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Are you treating pain adequately for procedures?
Many children are given no pain meds
If a child was undergoing an intravenous (IV) catheter placement, would you offer anything to relieve the pain? The answer for many ED nurses would be "no," according to a new study.1
Researchers reviewed 1,727 procedures performed in 1,210 children undergoing venipuncture, intravenous (IV) catheter placement, fingersticks, intramuscular (IM) or subcutaneous injections, urethral catheterization, or nasogastric tube placement. They found that almost none received any pain management.
These minor procedures usually are done by ED nurses and pain management hasn't been part of the standard of care, says Kelly D. Young, MD, MS, one of the study's authors and director of pediatric emergency medicine and pain management education at Harbor — University of California Los Angeles Medical Center in Torrance. "However, there are pain management methods available," she says. "They just take a change in culture and maybe somebody to be the patient's advocate." Here are interventions for these procedures, suggested by Young:
Educate yourself on the different ways to manage pain and create protocols for their use in your ED, advises Young. "Then strive to make use of pain management methods the new standard of care," she says. Nurses also can advocate for pain management with physicians who are performing incision and drainage of abscesses and infant lumbar punctures, says Young. "Have staffing and physical space set up so that procedural sedation can be used for abscesses and complex lacerations," she suggests.
At Children's Healthcare of Atlanta, ED nurses initiate pre-procedural pain management for venipuncture, IV catheter placement, fingersticks, and IM injections, using protocols that allow the application of a topical anesthetic and cold spray before any type of invasive stick, including lumbar punctures, reports Marianne Hatfield, RN, BSN, system director of emergency services. "We are also actively participating in a study with the physicians on one of our campuses to instill viscous lidocaine prior to insertion to decrease the pain associated with urethral catheterization," she reports.
As an ED nurse, it's your role to advocate for pain control or medication when your patient is in pain, says Hatfield. "Every patient is assessed for pain at triage," she says. "We begin pain control or preparation for potentially painful procedures at that time."
Depending on the child's age, local anesthetics, oral, or IV sedation medications are given before fracture reduction, laceration repair, or abscess incision and drainage, Hatfield says. "There is usually some discussion between the nurse and the physician regarding what they feel will work best for each patient, but no patient undergoes any of these procedures without pain management," she says.
For more information on pediatric pain management in the ED, contact: