Improving Stakeholder Satisfaction: Nitrous Oxide for Peripheral Intravenous Cannulation for Pediatric Procedural Sedation

Abstract

Peripheral intravenous (PIV) cannulation needed for pediatric procedural sedation (PPS) is a common source of stress for patients and families. The goal of this project is to investigate the perceived effectiveness of nitrous oxide (N2O) in reducing anxiety and pain associated with PIV cannulation for PPS by various stakeholders. N2O was used as an adjunct to local anesthesia and child life intervention to reduce the anxiety and pain associated with PIV placement before PPS. N2O use was at the discretion of physician. Candidates included patients who were anxious or fearful about PIV placement or patients who had a failed prior PIV cannulation attempt without N2O. At the completion of the procedure, a survey was administered to determine stakeholder satisfaction with N2O for PIV cannulation. A total of 393 N2O sedations for PIV cannulation were identified. Overall, procedure success was 96.2%. Most stakeholders reported that they were very satisfied: physicians—341/382 (89.3%), nurses—350/380 (92.1%), parents—347/383 (90.6%), and patients—331/377 (87.8%). Overall patient-parent agreement about N2O satisfaction was 94.1%. The most common adverse events (AEs) seen were dysphoria—11/393 (2.8%) and vomiting—5/393 (1.3%). None of the patients required prolonged stay for AE. N2O can be successfully used for PIV cannulation for PPS without clinically significant AE and has a high degree of satisfaction among the stakeholders. N2O should be considered as a method to reduce anxiety and pain in patients requiring PIV cannulation and those subjected to repeated procedures.