Clinical Problem: Pediatric patients often undergo painful medical procedures, such as venipuncture, which can lead to detrimental long-term effects such as future medical care avoidance, phobias and misrepresented negative memories (Kuo, Pan, Creedy & Tsao, 2018).
Objective: The objective of this synthesis is to examine if using distraction techniques will reduce pain in pediatric patients undergoing venipuncture. Randomized control trials (RCT) were located by using PubMed and CINAHL regarding the use of distraction techniques to reduce pain. The key search terms used were distraction, pain, distress, venipuncture, intravenous, blood draws and pediatric.
Results: In pediatric patients undergoing venipuncture who receive distraction techniques, there is a reduction in pain compared to those who did not receive distraction techniques. Kuo et al. (2018) reported that distraction by cartoons and picture books significantly reduced Observational Scale of Behavioral Distress scores (p=.04). Risaw et al. (2017) reported a significant reduction on the Face, Legs, Activity, Cry, Consolability (FLACC) scale and Wong Baker’s Face Pain Scale when distraction by flippits were used (p<.0001). Karakaya and Gozen (2016) reported that distraction by kaleidoscope significantly reduced Faces Pain Scale- Revised (FPS-R) scores (p=.001). Sahiner and Bal (2015) reported a significant reduction on the Wong Baker’s Face Pain Scale when distraction by balloon inflation, distraction cards and cartoon music were used (p=.04). The non-invasive and low risk intervention of distraction can be used in hospitals to decrease pain in pediatric patients receiving venipuncture.
Conclusion: Despite distraction techniques being observed to decrease pain in pediatric patients undergoing venipuncture, more research is necessary to establish which type of distraction technique is most successful.
Using Distraction Techniques in Pediatric Patients Undergoing Venipuncture to Reduce Pain
In the clinical setting, patients often undergo painful and uncomfortable procedures in an attempt to restore and maintain maximal health. Painful medical procedures, such as venipuncture, often lead to detrimental outcomes in pediatric patients. Avoidance of future medical care, phobias and skewed negative memories are just a few of the long-term consequences children acquire in response to these acutely painful procedures (Kuo et al., 2018). Non-pharmacological interventions are often successful in minimizing pain in pediatric patients undergoing painful and uncomfortable procedures (Karakaya & Gozen, 2016). Therefore, the use of distraction techniques may reduce pain and discomfort associated with venipuncture and decrease the long-term consequences as well. Among pediatric patients undergoing venipuncture, do distraction techniques, compared to no distraction techniques, decrease pain, (T) over three months?
Literature Search
To obtain randomized control trials (RCT) concerning the use of distraction techniques to reduce pain, PubMed and CINAHL utilized. The key search terms that were used consisted of distraction, pain, distress, venipuncture, intravenous, blood draws and pediatric. The publication years researched included 2015 to 2018.
Literature review
In order to examine the effectiveness of distraction techniques in reducing pain among pediatric patients undergoing venipuncture, four RCTs were analyzed. This intervention does not yet have any guidelines.
Kuo et al. (2018) evaluated the effectiveness of using distraction techniques, such as cartoons or picture books, in pediatric patients undergoing venipuncture in reducing distress, compared with children who receive no distraction techniques. The randomized control study consisted of a sample size of 282 pediatric patients aged three to seven years who received their first venipuncture. The intervention group (n=186) was exposed to either a cartoon or picture book during the procedure. The control group (n=96) was exposed to no distraction techniques during the procedure. The procedure in the study was the insertion of an intravenous catheter. Pain level was determined using the Observational Scale of Behavioral Distress before, during and after the procedure. Using this scale, two trained observers assessed for crying, information seeking, emotional support, verbal resistance, verbal pain expression, screaming, need for restraints and flailing. The authors reported that both intervention groups experienced less distress compared to the control groups (p=.04). These results suggest that distraction techniques, such as cartoons and picture books, are an effective non-pharmacological intervention to decrease pain in pediatric patients undergoing venipuncture.
Risaw et al. (2017) evaluated the efficacy of using distraction techniques, such as flippits or distraction cards, in pediatric patients undergoing venipuncture in reducing pain, compared with patients who received no distraction techniques by conducting a randomized control trial. The same size was 210 pediatric patients aged four to six years who underwent blood sampling. The intervention group (n=105) was exposed to distraction cards using flippits protocol during the procedure. The control group (n=105) was exposed to no distraction technique. The procedure in the study was blood draws. Pain level was determined using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and Wong Baker’s Face Pain Scale. A trained researcher scored the pain using the FLACC scale and patients self-reported pain using Wong Baker’s Face Pain Scale. The authors reported patients in the intervention group had a significantly reduced behavioral response to pain compared to the control group (p <.0001). Patients in the intervention group also rated their pain as less compared to the control group (p <.0001). These results suggest that distraction techniques, such as flippits, are an effective non-pharmacological intervention to decrease pain in pediatric patients undergoing venipuncture.
Karakaya & Gozen (2016) conducted a randomized control trial to determine how effective distraction techniques, such as a kaleidoscope, are in reducing the pain level during venipuncture in school age children compared with no distraction techniques. The sample size was 144 pediatric patients aged seven to twelve years who underwent venipuncture after no previous venipuncture during the 6 months prior. The intervention group (n=72) was exposed to a kaleidoscope and told to describe what they saw. The control group (n=72) was exposed to no distraction techniques. The procedure in the study was venipuncture. Pain level was determined Faces Pain Scale- Revised (FPS-R). The scale was explained to patients before the procedure. After the procedure, patients were asked to mark their pain on FPS-R. The authors reported the intervention group experienced a lower pain level compared to the control group (p=.001). These results suggest that distraction techniques, such as kaleidoscopes, are an effective non-pharmacological intervention to decrease pain in pediatric patients undergoing venipuncture.