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Mortada H, Al Qurashi AA, Alnaim MF, Arab K, Kattan AE. Effectiveness of using a vibration device to ease pain during upper extremity injections: A randomized controlled trial. Saudi J Anaesth 2024; 18:488-495. [PMID: 39600438 PMCID: PMC11587978 DOI: 10.4103/sja.sja_242_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 11/29/2024] Open
Abstract
Objectives The current study aimed to evaluate the effectiveness of using a vibration device to ease pain during upper extremity injections. Specifically, the study aims to compare the pain levels of patients who receive the injection with and without the use of vibration therapy. The results of this study may have implications for improving patient outcomes and satisfaction during routine injection procedures. Material and Methods This randomized controlled trial included patients aged 18 years or older who were scheduled to receive an injection in the upper extremity. A total of 60 patients were enrolled and randomized to either the intervention group or the control group using a computer-generated randomization sequence. The level of satisfaction and pain levels were assessed using a visual analog scale. The study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board. Results The mean pain score immediately after the injection was 4.03 ± 2.11 out of 10 in the vibration group (n = 30), compared to 7.4 ± 1.37 out of 10 in the control group (n = 30) (P < 0.001). Patients in the vibration group also reported higher levels of satisfaction and comfort during the injection (P < 0.001). No adverse events were reported in either group. Conclusion Our study proves that using a vibration device during upper extremity injections can effectively reduce postinjection pain and improve patient satisfaction. Further research is needed to explore this intervention's long-term effects and feasibility in different clinical settings.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Al Qurashi
- Department of Clinical Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Jeddah, Saudi Arabia, King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia
| | - Muna F. Alnaim
- Department of Clinical Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Khalid Arab
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah E. Kattan
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Unesi Z, Amouzeshi Z, Jamavar J, Mahmoudzadeh Zarandi F. The Effect of a Combination of Vibration and External Cold on Pain Caused during Vaccine Injection in Infants: A Randomized Clinical Trial. Int J Clin Pract 2024; 2024:7170927. [PMID: 38469171 PMCID: PMC10927340 DOI: 10.1155/2024/7170927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/14/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
Aim This study was conducted to determine the effect of combining vibration and external cold on pain caused by vaccine injection among six-month-old infants. Design Randomized controlled trial. Methods In this clinical trial, 80 eligible infants were selected from the infants referred to a health center as per the inclusion criteria. The infants were assigned to either a control group or an intervention group by block randomization. In the intervention group, a vibrating and cold device was placed above the injection site from one minute before to 15 seconds after the pentavalent vaccine injection. In the control group, no intervention was performed, and they were vaccinated according to the routine procedure. The pain status in the two groups was measured using the Modified Behavioral Pain Scale (MBPS) 15 seconds after the injection, and the crying duration was assessed from the injection of the vaccine till the end of it. Data were analyzed in SPSS 23 software using Mann-Whitney, t, Spearman, and chi-square tests. The level of significance was set to p < 0.05. Results Most participants in the control (55%) and intervention (55%) groups were girls. Statistical data analysis of 80 infants showed that the mean pain intensity (p = 0.032) and duration of crying (p = 0.0001) in the intervention group (6.1 ± 1.8, 32.47 ± 16.78) were lower than those of the control group (7.2 ± 0.1, 51.02 ± 25.9), respectively. Conclusion Because the intensity of pain, especially the duration of crying, was lower in the intervention group than in the control group, we may suggest that nurses use simple pain relief solutions in vaccination centers, such as a combination of vibration and cold. This trial is registered with IRCT201207157130N2.
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Affiliation(s)
- Zahra Unesi
- Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Amouzeshi
- Department of Nursing, School of Nursing and Midwifery, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Javad Jamavar
- Science and Research Branch Islamic Azad University of Medical Sciences, Birjand, Iran
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Yıldırım BG, Gerçeker GÖ. 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. J Emerg Nurs 2023; 49:62-74. [PMID: 36376127 DOI: 10.1016/j.jen.2022.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Distraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success. METHODS A randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal-Wallis test. RESULTS There were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure. DISCUSSION Virtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.
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Cho YH, Chiang YC, Chu TL, Chang CW, Chang CC, Tsai HM. The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study. JMIR Pediatr Parent 2022; 5:e15757. [PMID: 35486419 PMCID: PMC9107058 DOI: 10.2196/15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 05/31/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001). CONCLUSIONS The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.
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Affiliation(s)
- Yen-Hua Cho
- Pediatric Department, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Chien Chiang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Division of Pediatric Hematology and Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Lan Chu
- Administration Center of Quality Management Department, Chang Gung Medical Foundation, Taoyuan City, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, LinKou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Chu Chang
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsiu-Min Tsai
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
- Administration Center of Quality Management Department, Chang Gung Medical Foundation, Taoyuan City, Taiwan
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Abstract
ABSTRACT I.V. catheter placement is one of the most common causes of procedural pain in children. Interventions to address this pain are readily available but inconsistently used in practice. The focus of this article is to identify and encourage best practice for pain mitigation in peripheral I.V. catheter placement in children.
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Affiliation(s)
- Christina Schott
- In Washington, D.C., Christina Schott is a clinical research assistant at Children's National Medical Center; Victoria Brown is an RN I at Children's National Medical Center; and Sarah Vittone is an assistant professor at the School of Nursing & Health Studies and a clinical bioethicist at the Pellegrino Center for Clinical Bioethics at Georgetown University
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Jain N, Juneja P, Masih U, Bhushan AKB, Bhaduaria US, Badjatya K. Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia. J Family Med Prim Care 2021; 10:4017-4022. [PMID: 35136761 PMCID: PMC8797120 DOI: 10.4103/jfmpc.jfmpc_305_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods. Method: A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed. Result: Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control. Conclusion: External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.
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Affiliation(s)
- Nivedita Jain
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Preene Juneja
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Updesh Masih
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - A K Bharath Bhushan
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Upendra Singh Bhaduaria
- Department of Public Health Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
| | - Khushboo Badjatya
- Department of Pediatric and Preventive Dentistry, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
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Cozzi G, Crevatin F, Dri V, Bertossa G, Rizzitelli P, Matassi D, Minute M, Ronfani L, Barbi E. Distraction Using Buzzy or Handheld Computers During Venipuncture. Pediatr Emerg Care 2021; 37:e512-e516. [PMID: 30601349 DOI: 10.1097/pec.0000000000001689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Venipuncture is one of the most frequently performed painful procedures in children. The aim of this study was to investigate the effectiveness of 2 analgesic strategies for venipuncture in children in a specific setting like a blood-drawing center. METHODS This was a prospective randomized controlled trial. It was conducted in the blood-drawing center of a tertiary level children's hospital in Italy, between November 2014 and February 2015. Eligible patients were children aged from 4 to 12 years referred to the blood-drawing center for venipuncture. Enrolled children were randomized to be distracted by Buzzy device or by playing with a handheld computer. The procedural pain was measured with the faces pain scale-revised by children aged from 4 to 7 years and with a numerical rating scale by children aged from 8 to 12 years. RESULTS Two hundred children with a median age of 8 years were enrolled in the study. The self-reported procedural pain was not statistically different between the Buzzy group and the handheld computer group: median (interquartile range) = 3.0 (1.0-4.8) and 2.0 (1.0-4.8), respectively (P = 0.72). Children reported significant pain in 25% of cases with both distraction strategies. The procedural success rate at the first attempt was not significantly different in the 2 groups. CONCLUSIONS Analgesia provided by Buzzy or by a handheld computer was not significantly different in children undergoing venipuncture in a blood-drawing center, with the great proportion of them reporting no or mild pain during procedure.
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Affiliation(s)
- Giorgio Cozzi
- From the Institute for Maternal and Child Health IRCCS Burlo Garofolo
| | - Franca Crevatin
- From the Institute for Maternal and Child Health IRCCS Burlo Garofolo
| | | | | | | | - Daniela Matassi
- From the Institute for Maternal and Child Health IRCCS Burlo Garofolo
| | - Marta Minute
- From the Institute for Maternal and Child Health IRCCS Burlo Garofolo
| | - Luca Ronfani
- From the Institute for Maternal and Child Health IRCCS Burlo Garofolo
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Ueki S, Matsunaka E, Takao K, Kitao M, Fukui M, Fujita Y. The effectiveness of vibratory stimulation in reducing pain in children receiving vaccine injection: A randomized controlled trial. Vaccine 2021; 39:2080-2087. [PMID: 33744043 DOI: 10.1016/j.vaccine.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although vaccine injections are important, children experience pain and discomfort upon their administration. BUZZY®, a vibratory stimulation tool with an ice pack, was reported to be an effective tool for reducing the pain caused to children during injection administration; its mechanisms were explained by gate control theory. However, the evidence is inadequate because of insufficient methodology in previous reports. Therefore, we aimed to assess whether the application of vibration would significantly reduce children's pain during vaccine injections. METHODS A single-blind randomized controlled trial recruiting children aged ≤6 years who were receiving vaccine injections was conducted between August and December 2019. If the children's parents consented to their participation, BUZZY® was attached to the child's arm prior to vaccination. BUZZY® was switched on before injection in the intervention group but not in the control group. The vaccination procedure was recorded, and researchers and parents assessed each child's pain using validated pain scales. Researchers conducted their assessment using video data to ensure blinding. Parents were administered a questionnaire after the children's vaccination. Data were analyzed using the t-test or chi-square test. RESULTS We analyzed 118 children (intervention group = 62, control = 56). No between-group difference was observed according to the researchers' assessment (mean score = 6.98 and 7.63, respectively; p = 0.25); however, a significant difference was found based on the parents' assessment (mean score = 7.39 versus 8.46; p = 0.02). Most responses received to open-ended questions were positive comments for this study. CONCLUSIONS We revealed that the effect of vibration is not significant in reducing vaccine injection pain among children. Further studies are needed to examine the other components of BUZZY®, which include its cooling effect, and the effect of BUZZY® itself in terms of whether children will undergo vaccination without resistance and have reduced trauma related to vaccination.
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Affiliation(s)
- Shingo Ueki
- School of Nursing, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo 668-8558, Japan.
| | - Eriko Matsunaka
- Faculty of Nursing, Japanese Red Cross Kyushu International College of Nursing, 1-1, Asty, Munakata, Fukuoka 811-4157, Japan.
| | - Kenji Takao
- Faculty of Health and Medical Sciences, Kyoto University of Advanced Science, 18, Gotanda, Yamanouchi, Ukyou, Kyoto, Kyoto 615-8577, Japan.
| | - Mika Kitao
- School of Nursing, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo 668-8558, Japan.
| | - Minae Fukui
- School of Nursing, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo 668-8558, Japan.
| | - Yuichi Fujita
- School of Nursing, Mukogawa Women's University, 6-46, Ikebiraki, Nishinomiya, Hyogo 668-8558, Japan.
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Sapçi E, Bilsin Kocamaz E, Gungormus Z. Effects of applying external cold and vibration to children during vaccination on pain, fear and anxiety. Complement Ther Med 2021; 58:102688. [PMID: 33640458 DOI: 10.1016/j.ctim.2021.102688] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/11/2020] [Accepted: 02/16/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness of the application of external cold and vibration on children experiencing pain, fear and anxiety during vaccination. DESIGN AND SETTING This randomized controlled, experimental study was conducted in primary schools selected within the scope of school immunization days by a community health center. The study population consisted of first grade students who were scheduled to receive a booster dose of diphtheria, tetanus, and acellular pertussis, inactivated poliovirus vaccine (DTaP-IPV) vaccine within the scope of the school immunization program of the said community health center and the study sample consisted of 90 students (experimental: 45, control:45). MAIN OUTCOME MEASURES In the experimental group, a device that applies external cold and vibration (Buzzy®) was placed on the injection site for 30 s before administration of the vaccine. The device was then placed above the injection site and kept there during the injection. No intervention was made during the injections in children included in the control group. The same nurse administered the injections in the experimental and control groups. RESULTS In the current study, it was found that there was a statistically significant difference between the experimental group and the control group in terms of the children's pain, the nurse's pain, the nurse's fear and the children's anxiety (p < 0.05), but no statistically significant difference in terms of the children's fear (p > 0.05). CONCLUSIONS It was concluded that applying external cold and vibration during vaccination has an effect on the level of children's pain and anxiety.
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Affiliation(s)
- Eda Sapçi
- Gaziantep 25 Aralık State Hospital, Turkey
| | - Elif Bilsin Kocamaz
- Gaziantep University, Faculty of Health Sciences, Department of Nursing, Turkey.
| | - Zeynep Gungormus
- Gaziantep University, Faculty of Health Sciences, Department of Nursing, Turkey
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Abstract
Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine. Pain management is also part of the core competency for emergency medicine residencies and pediatric emergency medicine fellowships. There are many benefits to providing local and/or topical anesthesia before performing a medical procedure, including better patient and family satisfaction and increased procedural success rates. Local and topical anesthetics when used appropriately, generally, have few, if any, systemic side effects, such as hypotension or respiratory depression, which is an advantage over procedural sedation. Use of local and topical anesthetics can do much toward alleviating the pain and anxiety of pediatric patients undergoing procedures in the emergency department.
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Bilsin E, Güngörmüş Z, Güngörmüş M. The Effıcacy of External Cooling and Vibration on Decreasing the Pain of Local Anesthesia Injections During Dental Treatment in Children: A Randomized Controlled Study. J Perianesth Nurs 2020; 35:44-47. [DOI: 10.1016/j.jopan.2019.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/14/2022]
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Chan E, Hovenden M, Ramage E, Ling N, Pham JH, Rahim A, Lam C, Liu L, Foster S, Sambell R, Jeyachanthiran K, Crock C, Stock A, Hopper SM, Cohen S, Davidson A, Plummer K, Mills E, Craig SS, Deng G, Leong P. Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials. J Pediatr 2019; 209:160-167.e4. [PMID: 31047650 DOI: 10.1016/j.jpeds.2019.02.034] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/29/2019] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. STUDY DESIGN In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. RESULTS In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. CONCLUSIONS In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358p.
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Affiliation(s)
- Evelyn Chan
- General Pediatrics, Monash Children's Hospital, Clayton, Victoria, Australia; General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michael Hovenden
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Emma Ramage
- Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Norman Ling
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Jeanette H Pham
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Ayesha Rahim
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Connie Lam
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Linly Liu
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Samantha Foster
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Ryan Sambell
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia
| | - Kasthoori Jeyachanthiran
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine Crock
- School of Psychology, Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Amanda Stock
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Simon Cohen
- Pain Management, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Andrew Davidson
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Karin Plummer
- Anaesthesia and Pain Management Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erin Mills
- Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Simon S Craig
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Pediatric Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Gary Deng
- DataConnect, Melbourne, Victoria, Australia
| | - Paul Leong
- School of Clinical Sciences, Monash University and Monash Health, Clayton, Victoria, Australia; Monash Lung & Sleep, Monash Medical Centre, Clayton, Victoria, Australia.
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Lambing A, Witkop M, Humphries TJ. Complementary and alternative therapy (CAM) in haemophilia pain management: a review of published literature. ACTA ACUST UNITED AC 2019. [DOI: 10.17225/jhp00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Angela Lambing
- Clinical Support Specialist, Bayer HealthCare , United States
| | - Michelle Witkop
- Head of Research, National Hemophilia Foundation , United States
| | - Thomas J. Humphries
- Formerly Senior Medical Director, US Medical Affairs, Bayer HealthCare , United States
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Küçük Alemdar D, Yaman Aktaş Y. The Use of the Buzzy, Jet Lidokaine, Bubble-blowing and Aromatherapy for Reducing Pediatric Pain, Stress and Fear Associated with Phlebotomy. J Pediatr Nurs 2019; 45:e64-e72. [PMID: 30711327 DOI: 10.1016/j.pedn.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed to investigate the effects of the Buzzy, Jet lidokaine, bubble-blowing and inhalation aromatherapy with lavender essence on pain, stress and fear in children undergoing phlebotomy. DESIGNS AND METHODS This study was a prospective, randomized controlled trial. The sample was comprised of children aged 5 to 10 years requiring blood tests. Children were assigned to five subgroups through randomization performed using a computer program: the Buzzy group (n = 39), Jet lidokaine group (n = 39), bubble-blowing group (n = 39), inhalation aromatherapy with lavender essence group (n = 39) and control group (n = 39). The children's levels of pain were evaluated and reported by the parents, observers and the children, who self-reported using the Oucher Pain Scale. The children's fear levels were assessed using the Children's Fear Scale, and salivary cortisol analysis was conducted to evaluate stress levels. RESULTS A significant difference was found between the intervention and control groups in terms of levels of pain during and after phlebotomy in favor of the Buzzy group (p < 0.05). There was a significant difference between the fear scores of the children in the intervention and control groups before phlebotomy (p < 0.05). This difference was found to be caused by the bubble-blowing method. There was a significant difference between intervention and control groups fear levels in favor of the Buzzy group during phlebotomy (p < 0.05). PRACTICE IMPLICATIONS It is recommended that the Buzzy and bubble-blowing be used during phlebotomy in children to reduce the severity of their pain.
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Affiliation(s)
- Dilek Küçük Alemdar
- Giresun University, Faculty of Health Sciences, Department of Midwifery Giresun,Turkey.
| | - Yeşim Yaman Aktaş
- Giresun University, Faculty of Health Sciences, Department of Nursing Giresun,Turkey
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Binay Ş, Bilsin E, Gerçeker GÖ, Kahraman A, Bal-Yılmaz H. Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial. J Perianesth Nurs 2019; 34:749-756. [PMID: 30797673 DOI: 10.1016/j.jopan.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years. DESIGN This study is a randomized controlled trial. METHODS The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy. FINDINGS A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group. CONCLUSIONS The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.
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Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study. Eur Arch Paediatr Dent 2018; 20:79-84. [DOI: 10.1007/s40368-018-0399-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 12/02/2018] [Indexed: 01/09/2023]
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Canbulat Sahiner N, Turkmen AS, Acikgoz A, Simsek E, Kirel B. Effectiveness of Two Different Methods for Pain Reduction During Insulin Injection in Children With Type 1 Diabetes: Buzzy and ShotBlocker. Worldviews Evid Based Nurs 2018; 15:464-470. [DOI: 10.1111/wvn.12325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Nejla Canbulat Sahiner
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayse Sonay Turkmen
- Pediatric Nursing DepartmentHealth Science FacultyKaramanoglu Mehmetbey University Karaman Turkey
| | - Ayfer Acikgoz
- Nursing DepartmentHealth Science FacultyEskisehir Osmangazi University Eskisehir Turkey
| | - Enver Simsek
- Child Endocrinology DepartmentMedical FacultyEskisehir Osmangazi University Eskisehir Turkey; Birgul Kirel,
| | - Birgul Kirel
- Child Endocrinology DepartmentMedical FacultyEskisehir Osmangazi University Eskisehir Turkey; Birgul Kirel,
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Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018; 10:CD005179. [PMID: 30284240 PMCID: PMC6517234 DOI: 10.1002/14651858.cd005179.pub4] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents. OBJECTIVES To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents. SEARCH METHODS We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013. SELECTION CRITERIA We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure. DATA COLLECTION AND ANALYSIS Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence. MAIN RESULTS We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention. AUTHORS' CONCLUSIONS We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
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Affiliation(s)
- Kathryn A Birnie
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Susam V, Friedel M, Basile P, Ferri P, Bonetti L. Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:6-16. [PMID: 30038198 PMCID: PMC6357594 DOI: 10.23750/abm.v89i6-s.7378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. METHODS A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). RESULTS Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. CONCLUSION The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.
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Affiliation(s)
- Volkan Susam
- General Medical Ward, ASST Monza-San Gerardo, San Gerardo Hospital, Italy..
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Stoltz P, Manworren RCB. Comparison of Children's Venipuncture Fear and Pain: Randomized Controlled Trial of EMLA® and J-Tip Needleless Injection System®. J Pediatr Nurs 2017; 37:91-96. [PMID: 28823623 DOI: 10.1016/j.pedn.2017.08.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/27/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA® or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System® (J-Tip®). DESIGN AND METHODS In this prospective, randomized trial, 150 consecutive pediatric patients 8 to 18years of age undergoing IV insertion were randomly assigned 1:1 to treatment group. Participants self-reported procedural pain using a Visual Analog Scale, and procedural fear using the Children's Fear Scale. RESULTS Procedural pain scores were significantly lower in the EMLA® group (mean score 1.63+1.659) vs. the J-Tip® group (2.99±2.586; p<0.001). Post-procedure fear scores were significantly lower than pre-procedure fear scores in both treatment groups (p<0.002), but there was no difference in fear scores between the two treatment groups (p=0.314). CONCLUSION EMLA® provided superior pain relief for IV insertion compared to J-Tip®. PRACTICE IMPLICATIONS Although EMLA® use resulted in lower self-reported pain scores compared to J-Tip®, pain scores for both treatments were low and fear scores did not differ. When IV insertion can be delayed for 60-90min, EMLA® should be used. When a delay is contraindicated, J-Tip® may be a reasonable alternative to minimize procedural pain of IV insertion.
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Affiliation(s)
- Petronella Stoltz
- Division of Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT, United States; Division of Pediatric Neurosurgery, Connecticut Children's Medical Center, Hartford, CT, United States.
| | - Renee C B Manworren
- Nursing Research & Professional Practice, Posey and Fred Love Chair in Nursing Research, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; (d)Northwestern University Feinberg School of Medicine, United States.
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Christian BJ. Translational Research: Linking Research With Practice: Evidence to Improve the Health of Children. J Pediatr Nurs 2015; 30:924-6. [PMID: 26548408 DOI: 10.1016/j.pedn.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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