Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial

Volkan Susam, Marie Friedel, Patrizia Basile, Paola Ferri, Loris Bonetti, Volkan Susam, Marie Friedel, Patrizia Basile, Paola Ferri, Loris Bonetti

Abstract

Background and aim of the work: procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture.

Methods: A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS).

Results: Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System.

Conclusion: The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.

Figures

Figure 1.
Figure 1.
Distraction Cards
Figure 2.
Figure 2.
Buzzy Application
Figure 3.
Figure 3.
Flow Diagram (CONSORT, 2010)
Graph 1.
Graph 1.
Pain Perception in Experimental and Control Groups

References

    1. Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. 12th ed. Philadelphia, PA: Wolters Williams Wilkins; 2010. Brunner and Suddarth’s Textbook of medical surgical nursing.
    1. Testa A, Bonetti C, Berretoni R, di Filippantonio S, Orsini P, Marinangeli F. Il dolore procedurale [Procedural pain] Pain Nursing Magazine Italian Online Journal. 2014 Available from: .
    1. Jeffs D, Wright C, Scott A, Kaye J, Green A, Huett A. Soft on sticks: an evidence-based practice approach to reduce children’s needlestick pain. J Nurs Care Qual. 2011;26:208–15.
    1. Stinson J, Yamada J, Dickson A, Lamba J, Stevens B. Review of systematic reviews on acute procedural pain in children in the hospital setting. Pain Res Manag. 2008;13:51–7.
    1. Van Cleve L, Johnson L, Pothier P. Pain responses of hospitalized infants and children to venipuncture and intravenous cannulation. J Pediatr Nurs. 1996;11:161–8.
    1. Baba LR, McGrath JM, Liu J. The efficacy of mechanical vibration analgesia for relief of heel stick pain in neonates: a novel approach. J Perinat Neonatal Nurs. 2010;24:274–83.
    1. Lynn K. Needle phobics: stuck on not getting stuck. MLO Med Lab Obs. 2010;42:46–8.
    1. Ministero della Salute. [Italian Ministry of Health]. Il dolore nel bambino. Strumenti pratici di valutazione e terapia. [Pain in children. Valid instruments for measures and therapy] Available from: .
    1. Marchioni G, Salerno S, Scalorbi S, Quarella P. Infermieristica in aerea materno-infantile [Nursing in the maternal and child area] Milano: Mc Graw Hill Education; 2014.
    1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–9.
    1. Inal S, Kelleci M. Relief of pain during blood specimen collection in pediatric patients. MCN Am J Matern Child Nurs. 2012;37:339–45.
    1. Moadad N, Kozman K, Shahine R, Ohanian S, Badr LK. Distraction Using the BUZZY for Children During an IV Insertion. J Pediatr Nurs. 2016;31:64–72.
    1. Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs. 2015;16:33–9.
    1. Baxter AL, Cohen LL, McElvery HL, Lawson ML, von Baeyer CL. An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department. Pediatr Emerg Care. 2011;27:1151–6.
    1. Kearl YL, Yanger S, Montero S, Morelos-Howard E, Claudius I. Does Combined Use of the J-tip® and Buzzy® Device Decrease the Pain of Venipuncture in a Pediatric Population? J Pediatr Nurs. 2015;30:829–33.
    1. Schreiber S, Cozzi G, Rutigliano R, et al. Analgesia by cooling vibration during venipuncture in children with cognitive Impairment. Acta Paediatr. 2016;105:e12–6.
    1. Friedel M, Whitman J, Magnani L. Boosting pain awareness through Buzzy Bee. Poster presentation at the 2nd European Congress on Pediatric Palliative Care, Fondazione Maruzza, Rome. 19-21th November 2014
    1. Schulz KF, Altman DG, Moher D. CONSORT GROUP. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
    1. Birnie KA, Noel M, Parker JA, et al. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol. 2014;39:783–808.
    1. Durante A, Ledonne G. Detecting pain in children of different cultures: a pilot study for new tools. Pain Nursing Magazine Italian Online Journal. 2012;4:192–7. Available from: .
    1. Templeton GF. A Two-Step Approach for Transforming Continuous Variables to Normal: Implications and Recommendations for IS Research. Communications of the Association for Information Systems. 2011;28(Article 4) Available from: .
    1. Polit DF, Tatano Beck C. Appraising Evidence for Nursing Practice. Philadelphia: Lippincott Williams and Wilkins; 2014. Essentials of Nursing Research.
    1. White Paper-Early Phase Clinical Research in Italy. 2014 Available from: .
    1. Murphy G. Distraction techniques for venepuncture: a review. Paediatr Nurs. 2009;21:18–20.
    1. Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013;10:CD005179.
    1. Vetri Buratti C, Angelino F, Sansoni J, Fabriani L, Mauro L, Latina R. Distraction as a technique to control pain in pediatric patients during venipuncture. A narrative review of literature. Prof Inferm. 2015;68:52–62.
    1. Accardi MC, Milling LS. The effectiveness of hypnosis for reducing procedure-related pain in children and adolescents: a comprehensive methodological review. J Behav Med. 2009;32:328–39.
    1. Pillai Riddell R, Racine N, Gennis H, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015;12:CD006275.
    1. Inal S, Kelleci M. Distracting children during blood draw: Looking through distraction cards is effective in pain relief of children during blood draw. Int J Nurs Pract. 2012;18:210–9.
    1. Sahiner NC, Bal MD. The effects of three different distraction methods on pain and anxiety in children. J Child Health Care. 2016;20:277–85.
    1. Ebrahimpour F, Sadeghi N, Najafi M, Iraj B, Shahrokhi A. Effect of Playing Interactive Computer Game on Distress of Insulin Injection Among Type 1 Diabetic Children. Iran J Pediatr. 2015;25:e427.
    1. Waibel KH, Katial RK. Effect of topical vapocoolant spray on skin test wheel, flare, and pain responses. Ann Allergy Asthma Immunol. 2005;95:149–53.
    1. Bechara FG, Sand M, Altmeyer P, Sand D, Hoffmann K. Skin cooling for botulinum toxin A injection in patients with focal axillary hyperhidrosis: a prospective, randomized controlled study. Ann Plast Surg. 2007;58:299–302.
    1. Sharma P, Czyz CN, Wulc AE. Investigating the efficacy of vibration anesthesia to reduce pain from cosmetic botulinum toxin injections. Aesthet Surg J. 2011;31:966–71.
    1. Mally P, Czyz CN, Chan NJ, Wulc AE. Vibration anesthesia for the reduction of pain with facial dermal filler injections. Aesthetic Plast Surg. 2014;38:413–8.
    1. Canbulat Şahiner N, İnal S, Sevim Akbay A. The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children. J Perianesth Nurs. 2015;30:228–35.
    1. Landier W, Tse AM. Use of complementary and alternative medical interventions for the management of procedure-related pain, anxiety, and distress in pediatric oncology: an integrative review. J Pediatr Nurs. 2010;25:566–79.
    1. Jensen MP, Jamieson GA, Lutz A, et al. New directions in hypnosis research: strategies for advancing the cognitive and clinical neuroscience of hypnosis. Neurosci Conscious. 2017;3:pii–nix004.
    1. Liossi C, White P, Hatira P. A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain. 2009;142:255–63.
    1. Claar RL, Simons LE, Logan DE. Parental response to children’s pain: the moderating impact of children’s emotional distress on symptoms and disability. Pain. 2008;138:172–9.
    1. Evans S, Meldrum M, Tsao JC, Fraynt R, Zeltzer LK. Associations between parent and child pain and functioning in a pediatric chronic pain sample: A mixed methods approach. Int J Disabil Hum Dev. 2010;9:11–21.
    1. Harper FW, Penner LA, Peterson A, Albrecht TL, Taub J. Children’s positive dispositional attributes, parents’ empathic responses, and children’s responses to painful pediatric oncology treatment procedures. J Psychosoc Oncol. 2012;30:593–613.
    1. Lipani TA, Walker LS. Children’s appraisal and coping with pain: relation to maternal ratings of worry and restriction in family activities. J Pediatr Psychol. 2006;31:667–73.
    1. Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol. 2014;69:142–2.
    1. Goffaux P, Redmond WJ, Rainville P, Marchand S. Descending analgesia--when the spine echoes what the brain expects. Pain. 2007;130:137–43.
    1. McCarthy AM, Kleiber C, Hanrahan K, et al. Matching doses of distraction with child risk for distress during a medical procedure: a randomized clinical trial. Nurs Res. 2014;63:397–407.

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