Smartinez Professional Presentation

Thermomechanical Stimulation as A
Distraction for Pain Reduction During

Venipuncture Procedures for Children
Stephanie Martinez
Background
 Children fear procedures involving needle pricks because they are

accompanied by pain and distress
 Outcomes from reoccurring painful events are pain sensitivity, maladaptive
pain responses, needle phobia, and long term traumatic memories
 Current practice for pain reduction in venipuncture procedures involve
topical anesthetics, use of parents for comfort, or no intervention
 Vibrations and cold applications appear to activate analgesic mechanisms
that can inhibit experimental pain without side effects
PICOT Question
 For school-age children between the ages of 4 to 12 years, does the use of
distraction such as the Buzzy, compared to no distraction, reduce pain
during venipuncture procedures, as measured by the Wong-Baker Faces
Pain Rating Scale (WBFPS), while the child is in the hospital?

Literature Review
 Methodology
 Randomized control trials
 Exclusion criteria:
 An abrasion on the skin where the Buzzy would be positioned
 Nerve damage
 Chronic illness
 Verbal difficulties
 Neurodevelopmental delays
Literature Review (continued)
 Sampling
 Participants were 4 to 12 years of age
 Some studies tested the effect of the Buzzy on samples that included
adolescents (4 to 18 years)
 Some participants were offered the chance to inspect the device, turn on the
vibration, and practice applying the device
 The studies included participants from hospitals in different countries such as:
 Italy
 Turkey
 United States
Literature Review (continued)
 Research findings
 The WBFPS was used to evaluate perception of pain by the children
 The Faces Pain Scale-Revised (FPS-R)
 Visual analog scale (VAS)
 Children’s Fear Scale (CFS)
 Most of the studies found statistical significances (P ≤ 0.05) using the Buzzy
compared to the control groups for pain, anxiety, and fear reduction
 Limitations
 Intervention could not be concealed from the participants, parents, and nurses
 Inconsistency of the inclusion criteria
 Some participants received analgesics before the studies
Hierarchy of Evidence
 Level Ι Randomized control trials

 Baxter, Cohen, McElvery, Lawson, & Baeyer, 2012; Bergomi et al., 2018; Canbulat,
Ayhan, & Inal, 2015; Inal & Kelleci, 2017; Moadad et al., 2016; Redfern, Chen, &
Sibrel, 2018
Clinical Implications
 There is sufficient evidence that supports the effectiveness of distraction

during venipuncture procedures for pain reduction. A new implementation
plain is appropriate for change in practice for pain management.
Implementation Plan
 The Buzzy will be implemented in the standard hospital for children

between the age of 4 to 12 years who require a venipuncture procedure.
 The plan is to present the Buzzy to school age children in an interactive
way.
 Nursing staff will be trained to secure the device with a Velcro strap or
tourniquet 5 cm above the injection site
Expected Outcome
 Measured outcomes
 Pain scores
 Measurement tools
 WBFPS will be main outcome measure of pain by the children and outcome
measures will be reviewed weekly
 The FPS-R will be used by the parents and parents to report their perspective
about the child’s pain
Potential Barriers
 Staff training
 Additional time needed for placement and patient education
 Additional time needed for children inspect the device, turn on the
vibration, and practice applying the device
 A preference to other distraction methods, such as cartoons or distraction

cards that do not require explanations
Ethical, Cultural, & Spiritual
Considerations
 Healthcare professionals have an ethical responsibility to make
venipuncture and medical procedures as painless as possible.
 Beauchamp & Childress (2013) define the principle of nonmaleficence as

an obligation to not inflict harm.
 Cultural expectations of male children to have high pain tolerance.
 Reoccurring painful events in childhood can cause long term traumatic

memories, maladaptive pain responses, and needle phobia
Conclusion
 Research shows that the Buzzy is effective on school-age children for pain
management during needle stick procedures.
 Main findings in literature requires a need to change nursing practice to

improve venipuncture experiences for school-age children.
 Nurses can help reduce the emotional and physical negative experiences
of painful procedures in children with the implementation of the Buzzy.
References
 Baxter, A. B., Cohen, L. L., McElvery, H. L., Lawson, M. L., & Baeyer, C. L. (2012). An integration of vibration and cold relieves venipuncture
pain in a pediatric emergency department. Pediatric Emergency Care, 27(12), 1151-1156. Retrieved from:
http://eds.b.ebscohost.com/eds/detail/detail?vid=0&sid=231401d4-9193-41a4-b620-
5a25f2d84f19%40sessionmgr102&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=000298146800011&db=edswsc
 Bergomi, P., Scudeller, L., Pintaldi, S., & Molin, A. D. (2018). Efficacy of non-pharmacological methods of pain management in children undergoing
venipuncture in a pediatric outpatient clinic: A randomized controlled trial of audiovisual distraction and external cold and vibration. Journal of
Pediatric Nursing, 1-7. doi: https://doi.org/10.1016/j.pedn.2018.04.011
 Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th edition). New York, NY: Oxford University Press.
 Bukola, I. M., & Paula, D. (2017). The effectiveness of distraction as procedural pain management technique in pediatric oncology patients: A
meta-analysis and systematic review. Journal of Pain and Symptom Management, 54(4), 589-600. Retrieved
from:http://eds.a.ebscohost.com/eds/detail/detail?vid=0&sid=6e03d8de-2345-471e-ba8c-
bdfe9f7c74aa%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=000414743800020& db=edswss
 Canbulat, N., Ayhan, F., & Inal, S. (2015). Effectiveness of externa cold and vibration for procedural pain relief during peripheral intravenous
cannulation in pediatric patients. Pain Management Nursing, 16(1), 33-39. doi: 10.1016/j.pmn.2014.03.003
References
 Davidson, J. (2018). Levels of Evidence Worksheet. Unpublished Document through San Diego Evidence-Based
Practice Institute.
 Inal, S. & Kelleci, M. (2017). The effect of external thermomechanical stimulation and distraction on reducing pain
experienced by children during blood drawing. Pediatric Emergency Care, 1-4. doi:
10.1097/PEC.0000000000001264
 Moadad, N., Kozman, K., Shahine, R., Ohanian, S., & Kurdahi, L. (2016). Distraction using the BUZZY for children
during an IV insertion. Journal of Pediatric Nursing, 31(1), 64-72. doi: 10.1016/j.pedn.2015.07.
 Polit, D. F., & Beck, C. T. (2010). Nursing research: Generating and assessing evidence for nursing practice (7th
ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Redfern, R. E., Chen, J. T., & Sibrel, S. (2018). Effects of thermomechanical stimulation during vaccination on
anxiety, pain, and satisfaction in pediatric patients: A randomized controlled trial. Journal of Pediatric Nursing, 38,
1-7. Retrieved from: http://eds.a.ebscohost.com/eds/detail/detail?vid=0&sid=1f0413f1-eeb2-48bb-9114-
1539e199f312%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=00042
3035000014&db=edswss
 Wente, S. J. (2013). Nonpharmacologic pediatric pain management in emergency departments: A systematic review
of the literature. Journal of Emergency Nursing, 39(2), 140-150. doi: 10/1016/j.jen.2012.09.011
 Wong, D. L., Hockenberry-Eaton, M. & Wilson, D. (2013). Wong's essentials of pediatric nursing, (9th ed.). St Louis,
MO, PP1301

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Thermomechanical Stimulation as A

Distraction for Pain Reduction During

 Children fear procedures involving needle pricks because they are

distraction such as the Buzzy, compared to no distraction, reduce pain

during venipuncture procedures, as measured by the Wong-Baker Faces

Pain Rating Scale (WBFPS), while the child is in the hospital?

 Level Ι Randomized control trials

 There is sufficient evidence that supports the effectiveness of distraction

 The Buzzy will be implemented in the standard hospital for children

 Additional time needed for placement and patient education

 A preference to other distraction methods, such as cartoons or distraction

 Beauchamp & Childress (2013) define the principle of nonmaleficence as

 Cultural expectations of male children to have high pain tolerance.

 Reoccurring painful events in childhood can cause long term traumatic

 Main findings in literature requires a need to change nursing practice to

Pediatric Nursing, 1-7. doi: https://doi.org/10.1016/j.pedn.2018.04.011

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