The Use of Topical Anesthesia to Reduce Pediatric IV Cannulation Pain in an Emergency Department

This dissertation, "The Use of Topical Anesthesia to Reduce Pediatric IV Cannulation Pain in an Emergency Department" by Yat-ming, Lai, 黎一鳴, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Intravenous cannulation of pediatric patients is a common procedure in emergency departments. It is a useful tool to facilitate medical investigations and drug administration. However, the pain induced by the procedure can lead to patient distress and bother the nursing and medical procedures afterwards. There are many kinds of topical anesthesia but no relevant evidence-based guideline for their use is available for the emergency departments. This dissertation synthesizes the available evidence in the literature to establish an evidence-based guideline for the use of topical anesthesia to reduce pain caused by pediatric intravenous cannulation in an emergency department. The communication, implementation and evaluation plan are also developed. A systematic literature review was conducted from 30th August to 2nd September, 2011. A number of electronic databases, including PubMed, CINAHL Plus and Embase were searched. Thirteen eligible randomized controlled trials were identified. They were integrated into a table of evidence and were critically appraised by the SIGN Methodology Checklist. After synthesis of evidence, it is suggested that needleless anesthesia with apparatus assistance significantly reduced pain as early as in five minutes. Patients should however be observed for two hours after the administration of anesthesia for signs of adverse effects. The implementation potential, in terms of the transferability, feasibility and cost-benefit ratio, was examined. Among the anesthesia devices, the Jet lidocaine device has satisfactory transferability, feasibility and cost-benefit ratio. The evidence is then translated into a practice guideline with the recommendations scored based on the "SIGN 50: A guideline developer's handbook." A fourteen-month implementation plan, including a communication plan, a pilot study and an evaluation plan is developed. The communication phase lasts for three months and the stakeholders including the Chief of Service, Department Operation Manager, Advanced Practice Nurses, frontline healthcare professionals and the pharmacy department are identified. The pilot plan lasts for ten weeks, which includes a two-week training period, a three-week observational period for baseline measurement, a three-week intervention period and an eight-week amendment period. The pilot study collects data regarding the pain level at baseline and identifies unanticipated problems in the guideline. Amendments would be made accordingly and the revised guideline would be sent for ethical approval before the implementation phase. In the evaluation plan, the primary outcome for the innovation is the level of pain. The secondary outcomes are the admission rate and length of hospital stay. Other outcomes are the satisfaction of healthcare professionals, utilization rate and cost. It is expected that the cannulation pain, admission rate and length of hospital stay would be lower with the application of topical anesthesia. DOI: 10.5353/th_b4833544 Subjects: Local anesthesia Intravenous catheterization Emergency nursing