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Parental Holding and Positioning to Decrease IV Distress in Young Children: A Randomized Controlled Trial

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Young children are generally restrained in supine position for IV starts, a position that creates fear but is presumed necessary. This study randomly assigned children of ages 9 months to 4 years (N = 118) to being held upright by a parent or lying flat on an exam table for their IV procedure. Distress scores as rated by the Procedure Behavior Rating Scale were significantly lower in the upright positioning group (p = .000); parents were more satisfied with the upright position, and the upright position did not significantly alter the number of IV attempts needed. The upright position appears to be an effective way to decrease IV distress in young children.

Section snippets

Review of the Literature

Receiving a needle (IV or injection) is rated by children as one of their most feared medical events (Broome & Hellier, 1987, Hart & Bossert, 1994, Siaw et al., 1986). Research has found long-term traumatic memories for some children receiving painful medical procedures (Chen et al., 2000, Stuber et al., 1996). Furthermore, “… an intervention that successfully reduces children's negative memories may alleviate their distress during future stressful events” (Chen et al., 2000, p. 944). Watching

Methodology

This study was conducted in a Level I trauma emergency department of a pediatric hospital in a large midwestern city. Research assistants trained in data collection explained the study and obtained consent from parents/guardians of eligible study children. Inclusion criteria for study children were as follows: ages of 6 months to 4 years; categorized through triage as requiring urgent or emergent care; needing an IV catheter placed; and had a parent or guardian who was able to give consent.

Results

One hundred thirty-five subjects were recruited for the study, but 17 of these were not used for the analysis; therefore, the total sample size comprised 118 subjects. Reasons for not being able to use the data included the following: video recording errors (seven); wrong age of subject (four); incomplete forms (two); no legal guardian (one); did not need IV (one); child became critically ill (one); mother refused flat position (one). In the last case, the mother of the child had been willing

Discussion

Parental holding and upright positioning appear to be successful in reducing the distress of having an IV started in young children. The two prior studies with upright positioning and IV/venipuncture procedures (Cavender et al., 2004, Kaher, 2003) both found lower distress scores with upright positioning, although in neither study was the difference statistically significant. However, both studies had small sample sizes. In this study, children in the experimental group had significantly lower

References (30)

  • E. Chen et al.

    Children's memories for painful cancer treatment procedures: Implications for distress

    Child Development

    (2000)
  • A.M. Frey

    Tips for pediatric IV insertion

    Nursing

    (1997)
  • A.M. Frey

    Pediatric IV insertion

    Nursing

    (2000)
  • D. Hart et al.

    Self-reported fears of hospitalized school-age children

    Journal of Pediatric Nursing

    (1994)
  • P.B. Jacobsen et al.

    Analysis of child and parent behavior during painful medical procedures

    Health Psychology

    (1990)
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