The Use of the Needle‐free Jet Injection System With Buffered Lidocaine Device Does Not Change Intravenous Placement Success in Children in the Emergency Department

Abstract

Objective Needle Free Jet Injection system with buffered lidocaine (J tip) has been shown to reduce pain for intravenous line (IV) insertion, but its relationship with successful IV placement has not been well studied. This study aimed to determine if J tip use is associated with improved first attempt IV placement success in children Methods This was a retrospective cohort study of children ages 1 to 18 years with emergent IV placement. Approximately 300 children were selected from each of three separate age groups: 1) 1 to 2 years, 2) 3 to 6 years and 3) 7 to 18 years. The standard treatment group (No Device) included children with an IV insertion from January 2009 through January 2010 with no J tip. The J tip treatment group (Device) included children with an IV insertion from December 2010 through December 2011 that received a J tip. Successful IV placement on first attempt was the primary outcome. Chi square test was used to compare the proportion of first attempt success and logistic regression was performed to assess the effect of device use and patient age, sex and race on first attempt success. Results A total of 958 children were enrolled, 501 in the No Device group and 457 in the Device group. The most common diagnoses were vomiting/dehydration (30.3%), trauma/burn (20.0%) and infection (15.5%). Overall, first attempt success was 69.0%; first attempt success was similar between the No Device (68.7%) and Device (69.4%) groups (p=0.81). No difference in first attempt success with the use of the Device was found in any of the age groups. Multivariate analysis found only age of 1 to 2 years was associated with lower odds of first attempt success. Conclusion The use of J tip was not associated with improved success on the first IV attempt for children. Treatment of pain during IV placement may not be sufficient to improve placement success.

A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology

“…Resistance toward implementation at the individual staff and unit level presented challenges during the rollout process. We found that the key to overcoming this resistance was providing necessary resources, support, and training to staff: “The new way had to be easier than the old way.” When we could demonstrate that wait times went down instead of up (as often anticipated by staff); that topical anesthetics did not decrease the chance of venous cannulation (there was not a single report of venous constriction impeding cannulation, confirming published data 38 , 48 ); and—most importantly—that the 4 strategies provided an immediate benefit to patients (eg, fewer tears; more calm and cooperative children), the Comfort Promise was embraced by nearly all staff. The Lean Value Stream process involves regular process audits, implementation of knowledge translation strategies, 76 development of educational and outreach materials (see supplemental figure for an example, available at http://links.lww.com/PR9/A24 ), and utilization of PDSA cycles.…”

“…Children and their parents/legal guardians had the option of declining any or all strategies, which included the following 14 : (1) “Numb the skin” (for children of 36-week corrected gestational age and older). We chose to use 4% lidocaine cream 63 or needle-less lidocaine application using a J-tip (sterile, single-use, disposable injector that uses pressurized gas to propel medication through the skin) 38 , 39 as topical anesthetics. (2) Sucrose 20 , 54 or breastfeeding 51 for infants 0 to 12 months.…”

“…(1) “Numb the skin” (for children of 36-week corrected gestational age and older). We chose to use 4% lidocaine cream 63 or needle-less lidocaine application using a J-tip (sterile, single-use, disposable injector that uses pressurized gas to propel medication through the skin) 38 , 39 as topical anesthetics.…”

Managing Pediatric Pain in the Emergency Department

“…Finally, a needlefree jet injection of 1 % buffered lidocaine prior to needle procedures also seems promising and provides analgesia in less than a minute. It was shown to be superior to topical anesthetics or vapocoolant in some RCTs but not to jet placebo [122][123][124].…”

Pain Experience in a US Children’s Hospital: A Point Prevalence Survey Undertaken After the Implementation of a System-Wide Protocol to Eliminate or Decrease Pain Caused by Needles

“…This large-scale initiative was the first of its kind worldwide to mandate offering 4 evidence-based practices for needle procedures to all patients (topical anesthetics, sucrose and/or breastfeeding [for infants], comfort positioning, and distraction). [26][27][28][29][30][31][32][33][34][35] After rollout in the outpatient laboratories in 2014 (30 000 children annually) and the medicalsurgical units, the remainder of the inpatient units, including all critical care areas, joined the campaign in 2015. At the time the current study was conducted, all inpatient units had implemented the initiative, but were in various stages of adoption.…”