Management of puncture pain in hospitalized children

Punctures are the main cause of pain during hospitalization in pediatrics. The application of a protocolized management improves the hospitalization experience. Objective: To describe the introduction of different strategies aimed at relieving pain associated with punctures in a pediatric middle care unit. Patients and Method: Descriptive retrospective study carried out between October 2018 and May 2020 in a pediatric intermediate care unit of the HCUC (Santiago, Chile). Data analysis included demographic information, type of painful procedure, therapeutic intervention, duration of the procedure, pain scales (CHEOPS and Frankl), and parent/caregiver opinion survey. Results: 89 procedures, in 72 children, mean age 4.5 years. The most frequent painful procedure was Peripheral venous catheter insertion in 41.6% (n = 37) of children, with a mean duration of 7.5 min. The most used therapeutic intervention was the application of topical 4% lidocaine in 76% (n = 68); 73% of the patients presented an evident positive behavior according to the FRANKL scale and, according to CHEOPS, 77.5% presented mild pain. The parent/caregiver survey showed that 79% reported less pain compared with previous puncture episodes, and 98% would request the same measures next time. Conclusions: The application of different strategies to manage pain caused by punctures is associated with low pain scores and favorable parental acceptance. The use of standardized management protocols could allow better approaches and experiences for patients and their parents/caregivers at low cost and easy applicability.