PAIN MANAGEMENT IN PEDIATRICS DURING VENIPUNCTURE

We cannot take away all the pain & distress associated with pokes, but we can certainly lessen them. Goal is to give children ways and tools to better cope with pokes, medical procedures, and life.

Children consider needle pokes as one of the most frightening and painful health related events, potentially leading to: • Health care avoidance behaviors across their lifespan • Vaccine non-compliance • Potential to contribute to outbreaks of vaccine preventable diseases • About 10% of the population avoids vaccination & needle procedures

Importance of Pain Interventions

  • Recognized in the medical principle to “First, do no harm.” • Pain relief is considered a basic human right , Lack of pain management exposes children to unnecessary suffering •

Pain and distress have a negative impact on the child’s level of cooperation & increase the need for physical restraint

World Health Organization & the Center for Disease Control -a Applying principles for immunizations to all “pokes” • Pain relief/management is considered part of good clinical practice  , Pain during pokes is manageable •,Pain mitigation may help counter vaccine/poke hesitancy • Have caregiver present

Hold infants & young children and allow children to sit upright , Using proper technique and appropriate size needle ,Offer one or more pain relieving options

Intervention/implementation

Oral Sucrose 24% (Sweet-Ease)

This sugar water helps with pain relief and also acts as a distraction to babies up to 6 months old.”

Give 2 minutes prior to any poke or procedure • Absorbed in cheek and sublingually, not swallowed • Utilizes opioid pathways • Synergistic with sucking • Pacifier • Gloved finger • Calming effect •Reduction in pain behaviors

Breastfeeding

“Breastfeeding your baby during pokes can help control pain. They benefit from the sweet taste, physical comfort from mom, and sucking.”

  • Reduces stress • Physical comfort • Sucking • Distraction • Sweet ‐tasting milk

Occlusive Dressing Tips

  • Have child remove the dressing or lift corner, pull parallel to skin while holding down opposite corner, then lift off ,Place a sticker on top of dressing ,

Cover with pants or wrap a blanket around dressing, All ages (vibration), 18 months up for vibration plus ice

Gate theory of pain – interrupts pain fibers ,  Cold and vibration help relieve pain

Distraction , Vibration alone on NICU patients reduced pain scores and heart rate upon heel lance

DISTRACTION TECHNIQUES & COMFORT POSITIONS

Distractions Active –  Interactive toys (iPad, games) , Virtual reality ,Controlled breathing (bubble blowing, party blowers , Guided imagery (relaxation) Passive ,Auditory (music, reading) ,Audiovisual (television with eyeglasses)

Comfort Positions for Infants   -They can isolate an extremity for procedure or poke , They allow for active caregiver participation . They decrease stress, not only for the patient, but for caregiver & staff

Process Interventions , Educate phlebotomists about pain management ,Seek permission to use various pain relieving options (distractions, topical analgesics, oral sucrose, etc.) Appointment guides/instructions for topical analgesics • Offer multiple strategies whenever possible • Educate parents and children 3 years and older about pain management

We need to move away from what is best for the provider to what is best for the patient.  Identify the best approach to deliver patient-centered care , Choose the least traumatic approach

Change our way of thinking

By – NURSING TUTOR – : Priyashu Uniyal
Department – Dept. of Nursing
UCBMSH Magazine – (YouthRainBow)
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