Elsevier

Pain Management Nursing

Volume 22, Issue 5, October 2021, Pages 645-651
Pain Management Nursing

Original Article
A Cross-Sectional Review of Pain Management Interventions Used for Painful Pediatric Blood Draw Procedures in Hospital

https://doi.org/10.1016/j.pmn.2021.03.001Get rights and content

Abstract

Background

Hospitalized children continue to experience procedural pain due to inconsistent implementation of readily available, evidence-based pain interventions.

Aims

To explore the prevalence of painful blood-testing procedures, pain management interventions, child-caregiver perceptions of effectiveness of, and satisfaction with, pain interventions, and adherence to best practice guidelines.

Design

A single-site cross-sectional study using a combination of child-caregiver interviews and chart reviews for hospitalized children, 0-18 years.

Methods

Interviews gathered information about the child's most recent blood test, procedural pain management intervention use, and participant perceptions of effectiveness of and satisfaction with these interventions. Concurrently, patient charts were reviewed for procedure documentation and pain management strategies used, including topical anesthetic and oral sucrose orders. Data were analyzed using descriptive statistics.

Results

Fifty children were included. At the time of data collection, 34 (68%) had experienced painful blood-testing procedures during their current admission. Pharmacologic pain interventions were documented for only 7 (21%) procedures and were often inconsistent with participant reports. Almost all interview respondents (n = 31, 91%) identified at least one pain intervention for the child's most recent painful blood-test. Twenty (59%) participants perceived pain interventions as effective and most were satisfied with utilized interventions (n = 27, 79%).

Conclusions

A multi-modal procedural pain management approach was infrequently used and documented, highlighting undertreatment based on recommended practices and guidelines. Perceived intervention effectiveness and satisfaction with pain management were however found to be relatively high.

Section snippets

Design

This study was cross-sectional and used two data sources. Data were collected using chart reviews and brief interviews conducted at the bedside of children. Interviews were conducted with children and/or the caregivers of children when children were unable or unwilling to self-report.

Setting and Sample

The setting was a single 14-bed inpatient pediatrics unit at a southeastern Ontario hospital. This hospital serviced a catchment area of over 20,000 square kilometers, including many northern rural communities, and

Sample & Demographic Characteristics

Data collection occurred between May 16 and June 5, 2019. Seventy-six children were screened over these 21 days. Of the 58 potential participants approached, eight (14%) refused to participate leaving a sample of 50 children included in this study (see Figure 1 for participant flow chart). There were slightly more males (n = 26, 52%) than females. The mean age was 7.06 ± 5.53 years. Children had been admitted for a median of one day (IQR = 1) at the time of the interview. The majority of

Discussion

More than two-thirds of the 50 children in this sample had undergone at least one painful procedure for bloodwork during their current admission at the time of the study. The most common painful procedures previously reported for children were peripheral IV cannulation, venipuncture, and heel sticks (Ellis et al., 2004; Harrison et al., 2014; Stevens et al., 2011). The findings from this study were no exception as these three procedures represented over 90% of the participants’ most recent

Conclusion

Findings demonstrate that procedural pain was undertreated when compared with an existing practice guideline despite the abundance of high-quality evidence, readily available PPM interventions, and existing published literature surrounding PPM. Despite these findings, both intervention effectiveness, as perceived by children and caregivers, and child-caregiver satisfaction with pain management were found to be relatively high. The development of local pain management policies, practice

Conflict of Interest

None.

Acknowledgements

We thank the infants, children, and caregivers who participated in this study, as well as the staff and unit manager for their cooperation and support with this study.

References (32)

  • D. Harrison et al.

    Pain prevalence in a pediatric hospital: Raising awareness during Pain Awareness Week

    Pain Research and Management

    (2014)
  • D. Harrison et al.

    Be sweet to toddlers during needles: Pilot randomized controlled trial of sucrose compared to placebo

    Nursing Reports

    (2015)
  • D. Harrison et al.

    Breastfeeding for procedural pain in infants beyond the neonatal period (Review)

    Cochrane Database of Systematic Reviews

    (2016)
  • D. Harrison et al.

    Too many crying babies: A systematic review of pain management practices during immunizations on YouTube

    Bio Med Central Pediatrics

    (2014)
  • D. Harrison et al.

    Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years

    Cochrane Database of Systematic Reviews

    (2015)
  • M.B. Harrison et al.

    Adapting clinical practice guidelines to local context and assessing barriers to their use

    Canadian Medical Association Journal

    (2010)
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