Postles McKenna, West Nicholas, Moxham Lindy, Ramji Jenna, Palm Jade, Morrison Christa, Görges Matthias, Chen James
Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada.
BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
Paediatr Anaesth. 2025 Aug;35(8):635-642. doi: 10.1111/pan.15138. Epub 2025 Jun 9.
Intravenous cannulation is a standard but potentially painful procedure. Distraction techniques can alleviate this discomfort by shifting attention from perceived pain. Bubble-blowing is an active distraction technique that combines breathing exercises and play therapy to alleviate pain and anxiety.
To assess the effectiveness of bubble-blowing versus video-watching in reducing pain during and anxiety before pediatric intravenous cannulation.
This ethically approved, randomized controlled trial assigned 2- to 5-year-old participants to bubble-blowing or video-watching groups during their intravenous cannulations in the medical imaging department. Patients who were non-verbal, did not have an awake intravenous cannulation, received premedication, or had topical anesthetic for < 30 min were excluded. The Face Legs Activity Cry Consolability scale rated pain before, during, and after intravenous cannulation. The modified Yale Preoperative Anxiety-Short Form rated anxiety immediately following parental consent (baseline) and before intravenous cannulation.
Data from 120 participants (60 females, median [interquartile range] age 3.8 [2.9-4.4] years) were available. Of these, 105 participants underwent intravenous cannulation and were included in the analysis. Pain scores during intravenous cannulation were 2.0 [0.0-7.0] in the video-watching and 2.0 [0.0-5.0] in the bubble-blowing group; median difference 0.0 (95% confidence interval (CI) -1.0 to 1.0), p = 0.888. Anxiety scores before intravenous cannulation were 36.5 [22.9-63.4] in the video-watching and 27.1 [22.9-52.1] in the bubble-blowing group; median difference 0.0 (95% CI -10.4 to 0.0), p = 0.178. Pain during intravenous cannulation increased in 29/52 (56%) children in the video-watching and 30/53 (57%) in the bubble-blowing group; odds ratio 0.97 (95% CI 0.42-2.24), p > 0.999. Anxiety increased in 27/52 (52%) children in the video-watching and 16/53 (30%) in the bubble-blowing group; odds ratio 2.48 (95% CI 1.04-6.02), p = 0.030.
The use of bubble-blowing as a distraction did not significantly reduce pain during or anxiety before IV cannulation compared to video-watching. However, further research is needed to explore whether active distraction techniques could be beneficial for young, neurodiverse, anxious, or fearful children.
This study was registered in ClinicalTrials.gov (NCT05899452; June 12, 2023).
静脉置管是一种标准但可能引起疼痛的操作。分散注意力技术可以通过将注意力从感知到的疼痛上转移来减轻这种不适。吹泡泡是一种主动分散注意力技术，它结合了呼吸练习和游戏疗法来减轻疼痛和焦虑。
评估吹泡泡与观看视频在减轻小儿静脉置管期间的疼痛及置管前焦虑方面的效果。
这项经伦理批准的随机对照试验将2至5岁的参与者在医学影像科进行静脉置管时分为吹泡泡组或观看视频组。排除无法言语、未进行清醒静脉置管、接受过术前用药或局部麻醉时间<30分钟的患者。使用面部、腿部、活动、哭闹、可安慰性量表对静脉置管前、置管期间和置管后的疼痛进行评分。使用改良耶鲁术前焦虑简表在获得家长同意后立即（基线）以及静脉置管前对焦虑进行评分。
共有120名参与者（60名女性，年龄中位数[四分位间距]为3.8[2.9 - 4.4]岁）的数据可用。其中，105名参与者进行了静脉置管并纳入分析。观看视频组静脉置管期间的疼痛评分为2.0[0.0 - 7.0]，吹泡泡组为2.0[0.0 - 5.0]；中位数差异为0.0（95%置信区间（CI）-1.0至1.0），p = 0.888。静脉置管前观看视频组的焦虑评分为36.5[22.9 - 63.4]，吹泡泡组为27.1[22.9 - 52.1]；中位数差异为0.0（95%CI -10.4至0.0），p = 0.178。观看视频组中29/52（56%）的儿童在静脉置管期间疼痛增加，吹泡泡组中30/53（57%）的儿童疼痛增加；优势比为0.97（95%CI 0.42 - 2.24），p>0.999。观看视频组中27/52（52%）的儿童焦虑增加，吹泡泡组中16/53（30%）的儿童焦虑增加；优势比为2.48（95%CI 1.04 - 6.02），p = 0.030。
与观看视频相比，使用吹泡泡作为分散注意力的方法在静脉置管期间的疼痛或置管前的焦虑方面并未显著降低。然而，需要进一步研究以探索主动分散注意力技术是否对年幼、神经发育异常、焦虑或恐惧的儿童有益。
本研究已在ClinicalTrials.gov注册（NCT05899452；2023年6月12日）。
