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Published online October 31, 2008
PEDIATRICS Vol. 122 Supplement November 2008, pp. S161-S170 (doi:10.1542/peds.2008-1055i)
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SUPPLEMENT ARTICLE


On the Front Lines: Lessons Learned in Implementing Multidisciplinary Peripheral Venous Access Pain-Management Programs in Pediatric Hospitals

Sarah Leahy, BA, RN, RSCNa, Robert M. Kennedy, MDb, Joy Hesselgrave, MSN, RN, CPONc, Karen Gurwitch, PharmDd, Mary Barkey, MA, CCLSe, Toni F. Millar, MS, CCLSe

a Center for Pain Relief, Children's Healthcare of Atlanta, Atlanta, Georgia
b Department of Pediatrics, Division of Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri
c Texas Children's Cancer Center and Hematology Service, Texas Children's Hospital, Houston, Texas
d Pharmacy Department, Texas Children's Hospital, Houston, Texas
e Family and Child Life Services, Rainbow Babies & Children's Hospital, Cleveland, Ohio

Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. By using case studies that analyze this issue from the perspective of the nurse, the physician, the pharmacist, and the child life specialist, this article illustrates how multidisciplinary programs designed to manage needle pain have been developed successfully in several institutions. Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience.

Key Words: venipuncture • peripheral cannulation • pain • local anesthetics • analgesics • institutional management teams • outcome assessment • behavioral medicine • pediatrics

Abbreviations: ED—emergency department • SLCH—St Louis Children's Hospital • IV—intravenous • TCH—Texas Children's Hospital

Accepted Jun 4, 2008.


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W. T. Zempsky
Optimizing the Management of Peripheral Venous Access Pain in Children: Evidence, Impact, and Implementation
Pediatrics, November 1, 2008; 122(Supplement_3): S121 - S124.
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