Reducing Pain and Fear in Children During Venipuncture: A Randomized Controlled Study

Atraumatic care practice from the child and parent perspective: The case of a pediatric phlebotomy unit

PURPOSE

This study aimed to determine the effect of the child's self-selected distraction methods used during the phlebotomy procedure on the feeling of fear and pain in children and parental satisfaction.

METHODS

The study, planned as a randomized controlled trial, was conducted with 219 children aged 5-10 years and their parents in the pediatric phlebotomy unit between March and June 2023. Different distraction methods (foam balloon, stress ball, musical book) were applied to the children in the intervention group during the phlebotomy procedure. The data were analyzed with the SPSS 22.0 package program.

RESULTS

There was a statistically significant difference between the scores of the children in the intervention and control groups on the Children's Fear Scale before the phlebotomy, and on the Wong-Baker Faces Pain Rating Scale after phlebotomy according to self- and parental assessment (p < 0.05). A statistically significant difference was found between the satisfaction levels of the parents after the procedure in the intervention and control groups with the health care service provided during the phlebotomy process (p < 0.05).

CONCLUSION

Distraction methods, one of the atraumatic nursing interventions used before the phlebotomy procedure, were determined to be effective in reducing the child's fear and the pain experienced due to the procedure. The study also showed that the satisfaction of parents was positively affected by the atraumatic care provided to their children.

PRACTICE IMPLICATIONS

The atraumatic care approach should be used to prevent anxiety and fear experienced by parents and children and to reduce the child's pain.

The Effect of Using Virtual Reality During Burn Dressing on Pain, Anxiety and Fear Felt in Children: A Randomized Controlled Trial

This study was conducted to determine the effect of using virtual reality (VR) during burn dressing on the level of fear, anxiety, and pain that children would experience. This randomized controlled trial was conducted in a pretest-posttest design. Randomization of the participants (n = 65) was performed with the block randomization method. Then, 33 children were included in the intervention and 32 children in the control group with simple sequential randomization. The study data were collected using the "Family and Child Personal Information Form," "Physiological Parameters Registration Form," "Wong-Baker Faces Pain Scale," "Children's Fear Scale," and "Children's Anxiety Meter-State." The chi-square test, t-test, Shapiro-Wilk, mean, and percentile distributions were used for the data analysis. After dressing, the physiological parameters of the children who used VR were found to be within normal limits (HR: 108.48 ± 12.43, O2: 98.39 ± 1.14) compared to the children who did not use (HR: 117.38 ± 15.25, O2: 97.81 ± 1.35) (P < .05). After the dressing, children using VR (0.85 ± 1.23) were determined to have less fear than those who did not use them (3.03 ± 1.06), and similarly, children who used VR (2.64 ± 2.73) experienced less anxiety than those who did not use them (5.84 ± 2.26). When the pain levels were evaluated, the VR group (1.79 ± 2.04) was reported to feel less pain compared to the control group (5.50 ± 2.36). The VR used by children aged 5-10 years during burn dressing has been found to affect their physiological parameters and is effective in reducing fear, anxiety, and pain levels.

Ventriloquist intervention prepared with drama technique in reducing pain, anxiety and fear in children during invasive procedures

INTRODUCTION

This study aimed to investigate the effects of a ventriloquist nursing intervention, incorporating drama techniques, on pain, anxiety, and fear experienced by children aged 5 to 10 years undergoing painful medical procedures.

METHODS

This study was designed as a time-series randomized controlled trial. Data were collected from the outpatient units of a Pediatric Hospital in a province in eastern Turkey between 24 May 2023 and 28 October 2023. This study involving a total of 72 children. Pain, anxiety, and fear levels were assessed before, during, and after intravenous cannula insertion.

RESULTS

Randomization ensured that both groups had similar demographics, with an average age of 7.50 ± 1.73 years and an equal distribution of gender. During the painful procedure, it was observed that both groups experienced an increase in pain, anxiety, and fear, though this increase was statistically less significant in the ventriloquist group. Ultimately, in the post-procedure period, children in the ventriloquist group exhibited lower levels of pain, anxiety, and fear compared to the control group (p < 0.05).

CONCLUSION

The findings of this study suggest that ventriloquist nursing interventions, utilizing drama techniques, can effectively reduce pain, anxiety, and fear in children undergoing painful medical procedures.

Non-pharmacological interventions to reduce procedural needle pain in children (6-12 years): A systematic review

PROBLEM

Children of different age groups frequently undergo painful procedures involving needles, which can be a source of significant discomfort. Regrettably, this aspect of care often receives insufficient attention from healthcare professionals. The existing literature proposes several methodologies for managing procedural pain, with nonpharmacological techniques being particularly promising. These techniques should be adapted to the patient's age, but literature predominantly emphasizes their use with infants. Thus, it is necessary to evaluate their effectiveness in diverse age groups. Consequently, the purpose of this systematic review is to identify non-pharmacological interventions used to prevent needle-related procedural pain in children (age group 6-12 years).

ELIGIBILITY CRITERIA

Primary studies in English language on non-pharmacological interventions in children aged 6-12 years undergoing needle-related procedures found on PubMed, CINAHL and Embase.

SAMPLE

A total of 18 studies were included.

RESULTS

The results indicate the potential application of various non-pharmacological techniques, with distraction methods standing out. These techniques include activities like utilizing cards, watching cartoons, employing virtual reality and playing video games.

CONCLUSIONS

Children's procedural pain represents a significant challenge in treatment plans. Literature offers several approaches, including nonpharmacologic methods, to control this problem. Prioritizing procedural pain management is critical both at clinical and organizational levels to improve the quality of pediatric care.

IMPLICATIONS

These findings offer different options to support clinical practice, holding the potential to enhance the quality of patient care.

Efficacy and safety of the Valsalva maneuver in relieving venipuncture pain in children and adults: A systematic review and meta-analysis

Venipuncture is a common invasive clinical procedure, and pain management during puncture has been of interest to healthcare professionals. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of the Valsalva maneuver (VM) for the relief of venipuncture pain in children and adults. PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP database, and CBM were searched from inception to December 2023 for all available randomized controlled trials (RCTs) that evaluated the impact of VM on venipuncture. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Continuous variables were analyzed by mean differences (MD) or standardized mean differences (SMD), whereas dichotomous variables were analyzed by risk ratios (RR). A total of 22 studies involving 1740 participants were included. The pooled results showed that VM relieved pain intensity during venipuncture in children (SMD = -0.89, 95% CI = -1.47 to -0.30, p = 0.003) and adults (SMD = -1.11, 95% CI = -1.46 to -0.77, p < 0.00001), reduced anxiety intensity (SMD = -1.07, 95% CI = -1.68 to -0.47, p = 0.0005), and shortened puncture time (MD = -13.52, 95% CI = -21.14 to -5.90, p = 0.0005). There was no significant difference in the success rate of venous cannulation, MAP, HR, or incidence of adverse events in subjects who performed VM compared to controls. VM was an effective and safe method of pain management that reduced pain intensity during venipuncture in children and adults without significant adverse effects. The results of this meta-analysis need to be further validated by more rigorous and larger RCTs.

The effect of two different methods on reducing the pain and fear during phlebotomy to children: A randomized controlled trial

INTRODUCTION

Reducing pain and fear during painful medical procedures in children is important since mismanagement of pain causes the child and parent to feel anxious, which can have negative long-term consequences. This study aimed to evaluate the effects of two different distraction methods in reducing pain and fear during the phlebotomy procedure in children.

METHOD

The study, which has a randomized controlled experimental design was conducted between July and October 2020 with 111 children aged 6-12 years who underwent phlebotomy in the emergency department of a public hospital and their parents. The children were randomly assigned to soap bubble blowing (n:37), ball squeezing (n:37) and control (n:37) groups. During the phlebotomy, soap bubble blowing, and ball squeezing methods were used as active distraction methods. Data were collected using the Wong Baker Faces Pain Rating Scale, and the Children's Fear Scale.

RESULTS

The pain scores of the soap bubble blowing group and the ball squeezing group during the phlebotomy procedure were found to be lower than the control group (p < 0.001). In addition, the soap bubble blowing group had lower fear scores than the ball squeezing and control groups (p < 0.001).

CONCLUSION

The active distraction methods used in the study reduced pain and fear during the phlebotomy procedure. In addition, the method of soap bubble blowing was found to be a more effective method in reducing fear. Distraction methods should be used as a nursing intervention to reduce pain and fear during the phlebotomy procedure in children.

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.

Very elevated serum copeptin concentrations occur in a subset of healthy children in the minutes after phlebotomy

OBJECTIVES

Although AVP and its surrogate, copeptin, are mainly regulated by osmotic and volume stimuli, their secretion is also elicited by stress and growth hormone (GH) stimulating agents. The aim of this report is to describe unusual patterns of copeptin response in a subset of children undergoing GH stimulation tests (GH-ST).

METHODS

We conducted a secondary analysis of a cohort of 93 healthy short children with no polydipsia, polyuria or fluid/electrolyte abnormalities, undergoing GH-ST with intravenous arginine, insulin, oral clonidine, or L-Dopa/carbidopa in various combinations. Serum copeptin concentrations were measured 1-3 min after phlebotomy (0 min) and at 60, 90, 120 min during GH-ST.

RESULTS

In 85 subjects (normal response group, NRG) serum copeptin concentrations increased from a 0 min median of 9 pmol/L (IQR 6, 11.5) (all values ≤21) to a median peak between 60 and 120 min of 22 (IQR15, 38) pmol/L, which varied depending on the stimulating agent. Conversely, in the eight outliers, copeptin concentrations decreased gradually from a median of 154 (IQR 61, 439) pmol/L (all ≥40 pmol/L) to values as low as 14 % of the basal value, by 120 min. Test-associated anxiety was described in 17 subjects in the NRG (20 %) and five of the outliers (63 %).

CONCLUSIONS

A distinctive pattern of very elevated serum copeptin concentrations occurred in 9 % of children undergoing GH-ST, similar to reports in previous pediatric studies. Etiology may include pain or stress of phlebotomy. This phenomenon should be recognized for proper interpretation of copeptin values in children.

Effectiveness of Virtual Reality Distraction on Pain Perception and Fear among Children with Cancer Undergoing IV Cannulation

Background

Cancer children are subjected to multiple cannulations during hospitalization. Pain and fear are most common during invasive procedures that are performed, especially IV cannulation, which can lead to worry. Exactly 25% of children are reported to have a fear of needle-related procedures. To examine the impact of virtual reality (VR) distraction on pain perception and fear in children with cancer undergoing IV cannulation.

Materials and Methods

Using a quasi-experimental design, 80 cancer children with IV cannulation between ages 7-18 were recruited to the intervention and control group (N = 40 + 40) using the purposive sampling technique. The virtual reality distraction device was used 10 min before the peripheral IV cannulation procedure and remained in place until the procedure was completed in the intervention group, and no device was used in the control group. Wong-Baker Faces Pain Rating Scale and Children's Fear Scale were used to assess the pain and fear of children and their mothers.

Result

Pain perception was found to be significantly lower in the VR distraction group among both children and mothers (1.82 ± 0.18, 8.01 ± 3.21) 95% confidence interval (CI) [0.82, 2.16] compared to the control group, respectively (P = 0.001**). Fear was found to be significantly lower in the VR distraction group among both children and mothers (0.81 ± 0.71, 3.01 ± 1.42) 95% CI [0.46, 0.91]. A strong positive correlation was found between children's and mothers' pain perception (r = 0.91, P = 0.001**) and fear (r = 0.84, P = 0.001**).

Conclusion

VR distraction can be used as an effective device in pain and fear management among children undergoing IV cannulation.

SuperKid makes it easier: Effect of an intervention prepared with cognitive behavioral technique on reducing fear and pain of children during intravenous insertion

PURPOSE

The aim of this randomized controlled trial was to evaluate the effectiveness of a cognitive-behavioral SuperKid intervention, in reducing fear and pain among children undergoing intravenous insertion in outpatient services.

DESIGN AND METHODS

This study was designed as a randomized controlled trial, with 96 children aged 5-7 years. SuperKid intervention employed cognitive-behavioral techniques, implemented through a set of prepared cards. Fear was assessed using the Child Fear Scale, while pain status was measured using the Wong Baker Face Pain Scale. Scoring was performed by the mother, child, and researcher. Time series tests were conducted using the Wilks Lambda test.

RESULTS

Most children in both the experimental and control groups reported fear regarding hospital procedures, particularly those involving pain and separation from their mothers. However, children in the experimental group who underwent the SuperKid intervention during and after IV insertion procedure experienced significantly less fear and pain than those in the control group.

CONCLUSIONS

SuperKid intervention was found to be effective in reducing the procedural fear and pain of children undergoing intravenous insertion in outpatient services. The utilization of cognitive-behavioral techniques through a set of prepared cards provides an accessible and engaging means of alleviating negative emotional experiences among children undergoing medical/nursing procedures.

PRACTICE IMPLICATIONS

SuperKid intervention can potentially improve children's attitudes toward medical care and make future procedures easier for them. Healthcare providers could consider incorporating cognitive-behavioral interventions, such as the SuperKid intervention, into their clinical practice to reduce the fear and pain experienced by children during medical/nursing procedures.

The Effect of Distraction Methods During Venous Blood Sampling on Pain Levels in School-Age Children: A Systematic Review

OBJECTIVES

This systematic review was conducted to examine the available evidence on the effects of distraction methods during venous blood sampling on pain levels in school-age children.

DESIGN

A systematic review.

DATA SOURCES

Pubmed, Web of Science, Scopus, Science Direct were searched using search terms.

REVIEW/ANALYSIS METHODS

A systematic review of all relevant articles published between June 2017 and June 2022, was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

The applied search strategy identified 612 articles in four databases. A total of 2,032 school-age children in the 15 studies who met the study inclusion criteria were included in the review. Four studies used active distraction, eight studies used passive distraction, and three studies used both distraction methods.

CONCLUSIONS

Active and passive distractions are efficacious interventions during venous blood sampling in reducing pain in school-age children. However, more studies are needed to determine the superiority between these two methods.

Effects of two different ball types on pain and anxiety during venous blood draw in children: A randomized controlled study

BACKGROUND

Children presenting to hospitals for healthcare are often exposed to venous blood draw procedures which cause significant pain and stress for children.

OBJECTIVES

Tactile stimulation and active distraction methods can be used during procedural pain management in children. This study was conducted to determine and compare the effects of tactile stimulation and active distraction methods on levels of pain and anxiety during venous blood draw procedure in children.

METHODS

A randomized controlled study design was adopted with a parallel trial design to compare four different intervention groups with a control group. The children's anxiety levels were evaluated using the Children's Fear Scale, and their perceived pain levels were evaluated using the Wong Baker Pain Scale.

RESULTS

The results of the child and observer evaluations revealed the perceived level of pain during the procedure to be lower in the intervention groups than in the control group, and lower in the spiky ball groups than in the round ball groups. The level of anxiety during the procedure was found to be significantly lower than that recorded prior to the procedure, based on the self-evaluation of the child and the evaluation of the observer in the intervention groups. A positive correlation was found between pain and anxiety levels during the procedure.

PRACTICE IMPLICATIONS

The results of this study support the effectiveness of the spiky ball method to reduce perceived pain and anxiety in children during venous blood draw procedures in the pediatric blood draw units.

Dried Blood Spots-A Platform for Therapeutic Drug Monitoring (TDM) and Drug/Disease Response Monitoring (DRM)

This review provides an overview on the current applications of dried blood spots (DBS) as matrices for therapeutic drug (TDM) and drug or disease response monitoring (DRM). Compared with conventional methods using plasma/serum, DBS offers several advantages, including minimally invasiveness, a small blood volume requirement, reduced biohazardous risk, and improved sample stability. Numerous assays utilising DBS for TDM have been reported in the literature over the past decade, covering a wide range of therapeutic drugs. Several factors can affect the accuracy and reliability of the DBS sampling method, including haematocrit (HCT), blood volume, sampling paper and chromatographic effects. It is crucial to evaluate the correlation between DBS concentrations and conventional plasma/serum concentrations, as the latter has traditionally been used for clinical decision. The feasibility of using DBS sampling method as an option for home-based TDM is also discussed. Furthermore, DBS has also been used as a matrix for monitoring the drug or disease responses (DRM) through various approaches such as genotyping, viral load measurement, assessment of inflammatory factors, and more recently, metabolic profiling. Although this research is still in the development stage, advancements in technology are expected to lead to the identification of surrogate biomarkers for drug treatment in DBS and a better understanding of the correlation between DBS drug levels and drug responses. This will make DBS a valuable matrix for TDM and DRM, facilitating the achievement of pharmacokinetic and pharmacodynamic correlations and enabling personalised therapy.

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial

OBJECTIVE

The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB).

MATERIALS AND METHODS

In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05).

RESULTS

Sixteen females and 16 males in the age range of 40 to 20 years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35 years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05).

CONCLUSION AND CLINICAL RELEVANCE

Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 years without changing vital signs.

CLINICAL REGISTRATION NUMBER

IRCT20220815055704N1.

Effect of soap bubbles technique, coughing and distraction cards on reducing pain and anxiety during phlebotomy in children

This study aims to compare three techniques (soap bubbles, distraction cards, coughing) to reduce pain and anxiety in children during phlebotomy and collection with the use of a control group. Pain levels of children were assessed with the Wong-Baker FACES Pain Rating Scale and anxiety levels of children were assessed with the Children's Fear Scale. This randomized controlled study involved intervention groups and a control group. The population of this study consisted of 120 Turkish children (30 subjects in each of the four groups soap bubbles technique, distraction cards, coughing, and control groups) between the ages of 6 and 12. The study found that pain and anxiety levels of the children in intervention groups were lower than those of the children in the control group during phlebotomy procedure and this difference was statistically significant (P < .05). No difference was found among the three techniques (Soap bubbles, distraction cards, and coughing) to reduce pain and anxiety in children during the phlebotomy procedure (P > .05). Soap bubbles, distraction cards and coughing techniques were found to reduce pain and anxiety in children during phlebotomy. Nurses can play an effective role in reducing pain and anxiety by using these techniques.

Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices

INTRODUCTION

Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs.

METHODS

RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence.

RESULTS

Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources.

CONCLUSION

The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.

Effectiveness of stress ball and relaxation exercises on polymerase chain reaction (RRT-PCR) test-induced fear and pain in adolescents in Türkiye

PURPOSE

This study aimed to determine the effectiveness of stress balls and relaxation exercises in relieving PCR test-induced fear and pain in adolescents.

DESIGN AND METHODS

A randomized controlled experimental study with a parallel-group design was conducted. The sample size was determined by G*Power analysis, and 32 adolescents were included in each group accordingly. The data were collected using the Adolescent and Parent Information Form, The Children's Fear Scale, and The Wong-Baker Faces Pain Scale. Descriptive statistics, t-test, paired t-test, ANOVA, and Tukey's forward analysis were used to analyze the data.

RESULTS

The mean age was 14.93 ± 2.07 years for the adolescents, 43.58 ± 4.50 years for the mothers, and 48.25 ± 4.92 years for the fathers. Adolescents were stratified according to age, gender, and fear of invasive procedures, and homogeneity was ensured in their distribution to the groups. The pre-procedural level of fear was moderate in each group with no significant difference (p > 0.05). However, a significant difference was found between the groups in terms of both post-procedure levels of fear and pain. The pre-procedural fear of the adolescents in the control group (3.91 ± 0.29) did not change much after the procedure (3.91 ± 0.30), while there was a decrease in the other groups. The least post-procedure fear (0.09 ± 0.29) and pain (0.44 ± 0.67) were found to be in the relaxation exercise group.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Relaxation exercise is the most effective method to reduce fear and pain during the PCR procedure. It is recommended to use it during the PCR procedure for being easily accessible, applicable, and cost-effective. Clinical Trials ID: NCT05250544.

The Effect of Robot-Led Distraction during Needle Procedures on Pain-Related Memory Bias in Children with Chronic Diseases: A Pilot and Feasibility Study

The current study evaluated the feasibility and preliminary clinical impact of robot-led distraction during needle procedures in children with chronic diseases on pain-related memories. Participants were 22 children (8−12 years old) diagnosed with a chronic disease (e.g., chronic immune deficiency) and undergoing a needle procedure as part of their routine treatment. Children were randomized to the experimental group (i.e., robot-led distraction) or control group (i.e., usual care). For feasibility, we evaluated study- and needle-procedure-related characteristics, intervention fidelity and acceptability, and nurse perceptions of the intervention. Primary clinical outcomes included children’s memory bias for pain intensity and pain-related fear (1 week later). Results indicated that intervention components were >90% successful. Overall, the robot-led distraction intervention was perceived highly acceptable by the children, while nurse perceptions were mixed, indicating several challenges regarding the intervention. Preliminary between-group analyses indicated a medium effect size on memory bias for pain intensity (Hedges’ g = 0.70), but only a very small effect size on memory bias for pain-related fear (Hedges’ g = 0.09), in favor of the robot-led distraction intervention. To summarize, while feasible, certain challenges remain to clinically implement robot-led distraction during needle procedures. Further development of the intervention while accounting for individual child preferences is recommended.

The comparative effects of ball squeezing and cartoon watching in pain management in children during intramuscular injection: A randomized control trial

This study was designed as a randomized controlled trial to investigate the comparative effect of ball squeezing and watching cartoons on pain management in children during intramuscular injection. The population of the study was comprised of 6-12 years old children who came to emergency for intramuscular injection. Power analysis was performed by G*Power program. Approximately 147 protocols completed with 6-12 years old children (each group 49 children). In the study, a questionnaire including child and socio-demographic characteristics their experiences of hospitalization data and Facial Pain Scale- Revised (FPS-R), Visual Analog Scale (VAS), and ball (for squeezing) were used. According to the results of the study, the FPS-R score during the procedure was the lowest in the stress ball group and was statistically significant (p˂0.05). The lowest VAS scores during the procedure the lowest score was in the stress ball group and the differences between the relevant groups were statistically significant (p˂0.05). It was determined that squeezing the ball and watching cartoons were effective in reducing pain during injection, however, the ball squeezing group had the lowest pain level. Among non-pharmacological methods, ball squeezing can be preferred as a practical and effective method, especially by pediatric nurses, in reducing pain during intramuscular injection in children.

Effects of cartoon watching and bubble-blowing during venipuncture on pain, fear, and anxiety in children aged 6-8 years: A randomized experimental study

PURPOSE

This study aimed to compare the effects of bubble-blowing (active distraction) and cartoon watching (passive distraction) techniques on pain, anxiety, and fear during venipuncture in children aged 6-8 years.

DESIGN AND METHODS

This experimental study randomly assigned 56 children aged 6-8 years to cartoon watching or bubble-blowing groups. The child, parent, and researcher assessed pain using the Wong-Baker FACES Pain Rating Scale, anxiety using the Children's State Anxiety Scale, and fear using the Children's Fear Scale. The study data were analyzed using the Chi-square tests and independent Sample t-tests.

RESULTS

The groups were similar in clinical and demographic characteristics. The scores on pain, anxiety, and fear during the procedure were lower in the cartoon watching group than in the bubble-blowing group (pain t(47) = 2.638, p = .013; anxiety t(47) = 2.358, p = .023; and fear t(47) = 2.784, p = .008).

CONCLUSION

This study revealed that cartoon watching as a passive distraction method was more effective in reducing pain, anxiety, and fear during venipuncture in children aged 6-8 years compared to bubble-blowing as an active distraction method.

PRACTICE IMPLICATIONS

The cartoon watching technique, which is affordable, easy to access, and effective (in reducing pain, anxiety, and fear), can be safely used during venipuncture in children aged 6-8 years.

Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial

Background

Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia.

Methods

The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements.

Results

During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control.

Conclusions

Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation.

Trial registration

The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904.

Effect of active and passive distraction techniques while administering local anaesthesia on the dental anxiety, behaviour and pain levels of children: a randomised controlled trial

Purpose

The aim of the study was to compare the effect of a stress ball, an active distraction technique with audio-visual eyeglasses, a passive distraction technique during local anaesthesia administration, on dental anxiety (primary outcome), behaviour and pain levels of children (secondary outcomes).

Methods

In this randomised controlled parallel arm trial involving 123 children aged 8–12 years, who required dental treatment under inferior alveolar nerve block, children were randomly allocated into the following three groups: Group 1: Stress ball, Group 2: Audio-visual eyeglasses, Group 3: Control group (basic behaviour guidance without distraction). Dental anxiety was measured using modified child dental anxiety scale and pulse rate, behaviour was rated using Venham’s scale and pain was measured by both self-reporting and observational scales.

Results

No significant difference between the groups was observed for dental anxiety, but a significant decrease was seen in dental anxiety scores within all groups. No significant differences were seen between the groups for behaviour ratings and pain scores.

Conclusion

Use of active stress ball distraction or passive audio-visual eyeglasses during local anaesthesia administration decreased dental anxiety but did not result in a significant improvement in the dental anxiety, behaviour and pain levels when compared to basic behaviour guidance without distraction.

Clinical trial registration

The clinical trial was registered at Clinical Trials Registry–India (CTRI Reg no: CTRI/2019/04/018768, Dated 24 April 2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00698-7.