The Effect of Acupressure on Acute Pain During Venipuncture in Children: Implications for Evidence-Based Practice

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.

The effects of acupressure on post-dressing pain in burn patients: A clinical randomized trial

BACKGROUND AND OBJECTIVES

Burns often cause severe pain, especially during dressing changes. This study aimed to investigate the effect of acupressure on pain during dressing changes in burn patients.

METHODS

This randomized clinical trial was conducted on 76 burn patients. The eligible patients were randomly assigned to the intervention and control groups after obtaining informed consent. Eligible patients were randomly assigned to the intervention and control groups by blocking. The study was conducted over two days using the same method. Before entering the dressing room, acupressure was performed in the intervention group for 10 min in acupressure points and the control group in other points. Pain intensity was measured in two groups 30 min before entering the dressing room and 15 and 30 min after leaving the dressing room using VAS. Finally, the data were analyzed using SPSS software 25th edition.

RESULTS

Pain scores were similar for the two groups before the dressing change. The results of this study revealed a significant decrease in the patient's pain intensity mean in the test group following acupressure compared to the control group on day one which remained on day two (P < 0.05).

CONCLUSION

Considering the experience of severe pain in burn patients, acupressure is recommended as a complementary method along with modern medicine to reduce these patients' pains.

A Comparison of the Effects of Acupressure and Music on Venipuncture Pain Intensity in Children: A Randomized Controlled Clinical Trial

Pain from injections is common in children of all ages, and more than 90% of hospitalized children experience invasive and painful procedures such as venipuncture. In light of the complications associated with pain relief medications, nonpharmacological and complementary medicine approaches have gained attention. This study aims to compare the effects of acupressure and music on venipuncture pain intensity in children. This randomized controlled clinical trial involved 180 children aged 3-6 years who sought treatment at the Children's Medical Center Hospital Emergency Department at Tehran University of Medical Sciences, Iran. The children were randomly assigned to one of three groups: acupressure, music, or control. The interventions were given within 5 minutes, starting 3 minutes before the venipuncture and continuing until completion. The interventions included playing music through headphones and applying acupressure to the Hugo point. Venipuncture was carried out under identical conditions using an Angiocath 24G needle. Pain intensity was assessed using the Oucher scale. Data were analyzed using SPSS 24, employing the Kruskal-Wallis, chi-square, and Bonferroni pairwise comparison tests, with a significance level of 0.05. The mean pain intensity was 3.32 ± 1.44 in the music group, 4.82 ± 1.51 in the acupressure group, and 8.32 ± 1.10 in the control group. Pain intensity significantly differed among the three groups (p < 0.001). Specifically, pain intensity was lower in the music group compared to both the acupressure (p < 0.001) and control (p < 0.001) groups. Furthermore, pain intensity was lower in the acupressure group than in the control group (p < 0.001). Based on the results, music and acupressure methods effectively reduce pain intensity during venipuncture in children. Considering that music demonstrated a more pronounced effect in alleviating venipuncture pain than acupressure, the recommendation is to utilize music as a method of pain management during venipuncture in children. Iranian Registry of Clinical Trials, Trial No. IRCT20120109008665N15, was registered on 6 December 2021.

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.

The Effect of 3 Methods (Buzzy, ShotBlocker, and DistrACTION Cards) Used While Taking Blood Samples From Children with Pain and Anxiety: A Randomized Controlled Trial

OBJECTIVES

The aim of this study was to compare the effectiveness of 3 methods (Buzzy, ShotBlocker, and DistrACTION Cards) in reducing pain and anxiety while taking venous blood samples in children.

METHODS

The study population consisted of children aged 9 to 12 years admitted to the Child Health and Diseases Department in a Faculty of Medicine in Turkey. The sample of the study consisted of 242 children (Buzzy = 60, ShotBlocker = 61, DistrACTION Cards = 60, control = 61) who met the patient selection criteria and agreed to participate in the study. The data were obtained using an Information Form, the State-Trait Anxiety Inventory for Children, visual analog scale, and the Faces Pain Scale-Revised.

DESIGN

This article is an experimental randomized controlled study.

RESULTS

During venous blood collection, the scores of visual analog scale were significantly lower in ShotBlocker, Buzzy, and DistrACTION Cards groups than the control group. It was also observed that the control group experienced more anxiety than the other groups.

CONCLUSIONS

Methods such as Buzzy, ShotBlocker, and DistrACTION Cards can be used to reduce the anxiety and pain of children during painful procedures such as blood collection and vascular access. Among these methods, "Buzzy" and "DistrACTION Cards" can be preferred as it is equally effective, and then ShotBlocker can be preferred.

The effect of acupressure on pain level and hemodynamic parameters after coronary angiography: a randomized controlled study

Background

Subsequent to coronary angiography, procedures performed to prevent bleeding may cause pain in the patient. In this study, we aimed to determine the effect of acupressure on pain level and hemodynamic parameters in patients undergoing coronary angiography.

Method

In this prospective, a two-arm (1:1), randomized controlled trial was conducted, with 124 patients undergoing coronary angiography included. The randomly assigned study group (n = 62) received acupressure on the LI4 (on the dorsum of the hand, between the 1st and 2nd metacarpal bones), PC6 (three fingers above the wrist), and LI11 (at the lateral end of the transverse cubital crease) points for 15 min 2 h after angiography, while the control group (n = 62) received no acupressure. Data were collected using the visual pain scale (VAS) and hemodynamic parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO₂)], monitoring form before, immediately after, and at 10, 20, and 30 min after acupressure.

Results

In the study, it was found that patients had moderate pain after coronary angiography (study group: 5.02 ± 2.27; control group: 3.98 ± 1.82). When the groups were compared, it was found that the VAS score of the study group before angiography was significantly higher than that of the control group, but lower than the control group immediately after acupressure, and at 10, 20, and 30 min after acupressure. In addition, it was determined that acupressure was significantly higher in DBP and RR in the study group compared to the control group at 20 and 30 min; it was not effective in terms of SBP, HR, and SpO₂ values.

Conclusion

The results of the study indicated that patients reported moderate pain after coronary angiography, and that acupressure was effective in reducing the pain level, but affected only the DBP and RR hemodynamic parameters. Since the study was single-centered and followed for a short time, it is recommended to conduct new studies with a longer duration.

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.

A Randomized Controlled Trial: The Effect of Acupressure and Foot Reflexology on Pain During Heel-Lancing in Neonates

This randomized controlled study aimed to determine the effects of acupressure and foot reflexology on procedural pain during heel-lancing in newborns. This study was conducted with 105 neonates (35 foot reflexology group, 35 acupressure group, and 35 control group) who met the inclusion criteria and who were delivered by cesarean section between October 2017 and March 2018 at a state hospital in Turkey. A "Newborn Information Form" and a "Neonatal Pain, Agitation, and Sedation Scale" (N-PASS) were used to collect data. The study found a significant intergroup difference between pain scores of neonates during the procedures (p < .05). Advanced analyses found that the pain scores in the acupressure and foot reflexology groups were similar, whereas the pain scores in the control group were higher than in the other two groups. Acupressure and foot reflexology administered during heel lancing in newborns are effective methods for reducing pain.