The effect on pain of three different nonpharmacological methods in peripheral intravenous catheterisation in adults

Effect of Breathing Exercise During Peripheral Venous Catheterization on Pain, Anxiety, and Patient Satisfaction: A Randomized Controlled Trial

PURPOSE

This study was carried out to determine the effect of a breathing exercise during peripheral venous cathetererization on pain, anxiety, and patient satisfaction.

DESIGN

Randomized Controlled Study.

METHODS

The study was completed with a total of 130 individuals. Individuals in the intervention group performed diaphragmatic breathing exercises during catheterization.

FINDINGS

The mean pain, anxiety, and satisfaction scores of the individuals in the intervention group were 0.29 ± 0.70, 3.18 ± 2.29, and 7.66 ± 2.20, respectively. In the control group, the mean pain score was 1.30 ± 1.47, the anxiety score was 4.35 ± 2.42, and the satisfaction score was 4.87 ± 1.63. The pain and anxiety levels of the individuals in the intervention group were lower and the satisfaction scores were higher than the control group.

CONCLUSIONS

Breathing exercises reduced individuals' pain and anxiety levels and increased individuals' satisfaction. In addition, it reduced the application time, pulse rate, and blood pressure.

The effects of Valsalva maneuver on pain intensity and hemodynamic status during short peripheral cannula insertion in adults: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to summarize the randomized clinical trial studies regarding the effects of Valsalva maneuver on the severity of short peripheral cannula insertion pain and hemodynamic status in adults. A systematic search was conducted on PubMed, Web of Science, Scopus databases, Cochrane, ClinicalTrials.gov, and Google Scholar Search Engine using keywords extracted from Medical Subject Headings, such as "Valsalva Maneuver," "Valsalva's Maneuver," "Forced Expiratory," "Balloon Inflation," "Pain," "Ache," "Cannulation," "Peripheral Intravenous Cannulation," "Peripheral Catheterization," "Vascular Access," "Venous Cannulation," "Venous Catheterization," and "Catheterization," from the inception to January 1, 2022. Finally, 12 and 11 articles were included in the qualitative and quantitative analysis of this systematic review and meta-analysis, respectively. Overall, pain intensity based on both the Numeric Rating Scale and Visual Analog Scale resulted in a large clinical effect (Effect Size: -1.20, 95% Confidence Interval: -1.69 to -0.71, p < 0.001). A large clinical effect was observed in a separate study of both scales because clinical effect has been determined in studies based on the Numeric Rating Scale (Effect Size: -1.26, 95% Confidence Interval: -1.90 to -0.62, p < 0.001 (and Visual Analog Scale (Effect Size: -1.09, 95% Confidence Interval: -1.98 to -0.20, p = 0.016). Valsalva maneuver significantly increased the mean heart rate (Weighted Mean Difference: 1.90, 95% Confidence Interval: 1.56-2.24, p < 0.001), decreased the mean arterial pressure (Weighted Mean Difference: 0.73, 95% Confidence Interval: -0.13 to 1.60, p = 0.096), and caused a non-significant decrease in anxiety (Weighted Mean Difference: -1.95, 95% Confidence Interval: -5.24 to 1.34, p = 0.25). The results showed that Valsalva maneuver significantly reduced pain intensity. Therefore, it is recommended that nurses use it as a convenient and low-cost non-pharmacological intervention to alleviate the severity of pain in non-cardiac patients. Also, it is suggested to conduct the studies with a strong methodological design and consider its effects on hemodynamic parameters in future investigations.

The Effect of Virtual Reality, Music Therapy, and Stress Ball Application on Pain and Anxiety During Outpatient Gynecological Procedures: A Randomized Controlled Trial

PURPOSE

The aim of this study was to determine the effect of virtual reality, music therapy, and stress ball applications, which are methods of distraction, on pain, anxiety, and patient satisfaction during outpatient gynecological procedures.

DESIGN

This study was a randomized controlled trial with control and intervention groups, pre-test and post-test.

METHODS

The study was conducted with 200 women who underwent gynecological surgical procedures without sedation in a state hospital on the European side of Istanbul between October 2022 and March 2023. There were four groups in the study: Virtual Reality (n = 50), Music Therapy (n = 50), Stress Ball (n = 50), and Control group (n = 50). Data were collected using a Descriptive Information Form, Visual Analog Scale, State-Trait Anxiety Inventory, Life Information Follow-up Form, and Patient Satisfaction Evaluation Form. The scales were completed separately by the investigator before the procedure, 10 minutes after the procedure, and 1 hour after the procedure.

FINDINGS

A statistically significant difference between the intervention groups and control groups of women who underwent a gynecological procedure at the 10th minute after the procedure (P=.000) and at the 1st hour after the procedure (P=.000) was significant. State-Trait Anxiety Inventory of women by groups decreased after the procedure and showed a statistically significant difference (P =.000). Satisfaction scores of the women with the intervention according to the groups also showed a significant difference (P =.000). When the satisfaction scores of the women with the intervention were compared by groups, the satisfaction scores ranged from the highest to the lowest, as virtual reality, music therapy, and stress ball application, respectively.

CONCLUSIONS

Virtual reality, music therapy, and stress ball applications, which are methods of distraction during the outpatient gynecological procedure, were effective in reducing anxiety and pain and increasing patient satisfaction.

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.

Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial

BACKGROUND

Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty.

OBJECTIVE

This study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas.

METHODS

We conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study-pain experienced by patients and procedural difficulties experienced by clinical staff-were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires.

RESULTS

Data from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56-1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66-0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively.

CONCLUSIONS

There was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.

Three Distraction Methods for Pain Reduction During Colonoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain and Anxiety

PURPOSE

The aim of this study was to compare the effects of distraction methods on pain, anxiety, and satisfaction during a colonoscopy.

DESIGN

This experimental research was conducted as a single-center, randomized, parallel-group trial.

METHODS

A total of 120 patients were recruited and randomized into 4 groups (music, stress ball, audiovisual distraction, and control). The data were collected using individual an identification form, observation form, the Visual Analog Scale, and the State-Trait Anxiety Inventory.

FINDINGS

Pain severity during colonoscopy was found to be lower in the intervention (music and audiovisual distraction) groups compared to the stress ball and control groups (P < .001).There was no statistically significant difference between the pre- and postanxiety levels in the intervention groups compared to the control group. After the colonoscopy, satisfaction levels were significantly higher in the music group compared to the audiovisual, control, and stress ball groups (P < .001).

CONCLUSIONS

Distraction methods used during colonoscopy were found to reduce pain. Although sedation is widely used during a colonoscopy procedure and is accepted as a general standard, music and VR can be used as effective alternative strategies in reducing pain for colonoscopy patients.

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 the coughing technique during subcutaneous heparin injection on pain severity and individual satisfaction

to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

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.

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial

PURPOSE

The objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention.

DESIGN

This study was a randomized controlled trial.

METHODS

In this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients' pain, vital signs, and vasovagal reactions were measured.

FINDINGS

The primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients' heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different.

CONCLUSIONS

This study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.

Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain

BACKGROUND

  AIMS: The aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain.

DESIGN

This work was a prospective randomized controlled study.

SETTINGS

Study was conducted in the orthopedics clinic of a university hospital.

PARTICIPANTS/SUBJECTS

  METHODS: The sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded.

RESULTS

The patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ˂ .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group.

CONCLUSION

Valsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.

Mechanisms of "Cough-Trick" for Pain Relief during Venipuncture: An Experimental Crossover Investigation in Healthy Volunteers

Objectives

The easily performed “cough-trick” (CT) reduces pain during venipuncture (VP), although the underlying mechanism remains unclear. The aim was to investigate the pain-reducing effect of CT during VP in comparison with two distraction methods, as well as under the influence of naloxone.

Methods

54 healthy male volunteers participated in 3 investigations. Pain during standardized VP with CT was compared to a “weak” distraction (squeezing a rubber ball; investigation 1; n=20) and to a “strong” distraction (inflating a tourniquet to a given pressure; investigation 2; n=21). In investigation 3 (n=13), pain at a VP without intervention was compared to pain at VP with CT under naloxone; pressure pain thresholds before and after naloxone administration were also measured. Pain was assessed using a 100 mm visual analogue scale. Data were compared within each sample using Student's t-test for paired samples.

Results

Pain intensity at VP with CT was lower than under “weak” distraction (mean difference 5 mm; 95% CI: 0.5 to 9.6; P=0.03). Pain levels under CT and “strong” distraction were comparable. There was no difference between pain under CT after naloxone infusion and pain without intervention. Pressure pain threshold decreased (mean difference 1 mm; 95% CI: 0.1 to 1.0 mm; P=0.02) after naloxone administration.

Conclusion

Pain-reducing effect of CT during VP is superior to that of simple motor distraction and equivalent to a complex distraction method. This might be due to the activation of segmental pain inhibitory pathways during coughing indicated through the lack of pain reduction due to CT under opioid antagonist blockage.