Potts Debra Ann, Davis Katherine Finn, Elci Okan U, Fein Joel A
From the Department of Nursing.
Center for Pediatric Nursing Research and Evidence-Based Practice, Department of Nursing.
Pediatr Emerg Care. 2019 Jun;35(6):419-425. doi: 10.1097/PEC.0000000000001041.
Pain of intravenous (IV) catheter insertion can be mitigated with appropriate analgesia, thereby avoiding unnecessary distress. Our objective was to compare the self-reported pain of IV catheter insertion in children when using a vibrating cold device (VCD) versus standard of care 4% topical lidocaine cream (TL).
This was a 2-arm randomized controlled noninferiority trial with a convenience sample of 4- to 18-year-olds requiring nonemergent IV catheter insertion. Self-reported pain was measured with the Faces Pain Scale-Revised, anxiety with the Child's Rating of Anxiety scale, and observed pain with the Face, Legs, Activity, Crying, Consolability scale. Caregivers and nurses completed satisfaction surveys.
Two hundred twenty-four children were included in the analysis: 114 (90%) of 127 in the VCD group and 110 (89%) of 124 in the TL group. Faces Pain Scale-Revised scores for both groups were equivalent (median, 2.0 cm; interquartile range, 0-5 cm; linear regression difference, 0 [95% confidence interval, -0.82 to 0.82]), as were median Face, Legs, Activity, Crying, Consolability scale scores (difference, 0.33 [95% confidence interval, -0.01 to 0.68]). The time of completion for the IV procedure was significantly shorter for the VCD group compared with the TL group (median, 3.0 vs 40.5 minutes; P < 0.0001). There were no significant differences between groups for self-reported state or trait anxiety, success of IV catheter insertion on first attempt, or satisfaction of caregivers or staff.
A VCD and TL showed equal effectiveness in reducing pain and distress for children undergoing IV catheter insertion. The VCD has the added benefit of quick onset time and an acceptable alternative for caregivers and nurses.
通过适当的镇痛措施可减轻静脉（IV）置管时的疼痛，从而避免不必要的痛苦。我们的目的是比较使用振动冷敷装置（VCD）与标准护理4%外用利多卡因乳膏（TL）时儿童IV置管的自我报告疼痛情况。
这是一项双臂随机对照非劣效性试验，对4至18岁需要进行非紧急IV置管的儿童进行便利抽样。采用面部疼痛量表修订版测量自我报告的疼痛，用儿童焦虑量表评估焦虑程度，并用面部、腿部、活动、哭泣、安慰度量表观察疼痛情况。护理人员和护士完成满意度调查。
224名儿童纳入分析：VCD组127名中的114名（90%），TL组124名中的110名（89%）。两组面部疼痛量表修订版得分相当（中位数，2.0 cm；四分位间距，0 - 5 cm；线性回归差异，0 [95%置信区间，-0.82至0.82]），面部、腿部、活动、哭泣、安慰度量表中位数得分也相当（差异，0.33 [95%置信区间，-0.01至0.68]）。与TL组相比，VCD组IV操作完成时间显著更短（中位数，3.0对40.5分钟；P < 0.0001）。两组在自我报告的状态或特质焦虑、首次尝试IV置管成功率或护理人员或工作人员满意度方面无显著差异。
VCD和TL在减轻接受IV置管儿童的疼痛和痛苦方面效果相当。VCD具有起效快的额外优势，是护理人员和护士可接受的替代方法。
