Intravenous Line Placement Research Articles

Decreasing Pain in Hospitalized Patients by Increasing Topical Anesthetic Use for Peripheral IVs.

Venous access is a common source of pain for hospitalized patients. Topical anesthetics are effective at decreasing needle pain, can improve success rate, and decrease procedure time; however, use before peripheral intravenous line (PIV) placement is inconsistent. The aim was to reduce pain experienced by hospitalized pediatric patients by increasing topical anesthetic use for PIV placement from a mean of 11% to 40% within 6 months. The Model for Improvement was utilized. An institutional clinical pathway and PIV order panel were developed. Pre-checked orders for topical anesthetics were added to order sets. Visual aids were placed on IV carts, including reminders for anesthetics, pathway use and scripting examples. Nurses received individual feedback. Statistical process control charts were posted weekly on daily management system boards on medical-surgical floors, and data were shared at daily nursing huddles to increase awareness of performance and discuss opportunities for improvement. Topical anesthetic use for PIV placement increased from a mean of 11% to 46%. Documentation of comfort measures during PIV placement increased from a mean of 6% to 13%. The percentage of PIV placements with an order for a topical anesthetic in the electronic health record increased from a mean of 14% to 54%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 70%. Through systems and culture change, awareness of the importance of pain prevention for venous access procedures increased, and patient-centered care improved with greater collaboration between nurses, providers, and families for venous access planning.

Emergency Medical Services Compliance With Prehospital Stroke Quality Metrics Is Associated With Faster Stroke Evaluation and Treatment.

Emergency medical services (EMS) is an important link in the stroke chain of recovery. Various prehospital quality metrics have been proposed for prehospital stroke care, but their individual impact is uncertain. We sought to measure associations between EMS quality metrics and downstream stroke care. This is a retrospective analysis of a cohort of EMS-transported stroke patients assembled through a linkage between Michigan's EMS and stroke registries. We used multivariable regression to quantify the independent associations between EMS quality metric compliance (dispatch within 90 seconds of 911 call, prehospital stroke screen documentation [Prehospital stroke scale], glucose check, last known well time, maintenance of scene times ≤15 minutes, hospital prenotification, and intravenous line placement) and shorter door-to-CT times (door-to-CT ≤25), accounting for EMS recognition, age, sex, race, stroke subtype, severity, and duration of symptoms. We then developed a simple EMS quality score based on metrics associated with early CT and examined its associations with hospital stroke evaluation times, treatment, and patient outcomes. Five thousand seven hundred seven EMS-transported stroke cases were linked to prehospital records from January 2018 through June 2019. In multivariable analysis, prehospital stroke scale documentation (adjusted odds ratio, 1.4 [1.2-1.6]), glucose check (1.3 [1.1-1.6]), on-scene time ≤15 minutes (1.6 [1.4-1.9]), hospital prenotification ([2.0 [1.4-2.9]), and intravenous line placement (1.8 [1.5-2.1]) were independently associated with a door-to-CT ≤25 minutes. A 5-point quality score (1 point for each element) was therefore developed. In multivariable analysis, a 1-point higher EMS quality score was associated with a shorter time from EMS contact to CT (-9.2 [-10.6 to -7.8] minutes; P<0.001) and thrombolysis (-4.3 [-6.4 to -2.2] minutes; P<0.001), and higher odds of discharge to home (adjusted odds ratio, 1.1 [1.0-1.2]; P=0.002). Five EMS actions recommended by national guidelines were associated with rapid CT imaging. A simple quality score derived from these measures was also associated with faster stroke evaluation, greater odds of reperfusion treatment, and discharge to home.

Early exposure to anesthesiology: a summer preceptorship program for first-year medical students

Introduction A 4-week summer preceptorship offered first-year medical students early exposure to anesthesiology following their preclerkship courses in pharmacology and cardiopulmonary physiology. The main objective was to provide students with clinical skills and prepare them for rotations while immersing them in a unique experience, introducing a specialty not covered in core rotations. Methods Participants were selected via their responses to an application. In addition to shadowing anesthesiologists, curriculum components included weekly faculty lectures on core aspects of anesthesiology (introductory basics, perioperative drugs, airway, and crisis management); multiple simulation labs (workstation setup, intubation clinics, intravenous and central line placement, ultrasound techniques); research opportunities; and mentorship from physicians and senior medical students. The program culminated in each student successfully leading a simulated case to receive a certificate of completion. Results A survey of 15 participants revealed significant improvements in ability to intubate (P < 0.05), ability to perform a transthoracic echocardiogram (P < 0.05), interest in anesthesiology as a specialty (P < 0.05), and preparedness for future rotations (P < 0.05). Discussion This program accelerates clinical exposure for preclerkship students, providing insights into anesthesiology early in their medical journey. It provides research and mentorship, fosters professional growth, and enhances individual competitiveness for residency program applications.

Cause analysis and nursing strategy of chemotherapy-induced phlebitis in cancer patients with peripheral intravenous line placement

Cause analysis and nursing strategy of chemotherapy-induced phlebitis in cancer patients with peripheral intravenous line placement

Delays in treatment and disposition attributable to undertriage of pediatric emergency medicine patients

BackgroundTriage, the initial assessment and sorting of patients in the Emergency Department (ED), determines priority of evaluation and treatment. Little is known about the impact of undertriage, the underestimation of disease severity at triage, on clinical care in pediatric ED patients. We evaluate the impact of undertriage on time to disposition and treatment decisions in pediatric ED patients. MethodsThis was a case control study of ED visits for patients <22 years of age, with an assigned Emergency Severity Index (ESI) score of 4 or 5, and associated hospital admission, nebulized treatment, supplemental oxygen, and/or intravenous (IV) line placement, between January 1, 2018, to June 30, 2022. Controls were sampled from a pool of patient visits with an ESI score of 3, matched by intervention, disposition, and date and hour of arrival.Primary outcome measures were time to order of intervention (nebulized treatment, oxygen administration, or IV placement) and time to disposition decision. A secondary outcome measure was return visits requiring admission or emergency intervention within 14 days of the index visit. Continuous variables (time to orders) were analyzed using Wilcoxon rank sum test and dichotomous outcomes (return visits) were compared using odds ratios with 95% confidence intervals. Analysis was performed with Python v3.10. ResultsThe final analysis included 7245 undertriaged patients. Undertriaged patients had longer times to orders for nebulized treatments, (p < 0.001) IV placement, (p < 0.001) and admission (p < 0.001) when compared to controls. There were no significant differences in time to supplemental oxygen delivery and time to discharge compared to controls. Undertriaged patients were more likely to experience a return visit requiring admission or emergency intervention (OR 3.74, 95% CI 3.32,4.22). ConclusionsUndertriage in the pediatric ED is associated with delays in care and disposition decisions and increases likelihood of return visits.

The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department.

Despite the pivotality of emergency medical services (EMS) in prehospital care for patient stabilization, prehospital intravenous(IV) access, a standard practice, remains an ambiguity in Saudi Arabia in terms of its prevalence of placement, justification, and utilization. In this study, we aim to estimate the prevalence and utilization rate of prehospital IV access placement in patients transported to King Khalid University Hospital (KKUH)Emergency Medicine Department in Riyadh by EMS and determine the relationship between the prevalence and utilization rate of prehospital IV access in Canadian Triage and Acuity Scale (CTAS) levels 1 and 2in trauma and non-trauma patients. This observational cross-sectional study was conducted over six months. A total of 181 cases of CTASlevels 1 and 2 adult patients were included. Data were collected by trained nurses using convenient sampling through an author-developed questionnaire. The prevalence of prehospital IV line placement was 28.7%, with a utilization rate of 50%, and was notably higher among CTAS level 1 cases (69.2%). Additionally, trauma cases had a higher prevalence of prehospital IV access (53.5%) compared to medical cases (odds ratio (OR): 4.73, 95% confidence interval (CI): 4.73, 4.73, p<0.05). Among patients with prehospital IV lines, the majority (92.3%) were patent and functional. Upon arrival, 73.1% of patients had their prehospital IV line replaced, with hospital protocol being the most common reason for the replacement (73.7%). A minority of the patients had prehospital vascular access, and of those, half remained unused. Trauma cases and CTAS level 1 patients had a higher prevalence and utilization of prehospital IV access. Furthermore, trauma cases were more associated with prehospital IV access establishment and utilization.

Augmentation of peripheral venous diameter for ultrasound-guided peripheral intravenous line insertion

ObjectivesUltrasound-guided intravenous line placement is utilized often in the emergency department for venous access in patients whose veins are difficult to cannulate by traditional methods. This study aims to identify specific interventions that will augment venous cross-sectional area. MethodsResidents and medical students volunteers each had their basilic vein identified using the linear array probe on an ultrasound. The area of the vein was measured with no intervention with the arm positioned parallel to the floor as well as approximately 45 degrees below the level of the bed. These two positions were repeated with the following interventions: one standard rubber tourniquet applied proximal to the vein measurement, an additional rubber tourniquet applied proximal to first tourniquet, blood pressure cuff inflated to between 160 and 200 mmHg applied proximal to the vein, CAT battle tourniquet application proximal to measurement site, and soaked warm towel applied to brachium for up to one minute. The primary outcome was to evaluate the increase in venous cross-sectional area from the baseline measurement after the interventions. ResultsWe had 41 participants in this study. All interventions were statistically significant in increasing venous cross-sectional area as compared to no intervention, with the most significant augmentation being from the CAT battle tourniquet (mean change +7.32 mm2, 95% CI, 5.73–8.91 mm2) . The change in position of the arm, was not statistically significant for any intervention except for the CAT tourniquet (mean change −1.74 mm2, 95% CI, −0.54 to −2.93 mm2). There was no significant difference between two tourniquets and blood pressure cuff (mean change +0.58 mm2, 95% CI, −1.13 to +2.29 mm2), but there was a significant increase in cross-sectional area with CAT tourniquet use compared to blood pressure cuff (mean change +1.62 mm2, 95% CI, 0.29–2.95 mm2). Lastly, two tourniquets increased cross- sectional area compared to one tourniquet (mean change +2.20 mm2, 95% CI, 1.14 − +3.26 mm2). ConclusionsThis study identified several potential interventions for maximizing venous cross-sectional area on ultrasound. All the tested interventions resulted in statistically significant increases in cross-sectional area. Arm positioning did not show significant changes in most interventions, with the exception of the CAT tourniquet. Further studies should be performed on how these maneuvers affect success in ultrasound-guided intravenous line placement.

Analytic Hierarchy Process Analysis of Patient Preferences for Contrast-Enhanced Mammography Versus MRI as Supplemental Screening Options for Breast Cancer

ObjectiveTo guide implementation of supplemental breast screening by assessing patient preferences for contrast-enhanced mammography (CEM) versus MRI using analytic hierarchy process (AHP) methodology. MethodsIn an institutional review board–approved, HIPAA-compliant protocol, from March 23 to June 3, 2022, we contacted 579 women who had both CEM screening and MRI. Women were e-mailed an invitation to complete an online survey developed using an AHP-based model to elicit preferences for CEM or MRI. Methods for categorical data analysis were used to evaluate factors affecting preferences, under the Bonferroni correction for multiplicity. ResultsComplete responses were received from 222 (38.3%) women; the 189 women with a personal history of breast cancer had a mean age 61.8 years, and the 34 women without a personal history of breast cancer had a mean age of 53.6 years. Of 222 respondents, 157 (70.7%, confidence interval [CI]: 64.7-76.7) were determined to prefer CEM to MRI. Breast positioning was the most important criterion for 74 of 222 (33.3%) respondents, with claustrophobia, intravenous line placement, and overall stress most important for 38, 37, and 39 women (17.1%, 16.7%, and 17.6%), respectively, and noise level, contrast injection, and indifference being emphasized least frequently (by 10 [4.5%], 11 [5.0%], and 13 [5.9%] women, respectively). CEM preference was most prevalent (MRI least prevalent) for respondents emphasizing claustrophobia (37 of 38 [97%], CI: 86.2-99.9); CEM preference was least prevalent (MRI most prevalent) for respondents emphasizing breast positioning (40 of 74 [54%], CI: 42.1-65.7). ConclusionsAHP-based modeling reveals strong patient preferences for CEM over MRI, with claustrophobia favoring preference for CEM and breast positioning relatively favoring preference for MRI. Our results should help guide implementation of screening CEM and MRI.

Distraksi Virtual Reality (VR) terhadap Tingkat Nyeri dan Cemas Anak Usia Sekolah yang Dilakukan Tindakan Invasif

This study aims to discover that healthcare technology has innovated in the quality and delivery of care to patients to motivate the promotion of safe, comfortable, and cost-effective care. The method used is a literature review from several online database searches using a research design in the form of a literature review. The results showed that from the six articles reviewed, several themes were obtained, namely 1) Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials, 2) A Systematic Review and Meta-analysis of virtual reality in Pediatrics: Effects on Pain and Anxiety, carried out meta-analysis, 3) Virtual reality distraction during pediatric intravenous line placement in the emergency department: A prospective randomized comparison study, 4). Virtual reality for pain and anxiety management in children, 5). Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting A Randomized Clinical Trial, 6). Effectiveness of virtual reality on pain and anxiety management in cancer patients, Literature review. So thus, the involvement of all parties is needed to improve distraction techniques using Virtual Reality during intervention so that it is hoped that it can reduce the pain scale in children according to standard care in every hospital that gets invasive procedures. In conclusion, the Virtual Reality distraction technique has or is very influential on the condition of the child to be carried out or to receive medical procedures.&#x0D; &#x0D; Keywords: School Children, Hospitalization, Pain and Cas Levels, Virtual Reality

Evaluating the Effect of Nursing-Performed Point-of-Care Ultrasound on Septic Emergency Department Patients.

Introduction Nursing-performed point-of-care ultrasound (NP-POCUS) studies have been performed on applications such as ultrasound-guided peripheral intravenous line placement and assessing bladder volume. However, research on the use of NP-POCUS in the management of septic patients remains limited. The purpose of this quality improvement study was to investigate how NP-POCUS could impact fluid treatment decisions affecting septic patients in the emergency department (ED)using a focused IVC and lung ultrasound protocol. Methods Nurses received standardized training in POCUS and performed inferior vena cava (IVC) and lung ultrasound scans on septic patients in the ED at predetermined intervals (hours: zero, three, and six). Based on their findings, they were asked to make recommendations on fluid management. Emergency physicians (EPs), both residents and attendings, are providing recommendations for fluid management without the use of ultrasound, which is being compared to the nurse-driven POCUS assessment of fluid management. EPs reviewed the NP-POCUS assessments of patient fluid status to determine nursing accuracy. Results A total of 104 patients were scanned, with a mean age of 60.7 years. EPs agreed with nursing ultrasound assessments in 99.1% of cases. Nursing ultrasound images changed management or increased physician confidence in current treatment plans83.7% and 96.6% of the time, respectively. Before reviewing saved nursing ultrasound images, EPs underestimated fluid tolerance in 37.5% of cases, overestimated fluid tolerance in 26% of cases, and correctly estimated fluid tolerance (within 500 ml) in 36.5% of cases. Throughout resuscitation, IVCs became less collapsible, the number of cases with B-lines was essentially unchanged, and less fluid was recommended. Conclusion This study demonstrated that nurse-performed POCUS is feasible and may have a meaningful impact on how physicians manage septic patients in the emergency department.

Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users

BackgroundDeaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data. ObjectiveTo examine the provision of common care practices in the emergency department (ED) to this population. MethodsED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted). ResultsThe ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47–0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission. ConclusionResults suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.

Effects of Patient Demographics and Examination Factors on Patient Experience in Outpatient MRI Appointments

ObjectiveThe objective of this article is to describe the effects of patient demographics and examination factors on patient-reported experience in outpatient MRI examinations. MethodsThis institutional review board–waived, HIPPA-compliant quality improvement study evaluated outpatient MRI appointments from March 2021 to January 2022 using a postappointment survey consisting of a 5-point emoji scale and text-based feedback. Patient demographics and examination information were extracted from electronic medical records. Ratings ≤ 3 were categorized as negative, and ratings ≥ 4 were categorized as positive. Continuous variables were analyzed using the Kruskal-Wallis test, and categorical variables were analyzed using the Fisher’s exact test. A P value less than .05 was considered significant. A natural language processing algorithm was trained and validated to categorize patient feedback. ResultsA total of 3,636 patients responded to the survey. Positive ratings had a higher proportion of male respondents compared with negative ratings (47.9% versus 37.0%, P = .004). Examination characteristics were also grouped by positive or negative rating. Patients who endured longer examination time (median 54.0 min versus 44.0 min, P < .001) and longer wait time after check-in (median 61.6 min versus 46.2 min, P < .001) were more likely to give negative ratings. The most common themes of free text feedback included excellent service (84.3%), on-time service (8.4%), and comfortable intravenous line placement (0.4%). Most common negative feedback included long wait times (10.5%), poor communication (8.4%), and physical discomfort during the examination (4.2%). ConclusionMale gender, short examination duration, and on-time start were associated with positive patient ratings.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Minimizing the "Kitchen Sink" Approach: De-implementation of Unnecessary Care for Patients with Anaphylaxis in a Pediatric Emergency Department.

Introduction:Epinephrine is the only medication that prevents morbidity and mortality in anaphylaxis. Systemic corticosteroids and H2 receptor antagonists (H2RA) may benefit select cases but are not universally indicated. This study aims to de-implement the universal use of steroids and H2RAs and emphasize epinephrine-focused care for children with anaphylaxis during acute care visits. The study aims to reduce steroid and H2RA use from 81% and 60%, respectively, to 30% by December 2019.Methods:The primary outcome measures were the percent of patients receiving steroids and H2RAs in the emergency department (ED) or urgent care (UC). Process measure was the frequency of intravenous (IV) line placement. Balancing measures were ED/UC length of stay, admission rate, and ED/UC return visit rate. In addition, a multidisciplinary team designed the following interventions: (1) anaphylaxis clinical pathway to emphasize epinephrine-focused care, outline criteria for second-line therapies and a provider guideline for ED/UC observation; (2) standardize unit-based anaphylaxis medication kits; (3) optimize electronic medical record tools, including order sets and discharge instructions to be concordant with guideline recommendations.Results:The study included 870 patients. There was special cause variation in the use of steroids (81%–33%) and H2RAs (60%–11%), ED/UC Length of stay decreased (6.2–5.0 hours). There was no special cause variation in admission rates or ED/UC return visit rates.Conclusion:Universal use of systemic steroids and H2RAs can be safely de-implemented in pediatric patients with anaphylaxis using quality improvement methods.

A Standardized Training Program in Ultrasound-Guided Intravenous Line Placement: Improving Nurses' Confidence and Success.

Ultrasound-guided imagery to obtain peripheral intravenous (USGIV) access is a technique that can be used to increase successful peripheral intravenous catheter insertion rates. Improving rates of USGIV use will subsequently decrease central venous catheter use and thus decrease the time to treatment initiation, reduce costs, and improve patient satisfaction. Current available programs teach nurses USGIV use for the adult population, mainly with a focus on the emergency department. To address this gap in knowledge, a USGIV program aimed at the specific needs of the neonatal intensive care unit (NICU) nurse was developed and implemented. Twelve NICU nurses were trained in USGIV access during a 4-hour combination didactic and simulation-based program. Participants took a pretest survey assessing baseline knowledge and confidence levels related to USGIV access. After didactic lecture, participants worked at stations focused on USGIV access. An 80% benchmark for each participant was set for successful USGIV attempts during simulation. Participants' knowledge and confidence levels were reassessed at the end of the program. Posttest scores increased by an average of 25%, demonstrating increased knowledge. The pre- to posttest confidence scores increased by a minimum of 1.6 points (based on a 5-point Likert scale). All participants (n = 12) successfully demonstrated proficiency by achieving at least 80% of attempted USGIV access on a mannequin. This project demonstrated that USGIV catheter can be employed in neonatal patients by training NICU nurses in USGIV techniques.

Feasibility study of cumulative sum (CUSUM) analysis as a competency assessment tool for ultrasound-guided venous access procedures.

Typically, physician training programs use a self-reported case-log competency assessment that does not measure procedure success or objectively assess competency. Cumulative sum (CUSUM) analysis could provide objective assessments of competency and progress over the training period. Our study objective was to determine the feasibility of CUSUM analysis to assess competency of ultrasound-guided peripheral intravenous (USG-PIV) line placement in pediatric anesthesiology fellows. We applied a CUSUM analysis to assess competency in USG-PIV placement in three consecutive pediatric anesthesia fellowship classes. After a didactic and hands-on training session, fellows placed a USG-PIV line and self-reported the outcomes via a web-based application. Fellows were deemed competent if the CUSUM curve crossed two consecutive boundary lines from above. Twenty-nine fellows reported 1,388 USG-PIV attempts, with 74% success. Most fellows (26/29; 90%) achieved competency by the end of the fellowship. Two fellows identified in the mid-year CUSUM as not progressing towards competency achieved competency after targeted interventions. Fellows achieving competency (11/29 vs 25/29; odds ratio, 15; 95% confidence interval [CI], 1.98 to 113.56; P = 0.01) and attempts needed to achieve competency (19 vs 11; mean difference, 8.5; 95% CI, 3.3 to 13.7; P = 0.002) were significantly lower in younger patients and significantly higher in older patients. Our study showed that CUSUM can be used to assess competence in USG-PIV procedures performed by pediatric anesthesia fellows and to identify learners not progressing toward competency in procedural skills. Ultrasound-guided venous access required more attempts to achieve competency in younger patients.

232 A Randomized Controlled Trial on Virtual Reality Use as a Distraction Technique for Orthopedic Injuries Requiring Sedation

Pain is a common medical complaint, and one that is exacerbated by several procedures in the emergency department (ED) including intravenous (IV) line placement and manipulative procedures (radiographic imaging, casting). Inadequate pain control during these procedures can intensify pediatric anxiety, potentially resulting in complications or need for escalation of care. Distraction techniques have been utilized to reduce pain and anxiety with varying success depending on the modality used. Recently, more immersive distraction techniques, namely virtual reality (VR), have shown a reduction in sedation needed in burn patients, as well as reduced anxiety around port access in pediatric cancer patients. The use of VR in the pediatric ED for sedation in orthopedic injuries requiring reduction and/or casting has not yet been fully explored. This study aims to assess anxiety, pain, and patient satisfaction while observing medication requirements during orthopedic fracture reduction procedures in the ED with and without the supplemental use of VR technology. The primary objective was to assess differences in anxiety levels between children that used a VR experience and those treated without VR during an orthopedic fracture reduction procedure. Secondary objectives included pain scores pre- and post-procedure, necessity of sedation redosing, and physician satisfaction with orthopedic procedure. This was a randomized control trial at a Pediatric Emergency Department and Level 1 Trauma Center located in the Southern United States. All pediatric orthopedic patients over five years old who required sedation for casting and/or reduction of their injury were asked to enroll (N= 115). Of those, 104 consented to participate (90%). After enrollment, using an online random generator, patients were randomized to one of two groups: VR experience or non-VR experience. The FACES scale and mYPAS were completed by a child life specialist to assess pain and anxiety, respectively. All data was collected prospectively and medical records were accessed only to validate data. A total of 104 pediatric patients were included in this study (n= 52 in each group). Average age of participants was 9.5 years old, and most were White or Hispanic, 55 (53%) and 22 (21%), respectively. There were no significant differences in age, race or ethnicity. Patients in the VR group (22.92 [IQR: 22.92 – 36.45]) were significantly less anxious than children in the non-VR group (35.42 [IQR: 22.92 – 50.00]), p =.001. Furthermore, because the use of midazolam as an anxiolytic is rather common during procedures, a sub-analysis of patients who did not need receive midazolam was conducted. Among children that did not receive midazolam, anxiety levels were also statistically significant, (p = .002). The number of sedative doses, pain scores, and the need for opioid use post procedure were similar between groups (ps >.05). Similarly, there were no significant difference in physician satisfaction, reduction time, need for open reduction, or pre-procedure opioid use. The use of a virtual reality experience is a successful distraction technique which can decrease pediatric anxiety levels during procedural sedation in the emergency department. This is an easy tool to incorporate into daily clinical practice and can improve patient outcomes.

Intranasal sufentanil compared with a classic protocol for acute pain management in an emergency department: A prospective sequential study

Introduction Pain is a frequent complaint in the emergency department and should be measured and treated according to the existing protocols. The intranasal route offers several advantages over the oral or intravenous routes. The aim of the study was to evaluate the efficacy and safety of intranasal sufentanil as the primary opioid for acute pain in the emergency department. Materials and methods This was a prospective open-label sequential study in patients who presented to the emergency department with severe non-visceral pain. The control group was treated according to the current standard of care including oral or intravenous opioids whereas the intervention group was treated according to a modified protocol, including intranasal sufentanil as the only opioid. Pain intensity was measured at different time points. The occurrence of side effects, the placement of intravenous lines and the need for additional analgesia were also recorded. Results Pain intensity in the two groups was not comparable at baseline (8.5; IQR 8–10 in the intervention group vs 7.9; IQR 7–9.4 in the control group; p = .026). However, the median reduction of the pain score was significantly larger in the intervention group compared to the control group after 15 minutes (2.5; IQR 1.2 – 4 vs 1.6; IQR 1–2.4; p = .005) and after 30 min (4; IQR 3–5.7 vs 3.1; IQR 2–4.4; p = .02). No significant difference in pain scores between the two groups was observed after 60 min from baseline. Conclusions Patients receiving intranasal sufentanil for severe pain achieved better pain relief at 15 min and 30 min compared to those receiving standard care. Vertigo, nausea, vomiting and diaphoresis were side effects more frequently observed in the sufentanil group. No differences in pain relief were observed after 30 and 60 min from baseline.

Comparison of the Effects of Hugo’s Point Massage and Play on IV-Line Placement Pain in Children: A Randomized Clinical Trial

Reduction of intravenous line placement pain is one of the most important nursing priorities in the pediatric wards. The present study was aimed at comparing the effect of Hugo's point massage and play on the severity of IV-line placement pain in hospitalized children aged 3–6 years in the pediatric ward. 72 children were selected and assigned randomly to three groups, i.e., control, play, and Hugo point massage. In the massage group, the middle angle between the first and second bones of the palm of the opposite hand was massaged, and the playgroup encouraged bubble-making play. The one-way analysis of variance (ANOVA) did not show a statistically significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups before interventions (p=0.838; p > 0.05). However, the ANOVA test revealed a significant difference between the mean IV-line placement pain in play, Hugo's point, and control groups after the interventions (p=0.006; p < 0.05). The result of the post hoc Scheffe test also showed a statistically significant difference between the mean intensity of IV-line placement pain in both play therapy and Hugo's point massage groups (p=0.028; p < 0.05). Moreover, this test showed that the playgroup children felt less pain than Hugo's point and control group children. This study showed that, in comparison with Hugo's point massage, the play was a more effective way for reducing pain caused by IV-line placement in children, and pediatric nurses can play a significant role in reducing and managing children's pain by using it.

Rethinking Routine Peripheral Intravenous Line Placement

Rethinking Routine Peripheral Intravenous Line Placement