MNAAP Immunization Work Group Conference Call

3/5/20

REDUCING PAIN AND ANXIETY WITH NEEDLE PROCEDURES

Donna Eull MA, RN, CHPPN, PhDc

March, 5 2019

The Comfort Promise

WHY

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• Friedrichsdorf S, Eull D, Weidner C, Haun M : Children Are Afraid of Needle Pokes.

Journal of Things We Already Knew. 2015:(1)1:1-518

What are children most afraid of when coming to the hospital or clinic?

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• Most children receive a

minimum of 18 needle

procedures, in their first 15

months of life.

• If they were born pre-term the

exposure is significantly higher.

Current state

WHAT

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4 Simple Steps

• Topical Anesthesia

• Sucrose or breast feeding

• Comfort positioning

• Distraction

Evidence based strategies for needle procedures

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HOW

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• 4% lidocaine (anacream, LMX)

• Apply 30 minutes prior to procedure

• Cover with to avoid getting in mouth or eyes

• Wipe off prior to injection, prep skin per protocol

• Can safely be left in place for 2 hours

• Effect lasts for 1 hour after it is removed

• Warm packs speed up numbing process and reverse vasoconstriction

Topical Anesthetic; numb the skin

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For best effect:• Sucrose

• Give solution (on pacifier, mom’s finger, or side of cheek)

• 2 minutes prior to procedure

• effect lasts for 4 minutes

• Re-administer as needed during the procedure

• Breast feeding

• Start 2-5 minutes before the

• procedure and continue

throughout

Sucrose or breast feeding

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• For Children <6 months of age

• Swaddle

• Skin to skin (warmth)

• Parent holding

• Facilitated tucking or nesting

Cochrane abridged review 2011,

Johston et al 2014, Liaw et al 2011,

Mcnair, Yeo, Johston , and Taddio 2013

Comfort positioning

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For Children > 6 months

• Upright is best

• Preference is for parents

• to hold

• or be close by

• Give children school age

and older a choice

Taddio et al 2010, Cochrane review , Curtis et al 2012.

Mcnair, Yeo, Johnston, & Taddio 2013

Comfort positioning

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Distraction

Encourage/assist parents to actively distract their child with age

appropriate options :

• Favorite toy, comfort item

• Music, singing

• Breathing exercises, ie bubbles, pinwheels, kleenex

• Books, find it sheets, stories

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“I never knew it (shots) could be this easy, why didn’t someone offer this before?”

CO Snapshot of School Recognition

CO Snapshot of School Recognition