Optimizing the Management of Peripheral Venous Access Pain in Children: Evidence, Impact, and Implementation

Venipuncture and intravenous (IV) cannulation procedures are a routine part of modern clinical practice. Unfortunately, these procedures also cause pain and distress, which can have a significant impact on children. Pediatric inpatients report IV line placement as the leading cause of procedure-related pain in the hospital, on par with postsurgical pain.1 A significant proportion of children undergoing venipuncture also experience moderate or severe pain2 and elevated levels of preprocedural and procedural distress.2,3 Clinical practice guidelines advocate the use of strategies to ameliorate the pain and distress of venous access procedures in children4–7; evidence to date, however, has suggested that implementation of such strategies often remains inadequate.8,9 A multidisciplinary roundtable of experts met in the summer of 2007 to discuss the problem of venous access pain in children. All participants were practicing health care providers and were local or international leaders in the field of pediatric pain management. The roundtable covered 3 broad topics: (1) the biology of the pain-response system in general and, specifically, the immediate and long-term effects of venous access pain on children; (2) behavioral and pharmacologic treatment modalities for pediatric venous access pain; and (3) practical recommendations for institutions that wish to improve systematically their treatment of pediatric pain, including venous access pain. To address the last topic, several centers of excellence in the area of venous access pain management presented their … Address correspondence to William T. Zempsky, MD, Pain Relief Program, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106. E-mail: wzempsk{at}ccmckids.org