mnaap immunization work group conference call
TRANSCRIPT
MNAAP Immunization Work Group Conference Call
3/5/20
REDUCING PAIN AND ANXIETY WITH NEEDLE PROCEDURES
Donna Eull MA, RN, CHPPN, PhDc
March, 5 2019
The Comfort Promise
WHY
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• Friedrichsdorf S, Eull D, Weidner C, Haun M : Children Are Afraid of Needle Pokes.
Journal of Things We Already Knew. 2015:(1)1:1-518
What are children most afraid of when coming to the hospital or clinic?
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• Most children receive a
minimum of 18 needle
procedures, in their first 15
months of life.
• If they were born pre-term the
exposure is significantly higher.
Current state
WHAT
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4 Simple Steps
• Topical Anesthesia
• Sucrose or breast feeding
• Comfort positioning
• Distraction
Evidence based strategies for needle procedures
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HOW
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• 4% lidocaine (anacream, LMX)
• Apply 30 minutes prior to procedure
• Cover with to avoid getting in mouth or eyes
• Wipe off prior to injection, prep skin per protocol
• Can safely be left in place for 2 hours
• Effect lasts for 1 hour after it is removed
• Warm packs speed up numbing process and reverse vasoconstriction
Topical Anesthetic; numb the skin
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For best effect:• Sucrose
• Give solution (on pacifier, mom’s finger, or side of cheek)
• 2 minutes prior to procedure
• effect lasts for 4 minutes
• Re-administer as needed during the procedure
• Breast feeding
• Start 2-5 minutes before the
• procedure and continue
throughout
Sucrose or breast feeding
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• For Children <6 months of age
• Swaddle
• Skin to skin (warmth)
• Parent holding
• Facilitated tucking or nesting
Cochrane abridged review 2011,
Johston et al 2014, Liaw et al 2011,
Mcnair, Yeo, Johston , and Taddio 2013
Comfort positioning
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For Children > 6 months
• Upright is best
• Preference is for parents
• to hold
• or be close by
• Give children school age
and older a choice
Taddio et al 2010, Cochrane review , Curtis et al 2012.
Mcnair, Yeo, Johnston, & Taddio 2013
Comfort positioning
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Distraction
Encourage/assist parents to actively distract their child with age
appropriate options :
• Favorite toy, comfort item
• Music, singing
• Breathing exercises, ie bubbles, pinwheels, kleenex
• Books, find it sheets, stories
Page 15© 2020 Page 15
“I never knew it (shots) could be this easy, why didn’t someone offer this before?”
CO Snapshot of School Recognition
CO Snapshot of School Recognition