Effect of an Immersive Virtual Reality Intervention on Pain and Anxiety Associated With Peripheral Intravenous Catheter Placement in the Pediatric Setting: A Randomized Clinical Trial.

Importance: The inclusion of digital therapeutics (eg, virtual reality [VR] systems) for the management of pain and anxiety associated with routine acutely painful medical procedures may have a substantial impact on treatment adherence and improve long-term health outcomes among young patients. Objective: To determine whether a VR intervention decreases pain and anxiety among patients undergoing peripheral intravenous catheter (PIVC) placement compared with standard care in the pediatric setting. Design, Setting, and Participants: This randomized clinical trial was conducted from April 12, 2017, to July 24, 2019, among 107 patients aged 10 to 21 years who were undergoing PIVC placement in 2 clinical settings (a radiology department and an infusion center) at an urban pediatric academic medical center in the US. Patients, caregivers, and clinicians completed pre-PIVC and post-PIVC placement questionnaires measuring patient pain, anxiety, and anxiety sensitivity; only participants with complete data from before and after PIVC placment were included in the analyses. Interventions: Patients were randomized to receive standard care (simple distraction techniques [eg, music, coloring, singing, and talking] and the application of numbing cream) or a VR intervention using a balanced computer-generated randomization scheme stratified by sex. All patients who received the VR intervention were offered concurrent standard care; however, VR plus standard care was not specifically examined. Main Outcomes and Measures: Primary outcomes were patient pain (measured by the Faces Pain Scale-Revised) and anxiety (measured by a visual analogue scale) reported by the patient, caregiver, and clinician after PIVC placement. Outcomes were analyzed using generalized linear modeling with backward stepwise selection for final model building. Results: A total of 107 patients (median age, 14.7 years [interquartile range, 12.8-16.9 years]; 63 male participants [58.9%]) completed the clinical trial; 54 patients received standard care, and 53 patients also received the VR intervention. Patients who received the VR intervention compared with standard care had significantly lower mean post-PIVC anxiety scores when patient-reported (1.85 points [95% CI, 1.28-2.41 points] vs 3.14 points [95% CI, 2.59-3.68 points]; P < .001) and clinician-reported (2.04 points [95% CI, 1.37-2.71 points] vs 3.34 points [95% CI, 2.69-3.99 points]; P = .002). Patients in the VR group vs the standard care group also had significantly lower mean post-PIVC pain scores when patient-reported (1.34 points [95% CI, 0.63-2.05 points] vs 2.54 points [95% CI, 1.78-3.30 points]; P = .002), caregiver-reported (1.87 points [95% CI, 0.99-2.76 points] vs 3.01 points [95% CI. 1.98-4.03 points]; P = .04), and clinician-reported (2.05 points [95% CI, 1.47-2.63 points] vs 3.59 points [95% CI, 2.97-4.22 points]; P < .001). Aside from lower levels of baseline pain and anxiety, no demographic variables among patients in the VR group were associated with lower levels of post-PIVC pain and anxiety. Conclusions and Relevance: In this randomized clinical trial, patients undergoing PIVC placement who received a VR intervention experienced significantly less anxiety and pain compared with those who received standard care. The use of patient, caregiver, and clinician data provided a variety of subjective information, as well as observable and objective data regarding perceived pain and anxiety beyond patient reporting alone. Trial Registration: ClinicalTrials.gov Identifier: CHLA-15-00549.

The Effect of a Cartoon and an Information Video About Intravenous Insertion on Pain and Fear in Children Aged 6 to 12 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial.

INTRODUCTION: Intravenous insertion is the most common invasive procedure made for administering intravascular fluid and medicine. Peripheral venous catheterization may cause pain, fear, and stress in children. This study aimed to compare the effects of watching a cartoon and an information video about intravenous insertion on the pain and fear levels of children aged 6-12 years. METHODS: The study was an experimental, randomized controlled clinical trial. It was conducted with 477 children aged 6-12 years randomized into 3 groups: the informative animated video group, the cartoon group, and the control group. Fear and pain perception were evaluated on the basis of the feedback from the child, observer nurse, and parents. The Children's Fear Scale was used to evaluate the fear level and the Wong-Baker FACES Scale was used to assess pain levels. Data were analyzed using one-way analysis of variance, the chi-square test, and the intraclass correlation coefficient test. RESULTS: The children who watched the information video before the intravenous insertion procedure and those who watched a cartoon during the procedure had lower mean pain and fear scores as evaluated by the child (pain: F = 278.67, P = 0.001; fear: F = 294.88, P = 0.001), parent (pain: F = 279.53, P = 0.001; fear: F = 294.47, P = 0.001), and nurse (pain: F = 286.88, P = 0.001; fear: F = 300.81, P = 0.001) than children in the control group. DISCUSSION: This study showed that watching an animation video or a cartoon was effective in lowering children's perceived level of pain and fear during an intravenous insertion intervention.

Safety, Efficacy, and Patient Satisfaction with Initial Peripherally Inserted Central Catheters Compared with Usual Intravenous Access in Terminally Ill Cancer Patients: A Randomized Phase II Study.

PURPOSE: The purpose of this study was to investigate whether routine insertion of peripherally inserted central catheter (PICC) at admission to a hospice-palliative care (HPC) unit is acceptable in terms of safety and efficacy and whether it results in superior patient satisfaction compared to usual intravenous (IV) access. MATERIALS AND METHODS: Terminally ill cancer patients were randomly assigned to two arms: routine PICC access and usual IV access arm. The primary endpoint was IV maintenance success rate, defined as the rate of functional IV maintenance until the intended time (discharge, transfer, or death). RESULTS: A total of 66 terminally ill cancer patients were enrolled and randomized to study arms. Among them, 57 patients (routine PICC, 29; usual IV, 28) were analyzed. In the routine PICC arm, mean time to PICC was 0.84 days (range, 0 to 3 days), 27 patients maintained PICC with function until the intended time. In the usual IV arm, 11 patients maintained peripheral IV access until the intended time, and 15 patients underwent PICC insertion. The IV maintenance success rate in the routine PICC arm (27/29, 93.1%) was similar to that in the usual IV arm (26/28, 92.8%, p=0.958). Patient satisfaction at day 5 was better in the routine PICC arm (97%, 'a little comfort' or 'much comfort') compared with the usual IV arm (21%) (p <0.001). CONCLUSION: Routine PICC insertion in terminally ill cancer patients was comparable in safety and efficacy and resulted in superior satisfaction compared with usual IV access. Thus, routine PICC insertion could be considered at admission to the HPC unit.

[Comfort Status and Its Influencing Factors in Patients With Gastrointestinal Cancer After PICC Catheterization].

BACKGROUND: Gastrointestinal cancer is one of the higher-incidence malignant tumors worldwide. A majority of patients with gastrointestinal cancer receive chemotherapy, with peripherally inserted central catheter (PICC) serving as the main infusion instrument. Little research has addressed the issue of post-catheterization comfort in patients. PURPOSE: The purpose of the study was to investigate the comfort status of patients with gastrointestinal cancer at a tertiary hospital in China after PICC catheterization and to analyze the influencing factors. METHODS: Ninety-one patients with gastrointestinal cancer who were currently receiving initial chemotherapy were recruited from a third-class hospital in Changsha City from June 2018 to August 2019. Patients received ultrasound-guided PICC catheterization and were then investigated one-month later using a general demographics questionnaire, comfort evaluation scale, Cancer Patients PICC Self-management Scale, and complications evaluation scale. RESULTS: Ninety-one effective questionnaires were received (recovery rate: 100%). The total comfort score was 34.99 ± 4.07, with 10 patients (11.0%) reporting 'general comfort' and 81 patients (89.0%) reported 'comfort'. The average score for self-management ability was 151.55 ± 18.33. Nineteen patients (20.9%) had blood leakage and 7 (7.7%) had catheter prolapse. Multiple stepwise linear regression analysis showed that the limb used for catheterization, self-management ability, and occupation were the factors that significantly influenced degree of comfort in the participants (p < .05), predicting 21.9% of the total comfort score. CONCLUSIONS: The overall comfort level of patients with gastrointestinal cancer after PICC catheterization was comfort. In clinical work, nurses should choose the left limb based on patient wishes, pay attention to improving the self-management ability of patients, and provide appropriate nursing suggestions for patients who are wage earners to improve post-catheterization comfort.

Impact of arm choice for peripherally inserted central catheter (PICC) insertion on patients: a cross-sectional study.

Background: Arm choice for peripherally inserted central catheter (PICC) insertion is often determined by PICC nurses. Objectives: To explore the impact of arm choice (dominant or non-dominant) on the rate of catheter-related complications and degree of comfort in patients with PICCs. Design: A cross-sectional study. Methods: We used questionnaires and scales to collect 255 patients' general information, catheter-related complications and comfort degree. They were divided into two groups (PICC inserted in the dominant or non-dominant arm). Results: There were significant differences in the rate of PICC occlusion and insertion site bleeding (χ 2 = 9.829, P < 0.05; χ 2 = 6.502, P < 0.05), both were lower in the non-dominant group than in the dominant group. Patients in the non-dominant group had a higher degree of comfort (Z = -10.166, P < 0.01). Conclusion: Inserting into non-dominant arms is related to the lower rate of catheter-related complications and higher degree of comfort for patients. Impact statement: These findings provide practical evidence for nurses to make a better choice.

Effects of passive music therapy on anxiety and vital signs in lung cancer patients undergoing peripherally inserted central catheter placement procedure.

PURPOSE: To evaluate the effects of passive music therapy on anxiety and vital signs among lung cancer patients at their first peripherally inserted central catheter placement procedure in China. METHODS: A randomized controlled clinical trial was conducted in the cancer center of a hospital in Chengdu from May to December 2017. A total of 304 lung cancer patients who met the inclusion and exclusion criteria were recruited and randomly assigned to experimental (n = 152) and control (n = 152) group, respectively. The control group only received standard care, while the experimental group received standard care and passive music therapy during peripherally inserted central catheter placement (30-45 min) and after catheterization, until discharged from the hospital (twice a day, 30 min once). Measures include anxiety and vital signs (blood pressure, heart rate, and respiratory rate). RESULTS: Repetitive measurement and analysis of variance showed that the patients in experimental group had a statistically significant decrease in anxiety, diastolic blood pressure, and heart rate over time compared to the control group, but no significant difference was identified in systolic blood pressure and respiratory rate. CONCLUSION: Passive music therapy can efficiently relieve the anxiety of lung cancer patients during peripherally inserted central catheter placement. It also can lower the patient's diastolic blood pressure and slow down the heart rate. So, music therapy benefits patients with peripherally inserted central catheter.

Virtual reality during pediatric vascular access: A pragmatic, prospective randomized, controlled trial.

BACKGROUND: Vascular access is a minor procedure that is associated with reported pain and fear in pediatric patients, often resulting in procedural incompliance. Virtual reality has been shown to be effective in adult populations for reducing pain and anxiety in various medical settings, although large studies are lacking in pediatrics. AIMS: The primary aim was to determine whether pain would be reduced in pediatric patients using virtual reality undergoing vascular access. The four secondary aims measured patient fear, procedural compliance, satisfaction, and adverse events. METHODS: A prospective, randomized, controlled trial was completed at a pediatric hospital, enrolling children 7-18 years old undergoing vascular access in a variety of clinical settings, randomized to virtual reality or standard of care. Pain scores were measured using a numeric pain faces scale. The secondary outcomes of patient fear, procedural compliance, satisfaction, and adverse events were measured with the Child Fear Scale, modified Induction Compliance Checklist, and satisfaction surveys, respectively. Chi-squared, t tests, and regression models were used to analyze the results. RESULTS: The analysis included 106 patients in the virtual reality group and 114 in the control. There were no significant differences in postprocedure pain (VR group estimated 0.11 points lower, 95% confidence interval: 0.50 points lower to 0.28 points greater, P = .59), postprocedure fear (VR group estimated 0.05 points lower, 95% confidence interval: 0.23 points lower to 0.13 points greater), or compliance (adjusted odds ratio 2.31, 95% confidence interval: 0.96-5.56). Children in the virtual reality group were satisfied with the intervention. There were no adverse events. CONCLUSION: This study demonstrates no reduction in pain while using Virtual reality (VR) across a heterogeneous pediatric inpatient population undergoing vascular access.

Distraction-based relief of pain associated with peripheral intravenous catheterisation in adults: a randomised controlled trial.

AIMS AND OBJECTIVES: This study aimed to determine the effect of methods of distraction to relieve pain associated with the peripheral intravenous catheter (PIC) insertion procedure, thus improving patient satisfaction. Specifically, we examined such effect by playing 3D videos with virtual reality goggles and showing pictures to the patient containing distractive optical illusions. BACKGROUND: In the literature, although the efficacy of various pharmacological methods for reducing pain associated with the insertion of PIC has been evaluated in adults, studies on nonpharmacological methods are limited. METHODS: The research was conducted with a randomised controlled single-blind experimental study. The sample consisted of 120 patients. While nothing is applied to the control group, cards containing distractive optical illusion pictures and playing 3D videos with VR goggles during PIC insertion is applied for distraction groups. The data collection form consisted of items that measured the sociodemographic characteristics of the patients and a visual analog scale. The CONSORT checklist was followed in reporting this study. This study is registered with ClinicalTrials.gov. No. NCT03945929. RESULTS: The mean pain level was 4.72 ± 3.15 in the control group and 3.41 ± 2.81 in the distraction groups and the difference was found to be statistically significant (p = .02). When the mean satisfaction level between the groups was compared, it was found to be 5.12 ± 3.41 in the control group and 8.07 ± 2.67 in the groups undergoing distraction methods. The difference between them was statistically significant (p = .01). CONCLUSIONS: This study found that the use of cards containing distractive optical illusion pictures and playing 3D videos with VR goggles during PIC insertion in adult patients were both effective. RELEVANCE TO CLINICAL PRACTICE: These distraction methods may be used to reduce pain due to PIC insertion in nonurgent and less urgent adult patients in the emergency department.

What do patients say about their experience with urinary catheters and peripherally inserted central catheters?

BACKGROUND: Little is known about the patient experience with urinary catheters or peripherally inserted central catheters (PICCs). We sought to better understand patient perspectives on having a urinary catheter or a PICC by reviewing open-ended comments made by patients about having either of these 2 devices. METHODS: As part of a larger study, we asked patients about certain catheter-related complications at the time of catheter placement and on days 14, 30, and 70 (PICCs only). In this larger project, we performed a structured assessment that included an open-ended question about other comments (initial interview) or problems (follow-up interview) associated with the device. For the current study, we conducted a descriptive analysis of these open-ended comments, classifying them as positive, negative, or neutral. RESULTS: Positive comments about urinary catheters accounted for 9 of 147 comments (6%), whereas positive comments about PICCs accounted for 10 of 100 comments (10%). Positive comments for both catheter types were mostly related to convenience. More than 80% of comments about both types of devices were negative and fell into the following areas: catheter malfunction; pain, irritation, or discomfort; interference with activities of daily living; provider error; and other. CONCLUSIONS: Our findings underscore the need to optimize the patient experience with placement, ongoing use, and removal of urinary catheters and PICCs.

External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol.

INTRODUCTION: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. METHODS AND ANALYSIS: This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT02616419.

Factors affecting the first-attempt success rate of intravenous cannulation in older people.

AIMS AND OBJECTIVES: To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients. BACKGROUND: In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important. DESIGN: This is a prospective, observational, descriptive study. METHODS: Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (See Supporting Information Appendix S1). RESULTS: A total of 472 patients were included in the final analyses. According to the logistic regression analysis, independent factors which affected first-attempt failure were found to be: choosing a nonupper extremity site for PIVC (OR: 4.72, 95% CI: 1.35-16.45, p-value: 0.015), history of difficult intravenous access (OR: 3.02, 95% CI: 1.72-5.29, p-value: <0.001), nurse having less than 2 years of professional experience (OR: 3.45, 95% CI: 2.00-5.97, p-value: <0.001), nonpalpable veins observed after the application of tourniquet (OR: 2.21, 95% CI: 1.10-4.41, p-value: 0.025), a moderate degree of difficulty anticipated by the nurse prior to the procedure (OR: 4.32, 95% CI: 2.31-8.08, p-value: <0.001) and a high degree of difficulty anticipated by the nurse prior to the procedure (OR: 8.41, 95% CI: 4.10-17.24, p-value: <0.001). CONCLUSION: Factors affecting first-attempt success rates in peripheral intravenous catheter placement in older emergency department patients may be listed as follows: the anticipated difficulty of the procedure rated by the nurse, previous history of a difficult intravenous cannulation, choosing a nonupper extremity site for cannulation, the level of experience of the nurse and the palpability of the vein. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should consider alternative methods in the presence of factors affecting first-attempt success in older emergency department patients.

Child Life Reduces Distress and Pain and Improves Family Satisfaction in the Pediatric Emergency Department.

This study evaluated the effects of Certified Child Life Specialist (CCLS) intervention on pediatric distress and pain and family satisfaction during routine peripheral intravenous (PIV) line placement in the emergency department (ED). A convenience sample of 78 children (3-13 years) requiring PIV placement for their treatment at a regional level 1 pediatric trauma center ED with 70 000 annual visits were selected to receive either standard nursing care or CCLS intervention for PIV placement. CCLS involvement was associated with fewer negative emotional behaviors as indicated by a lower score on the Children's Emotional Manifestation Scale (-3.37 ± 1.49, P = .027), a reduction in self-reported pain on the Wong-Baker Faces pain rating scale (-1.107 ± 0.445, P = .017), an increase in parent-reported patient cooperation during PIV placement, and greater satisfaction with the ED visit. This study demonstrates that Child Life can have an impact on important outcomes in the pediatric ED such as distress, pain, and visit satisfaction.

Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials.

BACKGROUND: Intravenous cannulation is a routine procedure in hospitalized patients, and pain can occur during the cannulation process. Vapocoolant spray is an advantageous analgesic alternative for intravenous cannula insertion. OBJECTIVES: The objective of our meta-analysis is to compare the effectiveness of vapocoolant spray and placebo spray/no treatment for pain reduction during intravenous cannulation. DESIGN: A meta-analysis to identify evidence from randomized controlled trials. METHODS: We searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang Data for publications before January 2018. The outcomes measured included pain during intravenous cannulation, patients' anxiety due to the spray, first attempt success rate, technical ease of the attempt, adverse events, and participant satisfaction. RESULTS: We included 11 studies with 1410 patients. The meta-analysis results showed that vapocoolant spray significantly decreased pain during intravenous cannulation compared with placebo spray or no treatment in both adults and children. In addition, vapocoolant spray significantly increased the technical ease of the attempt and participants' satisfaction. However, patients' anxiety due to spray, first attempt success rate, and adverse events were not associated with vapocoolant spray. CONCLUSIONS: This meta-analysis suggests that vapocoolant spray significantly decreased pain during intravenous cannulation when compared with placebo spray or no treatment in both adults and children. We recommend the use of vapocoolant spray during intravenous cannulation to decrease pain. Future research may help to unify pain measurement standards. Patients' anxiety due to spray and technical ease of the attempt should be explored in future research.

The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy.

PURPOSE:: This study aimed to investigate the success of first-time phlebotomy and the affecting factors in children between 4 and 10 years of age. METHODS:: This descriptive, comparative, and cross-sectional study was conducted on 155 children who underwent phlebotomy. The Sociodemographic Data Form, the Children's Anxiety Meter-State, the Children's Fear Scale, and the Difficult Intravenous Access score were used to collect the data for the study. The relationship between the success of first-time phlebotomy, mean pre-phlebotomy fear and anxiety score, and Difficult Intravenous Access score were examined. The variables affecting the success of first-time phlebotomy were assessed by regression analysis. RESULTS:: Phlebotomies failed in 18.1% of children. A statistically significant relationship was found between the success of first-time phlebotomy, Children's Anxiety Meter-State, Children's Fear Scale mean scores assessed by the researchers, and Difficult Intravenous Access score. Factors affecting the success of first-time phlebotomy include difficult vascular access, age, mean Children's Anxiety Meter-State score, mean Difficult Intravenous Access score, and duration of the last phlebotomy performed. These factors explain 42% of the total factors affecting the success of first-time phlebotomy. CONCLUSION:: Child's fear, anxiety before phlebotomy, and difficult vascular access affects the first-time phlebotomy success.

Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries.

Peripheral intravascular cannula/catheter (PIVC) insertion is a common invasive procedure, but PIVC failure before the end of therapy is unacceptably high. As PIVC failure disrupts treatment and reinsertion can be distressing for the patient, prevention of PIVC failure is an important patient outcome. Consumer participation in PIVC care to prevent failure is an untapped resource. This study aimed to understand consumers' PIVC experience; establish aspects of PIVC insertion and care relevant to them; and to compare experiences of adult consumers to adult carers of a child. An international, web-based, cross-sectional survey was distributed via social media inviting adult consumers and adult carers of a child under 18 years who had experienced having a PIVC in the last five years (one survey each for adults and adult carers) to complete a 10-item survey. As such, sampling bias is a limitation and results should be carefully considered in light of this. There were 712 respondents from 25 countries, mainly female (87.1%) and adults (80%). A little over 50% of adults described insertion as moderately painful or worse, with level of insertion difficulty (0-10 scale) identified as moderate (median 4, IQR 1, 7). Adult carers reported significantly more pain during insertion and insertion difficulty (both p < 0.001). Rates of first insertion attempt failure were higher in children compared with adults (89/139 [64%] vs 221/554 [40%]; p < 0.001), and 23% of children required ≥ 4 attempts, compared with 9% of adults (p < 0.0001). Three themes from open-ended question emerged: Significance of safe and consistent PIVC care; Importance of staff training and competence; and Value of communication. The PIVC experience can be painful, stressful and frustrating for consumers. Priorities for clinicians and policy makers should include use of pain relief as standard practice to reduce the pain associated with PIVC insertion and developing strategies to increase first PIVC insertion attempt success particularly for children and older consumers.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study.

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Representação social da punção venosa pediátrica durante internação para acompanhantes e para equipe de enfermagem / Social representation of pediatric venous puncture during hospitalization for caregivers and for nursing team

A punção venosa periférica, procedimento de atribuição da equipe de enfermagem é fonte de dor, estresses e complicações graves e um desafio para a enfermagem ao lidar com a criança e seu acompanhante. Justifica-se o presente estudo por sua originalidade e necessidade da compreensão dos significados da punção em crianças para adequação sociocultural do cuidado. O objeto de estudo é a representação social da punção venosa pediátrica para os profissionais de enfermagem e para os acompanhantes de crianças internadas. Os objetivos foram compreender as representações sociais elaboradas pelos profissionais de enfermagem e pelos acompanhantes sobre a punção venosa periférica realizada em crianças internadas, descrever comparativamente os conteúdos simbólicos e a sua alocação dentro do sistema hierárquico, identificar as dimensões representacionais das representações sociais e refletir suas implicações à luz da teoria de Betty Neuman. O percurso metodológico foi delineado na pesquisa qualitativa no referencial teórico-metodológico da Teoria das Representações Sociais com a triangulação de dados com a abordagem processual e estrutural alicerçada na teoria Betty Neuman. Foram realizadas entrevistas individuais gravadas com pontos norteadores e aplicação da técnica da evocação livre não hierarquizada. A presente investigação foi submetida e aprovada sob parecer nº 2.543,592 dos Comitês de Ética em Pesquisa da instituição preponente do estudo e da instituição que foi realizada a pesquisa. A representação social de pegar veia para os profissionais de enfermagem se estrutura sobre a dificuldade da realização do procedimento e de inserção da mãe no cuidado e para o grupo dos acompanhantes das crianças internadas, possui um caráter de impacto psicológico negativo para o grupo social. A representação dos profissionais de enfermagem sobre manter o cateter na veia de uma criança é caracterizada pelos comportamentos técnicos e para os acompanhantes significa sentimento de tristeza, mas entendendo sua necessidade. E o significado de retirar o cateter da veia de uma criança pelos profissionais de enfermagem é o fim da terapia venosa comprovada pela verificação na prescrição médica, o que gera nos acompanhantes sentimentos positivos expressos por felicidade e de alívio ao término da terapia venosa. Foi possível identificar as dimensões representacionais e os estressores intrapessoais, intrapessoais e transpessoais presentes no processo de punção venosa em crianças que dificultam o enfrentamento desse procedimento durante uma internação hospitalar, que requer redimensionamento da atuação e gerenciamento dos profissionais de enfermagem expressados por objetos, ações e relações necessárias durante o procedimento. Concluímos que a presente investigação contribui para a identificação dos significados e sentimentos do processo de punção venosa nas crianças na visão dos profissionais de enfermagem e dos acompanhantes das crianças e aponta uma reflexão sobre estressores presentes para redimensionar a assistência de enfermagem na terapia venosa nas crianças.

Peripheral venous puncture, nursing staff assignment procedure is a source of pain, stress and serious complications and a challenge for nursing when dealing with the child and his companion. The present study is justified because of its originality and the need to understand the meanings of puncture in children for sociocultural adequacy of care. The object of study is the social representation of the pediatric venous puncture for the nursing professionals and for the companions of hospitalized children. The objectives were to understand the social representations elaborated by the nursing professionals and the companions about the peripheral venous puncture in hospitalized children, to describe the symbolic contents and their allocation within the hierarchical system, to identify the representational dimensions of the social representations and to reflect their implications in the light of Betty Neuman's theory. The methodological course was delineated in the qualitative research in the theoretical-methodological reference of Theory of Social Representations with the triangulation of data with the procedural and structural approach based on the Betty Neuman theory. Individual interviews were recorded with guiding points and application of non-hierarchical free evocation technique. The present investigation was submitted and approved under opinion nº 2,543,592 of the Committees of Ethics in Research of the preponderant institution of the study and of the institution that was carried out the research. The social representation of picking up vein for the nursing professionals is structured on the difficulty of performing the procedure and insertion of the mother in the care and for the group of the companions of hospitalized children, has a character of negative psychological impact for the social group. The representation of nursing professionals about keeping the catheter in the vein of a child is characterized by technical behaviors and for the companions means a feeling of sadness, but understanding their need. And the meaning of withdrawing the catheter from a child's vein by nursing professionals is the end of the venous therapy proven by the medical prescription, which leads to the positive feelings expressed by happiness and relief at the end of venous therapy. It was possible to identify the representational dimensions and the intrapersonal, intrapersonal and transpersonal stressors present in the venous puncture process in children that make it difficult to cope with this procedure during a hospital stay, which requires a re-dimensioning of the nursing professionals' performance and management expressed by objects, actions and during the procedure. We conclude that the present investigation contributes to the identification of the meanings and feelings of the venous puncture process in children in the view of the nursing professionals and the accompanying children and points out a reflection on present stressors to resize the nursing care in venous therapy in children.

En la mayoría de los casos, la mayoría de las personas que sufren de esta enfermedad, El presente estudio está justificado debido a su originalidad y la necesidad de entender los significados de la punción en los niños para el sociocultural adecuado de la care. El objeto del estudio es la representación social de los pediatras de los pediatras para los enfermeros de enfermería y las familias de hospitalizados niños. Los objetivos para entender las representaciones sociales elaboradas por los profesionales de la salud y las compañeras sobre el periférico venoso puncturan en hospitalizados niños, describen los símbolos y su configuración en el sistema jerárquico, para identificar las dimensiones de las representaciones sociales y las reflectantes y su influencia en la luz de la teoría de la neurosis. El método metodológico fue delineado en la investigación cualitativa en la metodología de referencia de la teoría de las representaciones sociales con la triangulación de la fecha con el procedural y el enfoque basado en la base de la teoría de la neta. La individualización se ha registrado con guiding points y aplicación de no jerárquica libre evocation technique. La presente investigación fue presentada y aprobada bajo la opinión nº 2.543,592 de los comités de ética en investigación de la institución preponderante del estudio y de la institución que se llevó fuera de la investigación. La social representación de picking up para los profesionales de la salud se basa en la dificultad de realizar el procedimiento y la inserción de la madre en el cuidado y para el grupo de las familias de hospitalizados niños, tiene un carácter negativo de impacto impactante para el grupo social . La representación de los enfermeros de los enfermos sobre el mantenimiento del catéter en la veintena de un niño está caracterizado por los comportamientos de conducta y las compañías a la vez un sentimiento de tristeza, pero su comprensión. Y el significado de retirar el catéter de un niño a través de los pacientes de edad es el final de la terapia venosa proveniente de la prescripción médica, que se dirige hacia los positivos positivos expresados por la felicidad y la atención en el end of venous therapy. Es posible identificar las representaciones dimensionales y los intrapersonal, intrapersonal y transpersonal estrés presentados en el proceso venoso en los niños que hace difícil a cope con este procedimiento durante el hospital de estancia, que requiere la reescaleción de los profesionales de la enfermería y gestión expresada por objetos, acciones y durante el procedimiento. Nosotros consideramos que la presente invención contribuye a la identificación de los significados y los sentimientos de la venosa de los procesos en los niños en la vista de los pacientes de edad avanzada y el seguimiento de los niños y los puntos fuera de la reflexión sobre los estrés actuales para resize el cuidado de la enfer- niños

Influencia de la presencia de los padres durante la punción venosas de sus hijos / Influence of the presence of parents during the venous puncture in their children on the level of stress and anxiety experienced by both

Objetivo: valorar si la presencia de los progenitores disminuye el dolor y el estrés de sus hijos e hijas durante punción venosa, y si su presencia durante el procedimiento disminuye su propia ansiedad. Método: ensayo clínico, controlado y aleatorizado con dos grupos de asignación. Muestra de 150 niños entre 1 mes y 14 años a los que se les realizó una punción venosa, 75 acompañados de sus progenitores (PP) y 75 con padres ausentes (PA). Se evaluó el dolor de los niños mediante escalas de valoración adaptadas a grupos de edad y el estrés con la Escala de Groningen. La ansiedad de los progenitores se evaluó con el cuestionario de ansiedad STAI. Se realizó análisis comparativo de las tres variables en función del grupo de asignación (media y desviación estándar-DE-). Se llevó a cabo análisis multivariante mediante regresión lineal para valorar el efecto de la presencia de los progenitores sobre los niveles de dolor y estrés de los niños y niñas. Resultados: 150 sujetos de estudio (grupo PP n=75 y grupo PA n=75). La mediana de edad en el grupo PP fue de 3 años y en el grupo de PA fue de 5 años, presentando los grupos de asignación diferencias estadísticamente significativas en relación a la edad del niño/a (p<0,05). La media de dolor de niños/as del grupo PP fue de 4,8 (DE: 2,8), con diferencias estadísticamente significativas entre grupos de comparación para dolor y estrés (p<0,05). La media de ansiedad en progenitores del grupo PP fue de 37,5 (DE: 4,5) y del grupo PA fue de 37,5 (DE: 4,5), sin diferencia estadísticamente significativa (p<0,05). La edad y el éxito en la venopunción está asociada al dolor y la edad se relación con la ansiedad del niño/a. Conclusiones: la ansiedad de los progenitores no se ve modificada en ningún grupo. El dolor y estrés de los pequeños en el grupo de progenitores presentes es superior que en el grupo de progenitores ausentes, asumiendo que la edad de los niños y niñas en el grupo de PP es menor que en el grupo de PA. La edad de los niños y niñas y el éxito de la venopunción influye en el dolor y la edad es un condicionan del estrés en los niños y niñas sometidos a una venopunción (AU)

Objective: to assess if the presence of parents reduces the pain and stress suffered by their sons and daughters during venous puncture, and if their presence during the procedure reduces their own anxiety. Method: a controlled and randomized clinical trial, with two assignment arms. A sample including 150 children from 1 month tp 14 years of age, who underwent a venous puncture; 75 of them were accompanied by their parents (PP) and the parents of the other 75 were absent (AP). Pain in children was assessed through evaluation scales adapted to their age groups, and stress was measured with the Groningen Scale. The anxiety in parents was assessed with the STAI Anxiety Questionnaire. A comparative analysis of the three variables was conducted according to the assignment arm (mean and standard deviation (SD)). A multivariate analysis was conducted through linear regression in order to assess the effect of the presence of their parents on the pain and stress levels of the children. Results: the study included 150 patients (PP arm n=75 and AP arm n=75). The mean age in the PP group was 3 years, and 5 years in the AP arm; the assignment arms presented statistically significant differences according to the child’s age (p<0.05). The mean pain in children from the PP arm was 4.8 (SD:2.8), and 3.8 in the AP arm (SD:2.2). The mean stress of children in the PP arm was 2.9 (SD:1.5), and 2.2 in the AP arm (SD:1.5), with statistically significant differences between comparison arms for pain and stress (p<0.05). The mean anxiety in parents of the PP arm was 37.5 (SD:4.5), and 37.5 in the AP arm (SD:4.5), without ant statistically significant difference (p<0.05). Age and success in venous puncture is associated with pain, and age is associated with children’s anxiety. Conclusions: parent’s anxiety was not modified in any arm. Pain and stress in children from the arm with parents present were higher than in the arm with absent parents, assuming that the age of boys and girls in the PP arm was lower than in the AP arm. The age of boys and girls and the success in venous puncture has influence on pain, and age is a determining factor for stress in children undergoing venous puncture (AU)

Relationship of Genetic Variants With Procedural Pain, Anxiety, and Distress in Children.

OBJECTIVE: This study used a candidate gene approach to examine genomic variation associated with pain, anxiety, and distress in children undergoing a medical procedure. STUDY DESIGN: Children aged 4-10 years having an IV catheter insertion were recruited from three Midwestern children's hospitals. Self-report measures of pain, anxiety, and distress were obtained as well as an observed measure of distress. Samples were collected from children and biological parents for analysis of genomic variation. Genotyped variants had known or suspected association with phenotypes of interest. Analyses included child-only association and family-based transmission disequilibrium tests. RESULTS: Genotype and phenotype data were available from 828 children and 376 family trios. Children were 50% male, had a mean age of 7.2 years, and were 84% White/non-Hispanic. In family-based analysis, one single-nucleotide polymorphism (SNP; rs1143629, interleukin ( IL1B) 1ß) was associated with observed child distress at Bonferroni-corrected levels of significance ( p = .00013), while two approached significance for association with high state anxiety (rs6330 Nerve Growth Factor, Beta Subunit, [ NGFB]) and high trait anxiety (rs6265 brain-derived neurotrophic factor [ BDNF]). In the child-only analysis, multiple SNPs showed nominal evidence of relationships with phenotypes of interest. rs6265 BDNF and rs2941026 cholecystokinin B receptor had possible relationships with trait anxiety in child-only and family-based analyses. CONCLUSIONS: Exploring genomic variation furthers our understanding of pain, anxiety, and distress and facilitates genomic screening to identify children at high risk of procedural pain, anxiety, and distress. Combined with clinical observations and knowledge, such explorations could help guide tailoring of interventions to limit procedure-related distress and identify genes and pathways of interest for future genotype-phenotype studies.