IV Pain

• Why Pain Matters
• Pharmacologic Management
• Taking Action
• Related Links

Why Pain Matters

Why are needles so scary?

It would be cruel to operate on a child without any pain medication. Yet children routinely endure IV starts without any sort of pharmacological intervention.

Perhaps that is why many children consider IV insertions and blood draws two of the most painful events of hospitalization.⁶ It may also be why parents cite the distress of cutaneous procedures, such as needle procedures, as frequently as separation events, including surgery.⁷

Unfortunately, the trauma of an IV start is often the first thing children, and their parents, encounter in the hospital. It can color their entire experience.

In addition to the actual pain suffered during the needlestick, the prospect of venipuncture results in a great deal of anticipatory distress in children.²

A prospective study of 171 children undergoing hand or arm venipuncture published in the journal Pain² revealed that 55% of children aged 3–6 were judged by their parent to be moderately to severely distressed prior to the procedure. During the procedure, 64% of these children displayed one or more distress behaviors such as crying, grimacing or verbally complaining. Thirty-six percent of children self-reported moderate or severe pain from the procedure.²

In addition, 35% of children aged 7–17 years self-reported their pre-venipuncture level of distress to be moderate or severe. During the procedure 43% of these older children displayed one or more distress behaviors as above and 13% self-reported moderate or severe pain from the procedure.²

In another study of 223 children who were scored by trained observers on degree of distress during venipuncture, high levels of distress defined as "serious distress, but still under control", "serious distress with loss of control", or "panic" was observed in 83% of toddlers (2.5 – 6 years), 51% of pre-adolescents (7 – 12 years), and 28% of adolescents (over 12 years).⁵

What's more, the impact can extend beyond the initial experience. Guidance from the Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine states that "inadequate sedation and pain control has negative implications for pediatric patients.

Neonates who undergo procedures with inadequate analgesia have long-standing alterations in their response to and perceptions of painful experiences.

Inadequate pain control during oncology procedures leads to significantly increased pain scores for subsequent painful procedures.

Post-traumatic stress disorder can occur after procedures or stressful medical experiences that are not accompanied by appropriate pain control or sedation."⁸

So it's no surprise that acute and chronic pain control is becoming a major public health issue. In 2000, the U.S. Congress declared 2001-2010 the decade of pain control and pain research.

The American Academy of Pediatrics (AAP) is adamant: "Acute pain is one of the most common adverse stimuli experienced by children, occurring as a result of injury, illness and necessary medical procedures."³

The AAP goes on to note that acute pain is associated with:

• Anxiety
• Avoidance
• Somatic symptoms
• Increased parental distress³

Yet pain in children is often inadequately addressed and treated.³

Learn more about ways you can manage IV pain by joining RN VOICE now.