University of California Los Angeles Medical Center, Santa Monica, California (Ms Lozano); University of California Los Angeles Mattel Children's Hospital, Los Angeles, California (Ms Sund); University of California Los Angeles Health, Los Angeles, California (Drs Guimera, Deukmedjian, and Miller).
Sally Lozano, BSN, RN, CPN , has worked as a pediatric nurse for 15 years at University of California Los Angeles (UCLA) Medical Center. She was recently promoted to clinical nurse manager in the general pediatric unit. Ms Lozano has extensive experience placing and teaching techniques for successful peripheral intravenous catheter insertions.
J Infus Nurs. 2021;44(6):346-356. doi: 10.1097/NAN.0000000000000449.
Peripheral intravenous catheter (PIVC) insertion is one of the most painful procedures pediatric patients undergo during hospitalization. To date, local anesthetics delivered via cream, patch, and needle-free injection have not been rigorously evaluated together. This study aimed to investigate feasibility and potential efficacy of local anesthetics on pain intensity during PIVC insertion in an unblinded, single-center, randomized clinical pilot trial. Between March 2017 and February 2020, 88 hospitalized children aged 12 months to 18 years in an acute pediatric unit at an academic medical center were randomized to 1 of 3 local anesthetics: 1) lidocaine/prilocaine cream, 2) lidocaine/tetracaine patch, and 3) unbuffered lidocaine needle-free injection. Feasibility outcomes were recruitment and protocol adherence. Pain intensity was measured using the Face, Legs, Activity, Cry, Consolability (age <8 years) and Verbal Numeric Rating (VNRS) scales (age ≥8 years) before, during, and after procedure. Secondary outcomes included catheterization attempts, procedure time, and parent satisfaction. Recruitment rate was acceptable (2.7 patients per month). Protocol adherence was high (92%). Preliminary clinical findings showed no significant difference in pain intensity across treatments. Procedure time to successful insertion differed in the VNRS group, favoring unbuffered lidocaine needle-free injection. Conduct of a definitive, full-scale randomized clinical trial in the hospitalized pediatric population is feasible.
外周静脉导管（PIVC）插入术是住院患儿最痛苦的操作之一。迄今为止，经乳膏、贴剂和无针注射给予的局部麻醉剂尚未经过严格的联合评估。本研究旨在一项非盲、单中心、随机临床试点试验中，调查局部麻醉剂对 PIVC 插入术期间疼痛强度的可行性和潜在疗效。2017 年 3 月至 2020 年 2 月，在一家学术医学中心的急性儿科病房中，88 名 12 个月至 18 岁的住院患儿被随机分为 3 组局部麻醉剂之一：1）利多卡因/丙胺卡因乳膏，2）利多卡因/丁卡因贴剂，和 3）无缓冲利多卡因无针注射。可行性结果为招募和方案依从性。使用面部、腿部、活动、哭泣、安慰（年龄 <8 岁）和数字评分量表（年龄≥8 岁）在操作前、操作中和操作后测量疼痛强度。次要结局包括导管插入尝试、操作时间和家长满意度。招募率可接受（每月 2.7 例）。方案依从性高（92%）。初步临床发现表明，各治疗组之间的疼痛强度无显著差异。在数字评分量表组中，成功插入的操作时间不同，无缓冲利多卡因无针注射更有利。在住院儿科人群中进行确定性、全面规模随机临床试验是可行的。
