The Effect of Virtual Reality and Buzzy on First Insertion Success, Procedure-Related Fear, Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial

The effect of pranic healing based on Rogers' therapeutic touch on cardiorespiratory indices and pain during venipuncture in pediatrics: A randomized clinical trial

BACKGROUND

Venipuncture is a commonly performed but distressing procedure for children, often leading to significant pain and anxiety. This study aimed to evaluate the effect of Pranic Healing, based on Rogers' Therapeutic Touch Nursing Theory, on the cardiorespiratory indices and pain associated with venipuncture in children.

METHODS

This double-blind, randomized clinical trial was conducted on a cohort of 46 school-aged children, selected via convenience sampling, at a hospital in Northern Cyprus. Participants were randomly allocated into the experimental group (n = 23) and the control group (n = 23). The experimental group received Pranic Healing. The Pranic Healing protocol was administered for 5 min before, during, and after venipuncture, while the control group received standard care. Pain levels were assessed using the Wong-Baker Facial Pain Scale, and physiological parameters including heart rate, respiratory rate, and oxygen saturation were measured at three specific time points. Data analysis was performed using SPSS version 25.0, employing independent t-tests, chi-square tests, and repeated measures ANOVA to assess differences between groups, with a significance level set at P < 0.05.

RESULTS

The study revealed a significant reduction in pain scores (P < 0.001) and improved cardiorespiratory indices, including heart rate (P = 0.004), respiratory rate (P = 0.001), and oxygen saturation (P = 0.005) in the intervention group compared to the control group. These findings suggest that Pranic Healing is effective in reducing pain and stabilizing physiological responses during venipuncture in children.

CONCLUSIONS

Pranic Healing, based on Rogers' Therapeutic Touch Nursing Theory, may serve as an effective, non-invasive method for managing pain and promoting physiological stability during painful medical procedures like venipuncture in children.

APPLICATION TO PRACTICE

Pranic Healing could be a valuable addition to pediatric care protocols, particularly for procedures that induce pain and discomfort.

Impact of cooling diabetic patients' fingertips compared to vibrating stimulation on pain from the glucometer needle: A cross-over trial study

INTRODUCTION

Blood glucose measurements using glucometers can cause discomfort due to needle insertion. Implementing effective pain management strategies is essential to alleviate this discomfort. This study aimed to evaluate the effects of cold and vibration stimulation on pain perception during glucometer needle insertion in diabetic patients.

METHODS

Sixty diabetic inpatients from Shahid Beheshti Hospital in Hamadan, Iran, participated in a crossover study, comprising 3 individuals with type 1 diabetes and 57 with type 2 diabetes. The cohort included 40 males and 20 females, with ages ranging from 18 to 70 years and a mean age of 55.7 years. The average duration of diabetes was 10 years. The study design consisted of six blocks, each containing three interventions: vibration stimulation (A), cold therapy (B), and a combination of both C. The sequences of interventions (ABC, ACB, BCA, BAC, CBA, and CAB) were randomly assigned. Each participant received the interventions at three different times: before breakfast, one to two hours after lunch, and at dinner. One hand was randomly selected for the intervention, while the other served as a control, with only the needle inserted. Pain levels were assessed using the Numeric Rating Scale (NRS) for both hands.

RESULTS

Participants receiving vibration stimulation in one hand reported a significant reduction in pain intensity, with a mean difference of 1.21 (p < 0.001) compared to the control hand. In contrast, cold therapy did not significantly affect pain intensity, showing a mean difference of only 0.06 (p > 0.05). The combination of vibration and cold therapy also did not significantly alter pain intensity, yielding a mean difference of 0.33 (p > 0.05). A significant difference (p = 0.002) was noted among the interventions, indicating varying effects on pain intensity.

CONCLUSION

Vibration stimulation effectively reduces pain associated with glucometer needle insertions. Among the methods examined, vibration stimulation proved to be the most effective for minimizing needle pain. Clinicians are encouraged to incorporate this technique into the care of diabetic patients to enhance their comfort during glucose monitoring.

The effects of virtual reality and stress ball distraction on procedure-related emotional appearance, pain, fear, and anxiety during phlebotomy in children: A randomized controlled study

BACKGROUND

Virtual reality (VR) and stress balls can be used during phlebotomy in school-age children.

OBJECTIVES

This randomized controlled study was conducted to evaluate the effect of distraction methods using VR and stress balls on the emotional behavior, pain, fear, and anxiety associated with phlebotomy in children aged 7-12.

METHODS

A parallel trial with a three-arm design approach was adopted for this randomized controlled trial, guided by the CONSORT checklist. The study sample (n = 150) was divided into VR, stress ball, and control group using stratified randomization. The mean scores obtained from the Children's Emotional Manifestation Scale, Wong-Baker FACES Pain Rating Scale, Child Anxiety Scale-State, and Child Fear Scale were compared between the groups. Linear regression analysis and correlation analysis were performed.

RESULTS

Significant differences were found in phlebotomy-related pain, fear, and anxiety. While there was no difference in emotional behavior before the phlebotomy, a significant difference was found after the phlebotomy. Being in the virtual reality group explained 30.8 % of the difference between the before and after phlebotomy-related-emotional behavior scores. A strong, positive, and significant relationship was found between emotional behavior scores after phlebotomy and phlebotomy-related fear, pain, and anxiety scores (p < .01).

CONCLUSION

Virtual reality and stress ball distraction were found to be effective in reducing pain, fear, and anxiety during phlebotomy. Virtual reality distraction is effective in reducing negative emotional behaviors.

APPLICATION TO PRACTICE

The VR distraction can be used in the pediatric population in pain, fear, anxiety, and emotional behavior management during phlebotomy.

CLINICALTRIALS

gov Identifier: NCT05818761.

Effects of the Helfer skin tap technique and Buzzy® application on the levels of pain and fear experienced by children during vaccination: A randomized controlled trial

PURPOSE

Vaccination is an invasive procedure that causes pain. Uncontrolled pain negatively affects all aspects of life, including health. This study aimed to determine the effects of the Helfer skin tap technique and Buzzy® application on the levels of pain and fear experienced by 4-year-old children during measles-mumps-rubella (MMR) vaccination.

METHODS

This study adopted a randomized controlled experimental design. The study sample consisted of 96 children (Helfer skin tap technique group: n = 32, Buzzy® group: n = 32, control group: n = 32) who received MMR vaccination. Children in the Buzzy® and Helfer skin tap technique groups received their respective interventions before and after vaccine injection, while children in the control group received routine vaccine injection.

RESULTS

Based on the parents' and nurse's observations, the pain and fear scores after vaccine injection were lowest in the Buzzy® group and highest in the control group. Based on the children's assessments, the pain scores after vaccine injection were lower in the Buzzy® group than in the Helfer skin tap technique group.

CONCLUSION

Buzzy® application and the Helfer skin tap technique have beneficial effects on children's pain and fear during MMR vaccination. Buzzy® application is more effective in reducing pain and fear during vaccine injection in children than the Helfer skin tap technique.

PRACTICE IMPLICATIONS

Nurses can increase the comfort of children by reducing pain during vaccination using Buzzy®.

Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review

PURPOSE OF REVIEW

This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations.

RECENT FINDINGS

Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.

The effect of the Veinlite PEDI2 and passive virtual reality distraction on peripheral catheter insertion-related emotional behavior, pain, fear, and anxiety of children: A randomized controlled trial

BACKGROUND

Virtual reality (VR) distraction can be used during peripheral intravenous catheter (PIC) insertion. The vein imaging devices are recommended for increasing PIC success.

OBJECTIVES

This study aimed to evaluate the effect of a Veinlite PEDI2 and passive VR distraction on the first attempt at PIC insertion success, duration of insertion, emotional behavior, pain, fear, and anxiety associated with PIC insertion in children aged 4-10 years in the pediatric emergency department.

METHODS

The study was conducted with a total of 160 children who were assigned to groups (control, vein imaging, VR, and vein imaging with VR) through stratified randomization. The duration and number of attempts for PIC insertion were recorded. The children's emotional state, fear, and anxiety were evaluated before and after the procedure. After the procedure, pain was evaluated using the Wong-Baker FACES and Color Analog Scale. The mean scores obtained from the scales were compared using the Kruskal-Wallis test.

RESULTS

The PIC success rate on the first attempt was 80-85% in the groups. A significant difference was found between the groups in terms of total emotional behavior scores (KW = 21.608, df = 3, p < 0.001). There were statistically significant differences among the groups in emotional behavior, pain, and anxiety scores after the procedure, while no difference was observed in fear scores (KW = 6.485, df = 3, p = 0.09).

CONCLUSIONS

VR distraction effectively reduced pain and anxiety, while the Veinlite PEDI2 did not affect the first attempt at PIC insertion or duration.

APPLICATION TO PRACTICE

VR and Veinlite PEDI2 can be used for PIC insertion-related pain and anxiety (ClinicalTrials.gov: NCT06243419).

The effect of virtual reality distraction on haemodialysis patients' pain and anxiety during arteriovenous fistula puncture: a randomised controlled trial

Background

Pain and anxiety during arteriovenous fistula (AVF) puncture are crucial factors affecting haemodialysis (HD) patients' quality of life.

Aim

The aim of this study is to assess the effect of virtual reality (VR) distraction on pain, anxiety, satisfaction and haemodynamics during AVF puncture.

Methods

This randomised controlled trial study was conducted in a Haemodialysis unit at Mansoura University Hospital. Ninety-six patients were randomly divided into the intervention (n = 48) and control (n = 48) groups. Six minutes prior to the puncture, patients in the intervention group used VR glasses to experience a 360° 'Relax River VR tour', whereas patients in the control group received no intervention.

Results

Following the intervention, pain, anxiety, systolic blood pressure and heart rate were significantly lower, and satisfaction scores were significantly higher in the intervention group than in the control group (p < 0.05).

Conclusion

VR distraction may help alleviate pain, anxiety and increase satisfaction. It may be considered a safe and cost-effective non-pharmacological therapy for HD patients undergoing AVF puncture.

Soothing venipuncture: Bubble blowing and ball squeezing in reducing anxiety, fear, and pain in children

PROBLEM

The objective of this study was to investigate the impact of bubble-blowing and ball-squeezing interventions on children's levels of anxiety, fear, and pain during venipuncture procedures.

METHODS

This study was designed as a randomized controlled trial. Out of 108 children aged 5-10 years, 72 were allocated to the two experimental groups, while 36 were assigned to the control group. The levels of anxiety, fear, and pain experienced by the children were assessed using the "Wong-Baker FACES® Pain Rating Scale," "Child Anxiety Scale-State," and "Child Fear Scale," respectively. Intergroup comparisons were analyzed using one-way ANOVA, while intragroup comparisons were conducted using Wilks' Lambda analysis.

FINDINGS

It was observed that 50% of the children in the control group, 47.2% in the bubble-blowing group, and 47.2% in the ball-queezing group did not receive information about the painful procedure. Anxiety, fear, and pain scores of all groups were statistically similar in the initial measurement without any intervention. Children in the bubble-blowing and ball-squeezing groups experienced lower anxiety, fear, and pain during and at the end of the painful procedures.

CONCLUSIONS

The study discovered that interventions involving bubble blowing and ball squeezing significantly decreased children's levels of anxiety, fear, and pain both during and after intravenous procedures. Information on procedures, alongside interactive techniques like bubble blowing and ball squeezing, helps pediatric nurses calm children, easing anxiety, fear, and pain. Implementing these strategies enhances treatment experiences and confidence in healthcare.

Effectiveness and safety of Buzzy device in needle-related procedures for children under twelve years of age: A systematic review and meta-analysis

BACKGROUND

Pain transcends simple physiology, encompassing biological, emotional, psychological, and social facets. Children show pronounced immediate and enduring responses to pain-related procedures. The aim of this meta-analysis is to investigate the efficacy and safety of the Buzzy device for needle-related procedures in children aged twelve years or younger.

METHODS

PubMed, Web of Science, and Embase were searched from inception to July 2023. Only randomized controlled trials utilizing the Buzzy device for needle-related procedures in children under twelve years old were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Random-effects models were utilized, and analyses were performed using mean differences or standardized mean differences as well as risk ratios.

RESULTS

A total of 19 studies were included, involving 2846 participants (Buzzy = 1095, Control = 1751). Compared to no intervention, the Buzzy device significantly reduced pain response [self-report SMD = -1.90 (-2.45, -1.36), parental SMD = -3.04 (-4.09, -1.99), observer SMD = -2.88 (-3.75, -2.02)] and anxiety scores [self-report SMD = -1.97 (-3.05, -0.88), parental SMD = -2.01 (-2.93, -1.08), observer SMD = -1.92 (-2.64, -1.19)]. Compared to virtual reality (VR), the Buzzy device reduced self-reported anxiety levels SMD = -0.47 (-0.77, -0.17), and compared to distraction cards, the Buzzy device reduced parental and observer-reported pain [parental SMD = -0.85 (-1.22, -0.48), observer SMD = -0.70 (-1.00, -0.40)] and anxiety [parental SMD = -0.96 (-1.46, -0.47), observer SMD = -0.91 (-1.40, -0.42)]. Subgroup analysis results showed that procedure type, patient age, measurement scales used, and distance of operation were not the reason of heterogeneity. The summarized first puncture attempt success rate did not differ from other interventions. There were no significant adverse events in the included studies.

CONCLUSION

The Buzzy device reduces pain and anxiety in children during needle procedures, ensuring success and safety. Additionally, the effectiveness of the Buzzy device in reducing pain during venipuncture is superior when compared to its effectiveness during intramuscular injections.

Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis

BACKGROUND

Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis.

METHODS

We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses.

RESULTS

In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018.

CONCLUSIONS

Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.

Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure

CONTEXT

Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers.

OBJECTIVES

We aimed to assess the benefits of NPD to medical providers.

DATA SOURCES

We searched 5 databases for relevant articles.

STUDY SELECTION

Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included.

DATA EXTRACTION

Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy.

RESULTS

We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff.

CONCLUSIONS

Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.

The effect of virtual reality on pain, fear and emotional appearance during blood draw in pediatric patients at the hematology-oncology outpatient clinic: A randomized controlled study

OBJECTIVE

Invasive attempts can be very painful and stressful for pediatric patients. Virtual Reality (VR) can be used to distract patients undergoing such procedures in pediatric hematology oncology patients.

METHODS

A parallel trial design approach was adopted for this randomized controlled trial, guided by the CONSORT checklist. The study sample (n = 69) was divided into a VR group (n = 34) and a control group (n = 35) using stratified randomization. For the blood draw attempt, no distraction method was applied to the control group, while the children in the VR group were distracted from the procedure with the Epic Roller Coasters VR application. The primary variable assessed was pain, while secondary variables were fear and emotional appearance. The scores of emotional appearance, fear, and pain were compared with a Mann-Whitney U Test.

RESULTS

The pre-procedure emotional appearance score was 11.3 ± 4.3 in the VR group and 11.0 ± 5.0 in the control group, and the post-procedure score was 6.5 ± 3.3 in the VR group and 11.8 ± 5.3 in the control group, indicating a difference in emotional appearance after the procedure. VR group had lower negative emotional appearance, lower pain, and lower fear scores after procedure compared to the control group.

CONCLUSION

VR can be considered an effective approach to reducing the negative emotional appearance and for relieving pain and fear in children aged 4-12 years undergoing blood draw procedures in pediatric hematology and oncology outpatient unit (ClinicalTrials.gov: NCT05675358).

Usefulness of virtual reality in the management of pain associated with venepuncture: a multicentre randomized clinical trial

OBJECTIVE

To assess the efficacy of virtual reality (VR) in reducing pain and anxiety associated with scheduled blood draws.

MATERIAL AND METHODS

We conducted multicentre randomized clinical trial in both primary care and hospital settings. The study included children aged 7-12 years undergoing blood extraction procedures between March and October 2022. The intervention group used headsets, and the control group received usual care. Pain was assessed using the visual analogue scale and anxiety using the Groningen Distress Scale. The anxiety of the nursing staff and family satisfaction were assessed with numerical scales ranging from 1 to 10.

RESULTS

The study included 83 patients: 40 in the control group and 43 in the VR group. The median age was 10 years (range, 7-12 years). In the VR group, 83.7% of the children reported mild pain, compared to 57.5% in the control group (P = .012). Also, 93% of children in the VR group showed calm or mild anxiety (score, 1-2), compared to 72% of the control group, a difference that was not statistically significant (P = .08). Family satisfaction was higher in the RV group (score ≥ 9/10: 93% of RV group vs 72.5% of control group; P = .026). The nursing staff anxiety score was less than 5 in more than 90% of cases, with no differences between groups (P = .13).

CONCLUSION

The use of VR during venepuncture decreases the pain perceived by children and increases the satisfaction of their families.

The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study

BACKGROUND

Non-pharmacological methods are often used as a creative strategy to reduce pain and fear in children during a painful procedure such as phlebotomy.

OBJECTIVES

This study was conducted to evaluate the effects of Bee Buzzy and puppet use on pain and fear during phlebotomy in children.

METHODS

This randomized controlled study was conducted in the pediatric phlebotomy unit of a university hospital. The CONSORT checklist was used in this study. The sample of 3-6 years children (n = 105) was divided into groups by block randomization. Children's pain and fear scores were evaluated with the Wong-Baker Faces Pain Rating Scale and Children's Fear Scale by the parents and the nurse who attempted phlebotomy during phlebotomy.

RESULTS

A statistically significant difference was found between the Bee Buzzy and puppet and Bee Buzzy and control groups in pain scores (p < .05). Pain scores were lower in the Bee Buzzy group than in the puppet and control groups. A statistical difference was found between Bee Buzzy and the control group or puppet and control group according to all fear scores (p < .05). Fear scores were lower in the Bee Buzzy and puppet group (p < .05).

CONCLUSIONS

The results show that the use of Bee Buzzy during phlebotomy has a pain-relieving effect, and the use of Bee Buzzy and puppet has an anti-fear effect in 3-6-year-old children.

IMPLICATIONS FOR PRACTICES

The use of Bee-Buzzy and puppets is effective in reducing pain and fear in children as they increase effective communication and distract attention.

CLINICAL TRIAL REGISTRATION

National Institutes of Health (NIH), ClinicalTrials.gov, NCT05827783.

The effect of the closed intravenous catheter system on first insertion success, indwelling time, and complications in pediatric hematology and oncology patients: A randomized controlled study

PURPOSE

The primary purpose of this research is to evaluate the effect of two different catheter systems (closed IV catheter system: BD Nexiva™, peripheral open IV catheter: BD Insyte™ Autoguard™) on first insertion success, catheter indwelling time, and the catheter complications.

METHOD

This randomized controlled study used a single-blind and parallel trial design guided by the CONSORT checklist. The "Peripheral Intravenous Catheter (PIVC) Bundle" was applied to all patients. A total of 214 catheters of 38 patients were included in the intervention (BD Nexiva™) (n = 107 catheter) and control (open IV catheter) groups (n = 107 catheter) of the study. The indwelling time and PIVC complications were followed.

RESULTS

The mean age of the patients in the study group was 5.9 ± 2.2, and the mean age of the patients in the control group was 5.7 ± 1.9. The PIVC was successfully placed in 68.2% of the patients in the study group and in 65.4% of the patients in the control group at the first attempt. It was determined that the indwelling time was 4.9 ± 3.9 (max. 20.25 days) in the study group and 2.9 ± 2.8 (max. 11.25 days) days in the control group. The complication rates were found to be 86.8 for the study group and 166.9 for the control group in 1000 catheter days. In this study, no difference was found in terms of complication.

CONCLUSIONS

The PIVC indwelling time is longer in patients with the closed IV catheter system. These new technology PIVCs can be used for this special patient population.

CLINICALTRIALS

GOV IDENTIFIER

NCT05769452.

Poke Plan: An Initiative to Improve Distraction and Pain Mitigation With Venous Access in Hospitalized Children

BACKGROUND

Adequate pain control and anxiety relief during peripheral intravenous cannula (PIV) placement improves patient, parental, and staff satisfaction and reduces health care-induced stress in children. We noted a low rate of analgesic/anxiolysis use (<20%) and child life utilization (3%) in our institution. This quality improvement project was initiated to increase pain mitigation strategies in hospitalized children requiring PIV access.

METHODS

From November 2020 to March 2021, we created a key driver diagram and summarized possible interventions with the aim to increase our use of pain control strategies to >40% and child life utilization to 25%. For 12 months, 8 Plan-Do-Study-Act cycles were conducted focusing on nursing education and training, improved documentation, electronic medical record optimization, easy access to analgesics and anxiolytics, family involvement, and weekly huddles. Our primary measure was the percentage use of pain medications for PIV access. The utilization of PIV experts from the ICU (advanced practice registered nurses and physicians) served as the balancing measure.

RESULTS

A total of 883 patient charts were reviewed. The use of topical anesthetics and anxiolytics increased from 16.2% at baseline to 78.9% after the implementation of the quality improvement project. Eighty percent of parents reported their child was kept comfortable during the procedure using pain mitigation and comfort measures. A slight increase from 2% to 5.8% was noted in the utilization of advanced practice registered nurses and intensivists.

CONCLUSIONS

Implementation of a standardized approach for PIV placement improved team communication and provided better preparation for pain control before needle insertions in hospitalized children.

Effect of virtual reality on pain during burn dressing in children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Burn dressing, a necessary and regular procedure for burn management, causes significant pain and distress for children. Recent technological advancements in VR have opened up new possibilities for pain management in children undergoing burn dressing. However, there is limited evidence regarding their efficacy in burn dressing specifically. This study aims to synthesize and analyze the effect of VR on pain during burn dressing in children.

METHODS

In this review, we investigated studies from PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Scopus and Google Scholar databases that met inclusion criteria. We also assessed the studies' methodological quality with the Cochrane and JBI checklists. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews.

RESULTS

A total of six published studies including 241 pediatric patients were included in this review. The meta-analysis results showed a significant effect of VR intervention on the pain levels of children (Hedge's g = -1199, Q = 31,106, I2 = 83,926%, p < 0.001).

CONCLUSION

Findings from this study show that VR is a promising and effective intervention for reducing pain scores in children undergoing dressing changes for burn injuries.

IMPLACATION TO PRACTICE

Our meta-analysis suggest that the significant potential of integrating VR into clinical practice, presenting a non-pharmacological intervention to reduce pain during dressing changes in pediatric burn patients. Implementing VR in healthcare settings can lead to improved pain management and better patient outcomes for pediatric population.