Needle-related Procedures Research Articles

Efficacy of New Vibration Device in Reduction of Injection Pain among Children-A Randomized Control Trial

Needle-related procedures considered as the very crucial sources of pain in children. Pain management during invasive procedure is a challenge to direct health care providers. Unnecessary pain can spoil the nurse-patient relationship. Injections usually reason for some level of pain at the injection site. To develop and validation of the new vibration device for reduction of injection pain and compare the injection pain score among children between experimental and the control group. We will base this study on Analytical intervention approach. A hospital-based Randomized Controlled Trial will consider the effect of a new vibration device in intervention and routine care in the control group for reduction of injection pain. The sample will be children of the age Group 4 years to 12 years. Researcher will take before data collection selection of children as per inclusion criteria, detail explanation about nature and purpose of the study the written consent from the child’s parent. The computerized randomized sampling technique will use for the group formation. The setting of the study will be Hospital Wardha. There will be an efficacy of interventions on children's outcomes reduce injection pain and stable emotional behaviour and stable physiological parameter. Researcher will draw conclusion after the analysis of data collected from the predetermined sample size. Researcher will publish the findings of the study in an open access peer-reviewed Journal.

A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital.

Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) - post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.

35 Implementation of a quality improvement initiative to reduce pain and anxiety associated with needle-related procedures in a Canadian paediatric emergency department

Abstract Primary Subject area Emergency Medicine - Paediatric Background Needle-related procedures such as intravenous (IV) insertion, venipuncture, and lumbar puncture (LP) are commonly performed in children, particularly in the emergency department (ED). Children consistently rate these needle-related procedures as very distressing. While topical anesthetics have been shown to be highly effective and are available, they are inconsistently used. The Children’s Comfort Promise was originally developed at the Minnesota Children’s Hospital. It requires nursing staff to use four strategies for children undergoing needle-related procedures: (1) topical anesthetic, (2) sucrose or breastfeeding if ≤ 12 months, (3) Comfort positioning (swaddling, skin-to-skin, or facilitated tucking if ≤ 12 months and sitting upright for children > 12 months), and (4) age-appropriate distraction. Objectives We sought to evaluate compliance with all 4 Comfort Promise strategies for managing children’s pain and anxiety during needle-related procedures in a Canadian paediatric ED. Design/Methods Implementation of The Comfort Promise in March 2020 included a focus group to perform a root cause analysis, designation of nurse champions, monthly steering committee and ED working group meetings, and didactic education sessions. Our institution’s decision support unit identified all encounters of children 0-17 years who underwent at least one needle-related procedure at our paediatric ED from January 1 to November 30, 2020. The outcome was compliance with all 4 Comfort Promise strategies. Balancing measures included adverse drug reactions and vasoconstriction. We used statistical process control to analyze the outcome from 2 months preceding and 7 months following implementation. Results From January 1 to November 30, 2020, 21,600 encounters were identified, of which 10,294/21,600 (47.7%) were female. Age ranged from 0-17 years with a mean (SD) of 6.9 (5.5) years. Needle-related procedures were performed in 730/21,600 (3.4%) encounters, most commonly IV insertion (289/730, 39.6%) and venipuncture for blood sampling (232/730, 31.8%). Half of all encounters had no compliance strategies electronically recorded (363/730, 49.7%). Compliance with all Comfort Promise strategies increased over the study period (Figure 1). Topical anesthetic increased from 3/35 (8.6%) to 35/83 (42.2%). Sucrose or breastfeeding increased from 0/6 (0%) to 2/16 (12.5%). Comfort positioning increased from 0/35 (0%) to 26/83 (31.3%). Distraction increased from 0/35 (0%) to 22/83 (26.5%). There were no adverse drug reactions or vasoconstriction. Conclusion Implementation of The Comfort Promise in a Canadian paediatric ED resulted in greater use of strategies, particularly topical anesthetic, to reduce needle-related distress in children. Ongoing compliance will depend on consistent electronic recording and provider education.

P16 Using virtual reality to help manage needle phobia in juvenile idiopathic arthritis

Case report - IntroductionNeedle phobia is a common issue amongst children, particularly with long-term illnesses requiring repeated interventions. Psychological interventions such as coping strategies and distraction techniques can be effective in many of these children, but is not universally successful. Recent research has reportedthat the use of virtual reality (VR) headsets as a distraction technique can be effective at alleviating both pain and fear in children receiving intravenous (IV) injections, cannulation and venepuncture. Although use of VR distraction is becoming more widespread in some disciplines (such as paediatric oncology/A&E), it is yet to be widely adopted in paediatric rheumatology.Case report - Case descriptionWe report the case of a 9-year-old boy (ME) who in early 2019 developed psoriatic juvenile idiopathic arthritis (JIA) and an associated severe, widespread plaque psoriasis causing him substantial discomfort and distress. He has been treated with subcutaneous adalimumab biosimilar 40 mg fortnightly and oral methotrexate 20 mg weekly, alongside Keppra 1000 mg twice daily for epilepsy. Although he is just tolerating the subcutaneous adalimumab, he is requiring intermittent steroid joint injections under general anaesthetic for recurrent flares of his polyarticular arthritis and regular monitoring phlebotomy. He has been developing progressive needle phobia over the past 8 months, with superimposed anxiety about general anaesthetics with particular fear of the anaesthetic provoking an epileptic seizure.Despite psychological intervention to teach coping strategies and standard play therapy distraction techniques, both phlebotomy and cannulation for general anaesthetics have become more distressing and challenging for him. During two recent day case admissions for joint injections, despite premedication with sedatives, distraction techniques and psychology interventions, he became so distressed that attempts to anaesthetise him had to be abandoned. This has resulted in prolonged periods of continuing joint inflammation and pain. Discussion with local paediatric oncology colleagues resulted in a suggestion of using recently acquired VR headsets as an effective distraction technique. He has had a previous positive experience of using VR headsets in a play environment. He is receiving VR training intervention from the oncology team and is now fully engaged with the idea of using VR to distract him from negatively focussing on his next planned general anaesthetic intervention.Case report - DiscussionUnmanaged needle-related procedural pain in children is associated with increasing pain and stress in subsequent procedures and fear/avoidance of medical care which can affect compliance in chronic disease management. The psychological distress for children with needle phobia can add to existing psychological impact from JIA and increase family stress of caring for an ill child. The cost of poor management of needle-phobic children can be considerable, with cancelled or increased time for procedural interventions and restricted therapeutic interventions. Needle phobias in childhood may persist into adulthood.Employing distraction techniques when children undergo medical procedures can help them reduce anxiety. VR is a method of captivating an individual’s interest in a virtual environment and can help divert attention from potentially distressing situations in the real world. Recent studies have reported VR as an effective distraction technique in children. Chan (2019) reports that VR significantly decreased the pain and post procedural anxiety experienced by children aged 4—11 years old during venepuncture/IV cannulation compared to controls. The majority of children in the VR group expressed interest in utilising VR again in the future, to improve their experience of IV injections. Chen (2020) subsequently reported a randomised controlled trial which significantly reduced pain and fear experienced from IV injections by the children in the VR group.There are cost implications to both buying VR headsets/software and training play specialists/specialist nurses to use the equipment effectively. Furthermore, the acceptability of using VR with regards to the child’s age, engagement with age-appropriate software packages and whether a passive VR or a more interactive ‘gaming’ experience is preferred should be considered. The use of VR is not a panacea, but is potentially effective as an additional new tool in clinicians’ efforts to reduce the impact of needle phobia.Case report - Key learning pointsAddressing needle phobia in children can require novel strategies.VR has shown success as a distraction technique to alleviate pain and fear in children undergoing needle related procedures.The implementation of VR in paediatric rheumatology has cost and staff training implications.The use of age-appropriate software and an individual child’s preference for passive/active interaction with VR should be considered.

Using Social Media to Disseminate Effective Pain Treatments for Newborns During Needle-Related Painful Procedures in China.

Social media has become a powerful approach to disseminating evidence to knowledge users. The BSweet2Babies video was developed in multiple languages showing the effectiveness of sweet solutions, skin-to-skin care, and breastfeeding during newborn painful procedures. This study aimed to disseminate the BSweet2Babies video in Chinese through social media platform of WeChat in China; evaluate the reach, acceptability, and recommendation of the video; and assess viewers' previous knowledge and experience of using the 3 strategies and intention to use these strategies in the future. Multiple dissemination strategies were used to maximize views for a 6-month dissemination period. The video received 19 812 views, 4306 "thumbs," and 671 participants completed surveys. Of the survey respondents, 393 were parents. Most respondents did not know these strategies and did not use or help parents use any of them. More healthcare professionals than parents intended to use or advocate for sweet solutions and breastfeeding. More healthcare professionals rated that the 3 strategies were easy to apply in real-life situations, but more parents evaluated that the length of the video was too long. Social media in China can be a promising approach to disseminating evidence on neonatal procedural pain treatments to healthcare professionals and the public.

Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety-A Systematic Review and Meta-Analysis.

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children’s pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = −2.85; 95% CI −3.57, −2.14, for the Wong–Baker Faces Pain Rating Scale and n = 2240 patients, MD = −0.19; 95% CI −0.58, 0.20, for the Faces Pain Scale—Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.

Nurses' perspectives on pain management practices during newborn blood sampling in China

IntroductionNurses' use of evidence-based pain treatments for newborns during needle-related procedures in China was unknown. This study aimed to ascertain knowledge and use of pain management strategies and usefulness of a publicly accessible 'BSweet2Babies' video, produced in Mandarin, demonstrating the use of breastfeeding, skin-to-skin care (SSC), and sweet solutions during painful procedures. MethodsAn online survey was conducted during six nursing conferences in China ascertaining nurses' previous viewing of the video and knowledge and use of the demonstrated strategies. Results221 nurses participated. Only 25 (11.3%) had previously seen the video. Over half knew that breastfeeding (n = 138, 62.4%) and SSC (n = 173, 78.3%) reduced pain, and 89 (40.3%) knew that sucrose reduced pain, but these strategies were infrequently used. Most intended to use the strategies in the future. DiscussionA knowledge-to-action gap for newborn pain management was identified. Future research is needed to improve the implementation of effective pain treatment for newborns.

Play and medical play in teaching pre-school children to cope with medical procedures involving needles: A systematic review.

Most toddlers experience pain and distress during doctor or dental visits. Aim of this systematic review was to investigate the role of play-based interventions in pain and fear or distress management in pre-school children (aged from 2 to 6 years old) undergoing needle-related medical procedures adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42020192161). The key database that was searched was PubMed/MEDLINE along with references of relevant review studies. Only randomised controlled trials (RCTs) that fulfilled inclusion and eligibility criteria were selected for analysis. Methodological quality was evaluated using the Cochrane Collaboration's Risk of Bias Tool for RCTs and Review Manager version 5.4 was utilised in order to calculate standardised mean differences (SMDs) and create a forest plot for included studies that presented data on self-reported pain ratings. Primary outcomes refer to pain, anxiety and fear assessments, while secondary outcomes refer to physiological measures and cortisol levels. All included RCTs suffered from high risk of bias that relied on selection and blinding methodology, while other sources of bias were also present in some cases. Despite low-quality of evidence, play-based interventions seem to favour less self-reported pain (SMD -0.39; 95% CI: -0.67 to -0.12; I2 = 84%). Limitations of evidence, except from high risk of bias, include inconsistency in reporting primary outcome assessments and study designs that preclude reproducibility. Play-based techniques seem to contribute to pre-schoolers' coping towards needle-related medical procedures and further research is warranted in order to explore clinical benefits.

Needle-Related Pain, Affective Reactions, Fear, and Emotional Coping in Children and Adolescents With Type 1 Diabetes: A Cross-Sectional Study

BackgroundThe self-care of type 1 diabetes (T1D) includes undergoing procedures with needles several times daily, which may cause pain and fear. AimsThe aim was to identify the degree of perceived pain, affective reactions, fear, and emotional coping among children and adolescents with T1D. DesignA cross-sectional survey was performed. MethodsChildren and adolescents 7-18 years of age (n = 197) and their parents (n = 123) completed the Coloured Analogue Scale (CAS), the Facial Affective Scale (FAS), the Diabetes Fear of Injection Questionnaire (D-FISQ), and the Faces Emotional Coping Scale (FECS) in relation to needle procedures. ResultsThe higher the values of the CAS, FAS and D-FISQ scores, the lower values for coping were reported by children and adolescents regarding treatment with insulin pen or pump, blood glucose test, and venipuncture (p < .001). Patients reported strong negative affect regarding insulin injections (35%) and blood glucose tests (32%), as well as negative affect (48%, 69%) and substantial pain (27%, 50%) for inserting a pump needle and venipuncture, respectively. Parents reported significantly higher values than children on all scales and procedures except D-FISQ (blood glucose tests) and FECS (venipuncture). ConclusionsChildren and adolescents who perceive greater pain during needle-related procedures have poorer coping ability. Pediatric diabetes teams need to identify those in need of extra support to develop pain coping strategies.

The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial.

Port needle insertions are painful and distressing for Pediatric Hematology-Oncology patients. Virtual Reality (VR) can be used during needle-related procedures in these patients. This study aimed to investigate the effect of VR distraction during access to the venous port with a Huber needle in reducing needle-related pain, fear, and anxiety of children and adolescents with cancer. This randomized controlled study used a parallel trial design guided by the CONSORT checklist. The sample of children (n=42) was allocated to the VR group (n=21) and the control group (n=21). Port needle-related pain was assessed using the Wong-Baker Faces Pain Rating Scale after the procedure. Before and after the port needle insertion procedure, anxiety and fear assessed using self- and parent-report using the Children's Anxiety Meter and Child Fear Scale. The primary outcome was the patient-reported pain scores after the procedure and fear and anxiety scores before and after the procedure. Pain, anxiety, and fear scores of the two groups and within groups were analyzed and also Spearman correlation analysis was used. Self-reported pain scores of patients in the VR and control group were 2.4±1.8 and 5.3±1.8, respectively. This study found a statistically significant difference between groups in pain scores (p<.001). A statistically significant difference was found between groups according to the self- and parent-reported fear and anxiety scores after the procedure. Self-reported fear scores in the VR and control group were 0.8±0.9, 2.0±1.0, self-reported anxiety scores were 2.9±2.0, 5.4±2.0, respectively (p<.001). Virtual reality is an effective distraction method in reducing port needle-related pain, fear, and anxiety in Pediatric Hematology-Oncology patients. ClinicalTrials.gov NCT04093154.

The effectiveness of the BuzzyⓇ device to reduce or prevent pain in children undergoing needle-related procedures: The results from a prospective, open-label, randomised, non-inferiority study

BackgroundPain from needle-related procedures in children can alter pain perception, increase pain sensitivity, and generate inappropriate pain responses. Currently pain management includes the use of lidocaine-containing patches, which is complicated to manage in a busy medical setting such as a vaccination centre. We assessed the BuzzyⓇ device, which combines vibration and cold, to manage pain in children undergoing a needle-related procedure, compared to the standard lidocaine patch. DesignProspective, open-label, non-inferiority trial. SettingThe vaccination centres of three university hospitals in France. ParticipantsFrench speaking children aged 4–15 requiring a needle-related procedure (vaccination or venepuncture) were eligible. Principal exclusion criteria were allergy or sensitivity to the lidocaine patch. MethodsChildren were randomly allocated (1:1) to use either the BuzzyⓇ device or the lidocaine patch during the needle-related procedure. The lidocaine patch was applied to the puncture site for the hour prior to the intervention. The BuzzyⓇ device was applied to the puncture site for 30 s and then moved 5 cm along the limb during the procedure. The refrigerated wings were detached if they bothered the child. The child assessed their pain using the validated Revised Faces Pain Scale. The revised faces pain scale comprised six facial expressions from 0, normal “no pain” to 10, a screaming face “severe pain” (2 points/face). The primary endpoint was the average pain score recorded by the child. The study aimed to test the non-inferiority of BuzzyⓇ. ResultsOverall 219 participants were randomised. The primary outcome was assessed in 215 children: 108 in the BUZZY group (43% asked for the refrigerated wings were de to be detatched before the end of the procedure) and 107 in the PATCH group. The baseline characteristics were similar between the study groups with an average age of 9 (range: 4.08–15.81). The average needle-related pain was 2.04 in the BUZZY group and 1.42 in the PATCH group. The average difference between the children's assessments in the groups was 0.62, thus faling to demonstrate non-inferiority. ConclusionsOur study failed to show that the BuzzyⓇ device was not inferior to the lidocaine patch in managing pain in children undergoing needle-related procedures.Tweetable abstract: Pain management in children undergoing a needle-related procedure vaccination: which efficacy for BuzzyⓇ device as an alternative to lidocaine patch? A prospective, randomised study.

Children's individual voices are required for adequate management of fear and pain during hospital care and treatment.

Children often report both fear and pain in conjunction with clinical care and treatment. Interventions developed in the field have still not been sufficient to prevent and relieve children's fear and pain. More knowledge, from children's own perspectives, is needed about how they deal with their experiences. To explore child-identified strategies that children use to manage fear and pain during needle-related medical procedures in hospital. Interviews with children, age 4-12years, with experience of hospital care were analysed qualitatively using content analysis. Children have self-identified strategies for dealing with fear and pain during hospital care and treatment. The strategies vary depending on examination or treatment and on how the child felt at that particular day. Children describe what they can do themselves, how adults can empower them and support from surroundings as strategies that give them a choice and a voice. Children wished to have influence, decide when and how information should be given, scream out loud or squeeze something hard, to deal with fear and pain. The results also show that children tried to be brave, gain control and think positively. Something nice to look at and opportunities to play with others also contributed. Strategies vary between children and are used differently on different occasions. Healthcare professionals pose a threat to the child's needs and ability to use their strategies due to lack of knowledge of the child's chosen strategies.

Can psychological interventions improve outcomes for children and adolescents undergoing needle-related procedures?

Can psychological interventions improve outcomes for children and adolescents undergoing needle-related procedures?

Efficacy of the Buzzy Device for Pain Management During Needle-related Procedures: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examined the effectiveness of the Buzzy device combining cold and vibration for needle-related procedural pain in children. Databases search was conducted from inception to December 2017 to identify randomized controlled trials using the Buzzy device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction, and assessment of risk of bias and quality of evidence were independently performed by 2 reviewers. Quantitative and qualitative analyses were conducted. A total of 9 studies involving 1138 participants aged between 3 and 18 years old were included in the systematic review and 7 were suitable for meta-analysis. The meta-analysis compared the Buzzy device with a no-treatment comparator and the effect of the device was significant in reducing self-report procedural pain (standardized mean difference [SMD]: -1.11; 95% confidence interval [CI]: -1.52 to -0.70; P<0.0001), parent-reported procedural pain (SMD: -0.94; 95% CI: -1.62 to -0.27; P=0.006), observer-report procedural pain (SMD: -1.19; 95% CI: -1.90 to -0.47; P=0.001), observer-reported procedural anxiety (SMD -1.37; 95% CI: -1.77 to -0.96; P<0.00001), and parent-reported procedural anxiety (SMD -1.36; 95% CI: -2.11 to -0.61; P=0.0004). There was no significant difference for the success of the procedure at first attempt and the occurrence of adverse events. The Buzzy device seems to be a promising intervention for procedural pain management in children. However, the comparative effect is uncertain due to the presence of significant heterogeneity and very low-quality evidence. There is a need to improve the methodological quality and rigor in the design of future trials to conclude to the efficacy of the Buzzy device.

100 External Cold and Vibration for Pain Management of Children Undergoing Needle-Related Procedures in the Emergency Department: A Randomized Controlled Non-Inferiority Trial

100 External Cold and Vibration for Pain Management of Children Undergoing Needle-Related Procedures in the Emergency Department: A Randomized Controlled Non-Inferiority Trial

A Randomized Controlled Trial on the Use of Virtual Reality for Needle-Related Procedures in Children and Adolescents in the Emergency Department.

Objective: A large number of children report fear and distress when undergoing blood work and intravenous placement. In pediatric departments, Child Life interventions are considered to be the gold standard in nonmedical pain management techniques. Virtual reality (VR) has also been identified as an effective tool for pain distraction in children undergoing painful medical procedures. The aim of this study was to document the efficacy of VR as a mode of distraction during a medical procedure compared with two comparison conditions: watching television (TV, minimal control condition) and distraction provided by the Child Life (CL, gold standard control condition) program. Materials and Methods: A total of 59 children aged 8-17 years (35% female) were recruited through the emergency department (ED) of the Children's Hospital of Eastern Ontario and randomly assigned to one of the three conditions. The key outcome measures were visual analog scale ratings of pain intensity and fear of pain, administrated before and right after the procedure. Patient satisfaction was also measured after the intervention. Results: A significant reduction in fear of pain and pain intensity was reported in all three conditions. A larger and statistically significant reduction in fear of pain was observed among children who used VR distraction compared with the CL and TV conditions, but this effect was not observed for pain intensity. The children's satisfaction with the VR procedure was significantly higher than for TV and comparable to CL. Discussion: The advantages of using VR in the ED to manage pain in children are discussed.

LO33: External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomized controlled non-inferiority trial

Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review.

The objective of this systematic review was to identify, evaluate and synthesize evidence of the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and younger. Needle-related procedures (NRPs) are common medical procedures associated with pain. Children, in particular, experience unpredictable and severe pain in response to NRPs. The gate control theory is commonly used to countermeasure this pain. Based on this theory, various types of vibratory stimulation have been used to reduce pain in several clinical studies. Participants were 0- to 18-year-old children who underwent NRPs for any condition. The intervention included any type of vibratory stimulation during the NRPs. The main outcome was pain measured on any pain scale, including both self-rated and observer-rated pain scales. The secondary outcomes were anxiety, the duration of the procedure and the success rate. All studies were randomized controlled trials (RCTs) or quasi-randomized trials published in English. The search strategy aimed to identify both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE and CINAHL was undertaken, followed by a search for unpublished studies. Nine databases were used for the search in October 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data were extracted from papers included in the review using a standardized data extraction tool. Where possible, quantitative data were pooled in the statistical meta-analysis. All results were subject to double data entry. Effect sizes were expressed as risk ratios (for categorical data) and weighted mean differences (for continuous data), and their 95% confidence intervals were calculated for analysis. Twenty-one RCTs involving 1727 children were identified. Blinding of the participants and those delivering the treatment was not achieved in all studies, introducing a potential risk of bias. Overall, the vibratory stimulation was significantly effective in reducing NRP pain in children as shown by measurement of self-rated pain outcomes (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI]: -0.92 to -0.18) and observer-rated pain outcomes (SMD: -0.47, 95% CI: -0.76 to -0.18). Among secondary outcomes, the effect on the child's anxiety (SMD: -1.03, 95% CI: -1.85 to -0.20) was significant. Vibratory stimulation was effective in reducing NRP pain in children; however, blinding was not possible in the trials. Moreover, heterogeneity was high. Therefore, the confidence in the evidence is low. Personal preference should be a priority when using vibratory stimulation in the clinical setting.

“WE do it together!” An Ethnographic Study of the Alliance Between Child and Hospital Clown During Venipunctures

PurposeHospital clowns are widely used as a means of non-pharmacological intervention in the treatment of hospitalized children. However, little research has examined the impact of clowns on common painful needle-related procedures. This study explored children's pain experience and their ability to cope during a venipuncture while interacting with a clown in the acute admission unit. Design and methodsAn ethnographic fieldwork study was conducted. Data were collected over a 10-month period through participant observation and informal interviews, supplemented by video recordings. The participants comprised 38 acutely admitted children aged 4 to 15 years undergoing a venipuncture in the presence of a hospital clown. Analysis was structured in three stages: before venipuncture; during venipuncture; and after venipuncture. ResultsThe development of a responsive interaction between child and clown, identified as a WE, was found to be beneficial to the child during venipuncture procedure. The WE was characterized by three themes “How do WE do this together?”; “WE are together”; and “I/WE did it!” ConclusionsThe study emphasizes the importance of a WE established between child and hospital clown from the first encounter until a final evaluation. This WE was verbalized repeatedly by the clown and the child and was essential in shaping a tailored approach which met the needs of each child. This approach seemed to strengthen the child's competence in pain management and ability to cope, thus building competence for future venipunctures. Practice implicationsEstablishing a WE might advance the psychosocial care of hospitalized children undergoing acute painful procedures.

Fear and Coping in Children 5–9 years old Treated for Acute Lymphoblastic Leukemia - A Longitudinal Interview Study

PurposeThe aim of this study was to describe the fears of 5- to 9-year-old children related to having acute lymphoblastic leukemia (ALL) and their strategies for coping with those fears. Design and methodsThe study had a qualitative descriptive longitudinal design and included a total of 35 interviews with 13 children at three different times during their treatment period. Data were analyzed using a matrix-based method inspired by the work of Miles et al. ResultsInitially, most children reported a fear of needles, but during the treatment period, fewer children reported this fear. Children's coping strategies also changed over time, as they wanted more involvement and control during needle-related procedures. Other fears were having adhesive tapes removed, having a nasogastric tube, and taking tablets. During the treatment period, existential fears related to the seriousness of ALL and its consequences, such as having impaired physical fitness and being different from before and different from others, became more prominent and caused feelings of loneliness and alienation. ConclusionsThe children described various fears through their treatment period, which they coped with using cognitive, emotional, and functional strategies. Over the 2.5-year period, their strategies changed. Practical implicationsBecause fears changed over time and varied among these different children, each child must be approached individually and attentively in every encounter.