scale-Revised (FPS-R), with 7-10 defined as high pain.
- Multivariable logistic regression identified factors associated with high pain scores.
Main Results:
- 42.3% of children experienced high pain during PIVC insertion.
- Factors independently associated with high pain included younger age, three or more attempts, history of negative PIVC experiences, a combative child, and using the antecubital fossa for the first attempt.
- Younger age (OR 0.83 [0.72-0.95]), multiple attempts (OR 17.3 [1.8-163.8]), and prior negative experiences (OR 7.0 [1.4-36.1]) were significant predictors.
Conclusions:
- High pain during PIVC insertion is prevalent in children.
- Repeated attempts are strongly linked to increased pain.
- Optimizing first-attempt success and implementing pain mitigation strategies are crucial, especially for younger children and those with a history of negative PIVC experiences.
Aim:
PIVC insertion can be a painful procedure, but limited research focuses on contributors and alleviators of pain. This study aimed to determine participant, proceduralist, and/or situational factors associated with a high pain score in children.
Methods:
This was a secondary analysis of a previously published single-centre prospective observational study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children aged under 16 years and recorded data relating to the patient, proceduralist, and event. Pain scores during each attempt were determined observationally using the Faces Pain Score Revised (FPS-R) scale, which ranges 0-10. A score of 7-10 was categorised as high pain. Multivariable logistic regression modelling was performed to identify factors associated with a high pain score.
Results:
A total of 198 attempts for 130 participants were evaluated. About half of the children were male (n = 64, 49.2%) and median age was 5.7 years (2.0-11.0). Fifty-five children (42.3%) had high pain scores during PIVC insertion. Factors that independently increased the likelihood of a high pain score during PIVC insertion were younger age Odds ratio, 95% confidence interval (OR [95% CI]) = 0.83 [0.72-0.95], three or more attempts (OR 17.3 [1.8-163.8]), history of negative PIVC experience (7.0 [1.4-36.1]), a combative child (10.7 [2.3-50.3]), and antecubital fossa site as first attempt (3.37 [1.07-10.66]).
Conclusions:
High pain during PIVC insertion is common and associated with repeated attempts. Optimising the first attempt-and employing strategies shown to mitigate pain are recommended, particularly in younger children and/or those with prior negative experiences.