On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals

Abstract

Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. By using case studies that analyze this issue from the perspective of the nurse, the physician, the pharmacist, and the child life specialist, this article illustrates how multidisciplinary programs designed to manage needle pain have been developed successfully in several institutions. Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience. Pediatrics 2008;122:S161-S170 A TTITUDES ON PREVENTING procedural pain in children are changing as medical centers seek to comply with recent policy statements and clinical guidelines. The American Academy of Pediatrics and the American Pain Society recommend that efforts to soothe and minimize pediatric distress be considered even for minor procedures such as venipunctures. 1 A recent publication by the International Association for the Study of Pain cited humanitarian, ethical, and practical reasons for managing and preventing pediatric pain. 2 It is important to note that the management and prevention of pain in children is not limited to highly painful conditions and procedures but also includes the prevention of pain associated with venous access procedures whenever possible. 1 In this article we review the experiences of 5 children's hospitals in the United States that have well-developed peripheral venous access pain-management programs. The case studies, written by roundtable members integrally involved in the development of these programs, summarize the strategies that were used successfully in implementing systematic and multidisciplinary programs for the management of venous access pain in the individual hospitals.When the case studies are viewed in totality, a number of common strategies are found to be essential in moving the pediatric venous access pain-management programs from theory to practice: (1) assembling a multidisciplinary team to advocate change; (2) using an evidence-based approach to determine which interventions would best suit a particular institution; (3) using a system-wide protocol for the administration of local anesthetics in the hospital setting; (4) storing local anesthetics in patient care areas and using physician standing orders to facilitate access to these agents; (5) securing department and hospital-wide support of the programs ...

Comparison of the Effectiveness of Buzzy, Distracting Cards and Balloon Inflating on Mitigating Pain and Anxiety During Venipuncture in a Pediatric Emergency Department

“…Pain perception in children is complexand children frequently undergo medical procedures that are applied using a needle, such as venipuncture and immunization which considered the most common sources of pain for children causes considerable stress and anxiety for children and their parents [1][2][3][4]. Venipuncture is one of the most widely used diagnostic and therapeutic procedures in pediatric patients.…”

“…Although pain may be reduced by behavioral and pharmacologic interventions (e.g., age appropriate patient preparation, parental presence, distraction techniques, vapocoolant cold spray, vibration near the site, subcutaneous local anesthetics, topical anesthetic and systemic anesthetics) and there are data to support each of these individual treatments most of these preparations are impractical in nonelective settings because they are too time consuming and there is no single integrated intervention to optimize pain relief [9]. Furthermore, most current options require excessive cost, or staff training, which are formidable barriers to practice change [4].…”

Flebitis asociada con accesos venosos periféricos en niños: revisión sistemática de la literatura

“…Ante la ausencia de evidencia, muchas guías recomiendan cambiar los accesos venosos periféricos según tiempos predeterminados (72 a 96 h), en vez de por indicación clínica, en los niños, sin tener en cuenta estos desarrollos y, además, asumiendo resultados obtenidos en estudios de adultos. Una consideración que parece no haberse tenido en cuenta es que el dolor de las venopunciones en los niños no solo es la principal causa de experiencias dolorosas en las hospitalizaciones pediátricas 45---50 sino que acarrea consecuencias psicológicas mayores que en el adulto 51 .…”

Managing Pediatric Pain in the Emergency Department

“…Combined strategies are recommended to reduce needlerelated pain [27,125]. It has been suggested that there are four essential components to eliminate pain related to needle procedures in children: (1) application of topical anesthetics prior to needle punctures, (2) use of sucrose in younger children, (3) distraction, and (4) positioning [126].…”