Parental Holding and Positioning to Decrease IV Distress in Young Children: A Randomized Controlled Trial

      Young children are generally restrained in supine position for IV starts, a position that creates fear but is presumed necessary. This study randomly assigned children of ages 9 months to 4 years (N = 118) to being held upright by a parent or lying flat on an exam table for their IV procedure. Distress scores as rated by the Procedure Behavior Rating Scale were significantly lower in the upright positioning group (p = .000); parents were more satisfied with the upright position, and the upright position did not significantly alter the number of IV attempts needed. The upright position appears to be an effective way to decrease IV distress in young children.
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        • Agency for Health Care Policy and Research, Public Health Service.
        Acute pain management in infants, children, and adolescents: Operative and medical procedures (AHCPR Publication No. 92-0020).
        U.S. Department of Health and Human Services, Rockville, MD1992
        • Bauchner H.
        • Vinci R.
        • Bak S.
        • Pearson C.
        • Corwin M.
        Parents and procedures: A randomized controlled trial.
        Pediatrics. 1996; 98: 861-867
        • Boorde M.
        Kicking and screaming.
        Nursing. 1998; 28: 6
        • Broome M.
        • Hellier A.
        School-age children's fears of medical experiences.
        Issues in Comprehensive Pediatric Nursing. 1987; 10: 77-86
        • Brown J.
        Registered nurse's choices regarding the use of intradermal lidocaine for intravenous insertions: The challenge of changing practice.
        Pain Management Nursing. 2002; 3: 71-76
        • Cavender K.
        • Goff M.D.
        • Hollon E.C.
        • Guzzetta C.E.
        Parent's positioning and distracting children during venipuncture.
        Journal of Holistic Nursing. 2004; 22: 32-54
        • Caty S.
        • Ellerton M.L.
        • Ritchie J.A.
        Use of a projective technique to assess young children's appraisal and coping responses to a venipuncture.
        Journal of the Society of Pediatric Nursing. 1997; 2: 83-92
        • Chen E.
        • Zeltzer L.K.
        • Craske M.G.
        • Katz E.
        Children's memories for painful cancer treatment procedures: Implications for distress.
        Child Development. 2000; 71: 933-947
        • Frey A.M.
        Tips for pediatric IV insertion.
        Nursing. 1997; 27: 32
        • Frey A.M.
        Pediatric IV insertion.
        Nursing. 2000; 30: 54-56
        • Hart D.
        • Bossert E.
        Self-reported fears of hospitalized school-age children.
        Journal of Pediatric Nursing. 1994; 9: 83-90
        • Jacobsen P.B.
        • Manne S.L.
        • Gorfinkle K.
        • Schorr O.
        • Rapkin B.
        • Redd W.H.
        Analysis of child and parent behavior during painful medical procedures.
        Health Psychology. 1990; 9: 559-576
        • Jay S.M.
        • Elliott C.H.
        A stress inoculation program for parents whose children are undergoing painful medical procedures.
        Journal of Consulting and Clinical Psychology. 1990; 58: 799-804
      1. Kaher, B. M. W. (2003). The effect of distraction and positioning for venous cannulation on pain responses in young children. Unpublished doctoral dissertation, Kansas State University, Manhattan, KS.

        • Katz E.R.
        • Kellerman J.
        • Ellenberg L.
        Hypnosis in the reduction of acute pain and distress in children with cancer.
        Journal of Pediatric Psychology. 1987; 12: 379-394
        • Katz E.R.
        • Kellerman J.
        • Siegel S.E.
        Behavioral distress in children with cancer undergoing medical procedures: Developmental considerations.
        Journal of Consulting and Clinical Psychology. 1980; 48: 356-365
        • Katz E.R.
        • Kellerman J.
        • Siegel S.E.
        Self-report and observational measurement of acute pain, fear and behavioral distress in children with leukemia.
        in: Paper presented at the 3rd Annual Meeting of the Society of Behavioral Medicine, Chicago, IL1982, March
        • Kennedy R.
        • Luhmann J.
        The “ouchless emergency department” getting closer: Advances in decreasing distress during painful procedures in the emergency department.
        Emergency Medicine. 1999; 46: 1215-1257
        • Kleiber C.
        • Craft-Rosenberg M.
        • Harper D.C.
        Parents as distraction coaches during IV insertion: A randomized study.
        Journal of Pain and Symptom Management. 2001; 22: 851-861
        • Klein E.J.
        • Shugerman R.P.
        • Leigh-Taylor K.
        • Schneider C.
        • Portscheller D.
        • Koepsell T.
        Buffered lidocaine: Analgesia for intravenous line placement in children.
        Pediatrics. 1995; 95: 709-712
        • Luhmann J.
        • Hurt S.
        • Shootman M.
        • Kennedy R.
        A comparison of buffered lidocaine versus ELA-Max before peripheral intravenous catheter insertion in children.
        Pediatrics. 2004; 113: 217-220
        • MacLaren J.E.
        • Cohen L.L.
        A comparison of distraction strategies for venipuncture distress in children.
        Journal of Pediatric Psychology. 2005; 30: 387-396
        • Naar-King S.
        • Siegel P.T.
        • Smyth M.
        • Simpson P.
        A model for evaluating collaborative health care programs for children with special needs.
        Children's Services: Social Policy, Research and Practice. 2000; 3: 233-245
        • Pederson C.
        Effect of imagery on children's pain and anxiety during cardiac catheterization.
        Journal of Pediatric Nursing. 1995; 10: 365-373
        • Schiff W.B.
        • Holtz K.D.
        • Peterson N.
        • Rakusan T.
        Effect of an intervention to reduce procedural pain and distress for children with HIV infections.
        Journal of Pediatric Psychology. 2001; 26: 417-427
        • Siaw S.K.
        • Stephens L.R.
        • Holmes S.S.
        Knowledge about medical instruments and reported anxiety in pediatric surgery patients.
        Children's Health Care. 1986; 14: 134-141
        • Stephens B.K.
        • Barkey M.E.
        • Hall H.R.
        Techniques to comfort children during stressful procedures.
        Advances in Mind–Body Medicine. 1999; 15: 49-60
        • Stuber M.L.
        • Christakis D.A.
        • Houskamp B.
        • Kazak A.E.
        Posttrauma symptoms in childhood leukemia survivors and their parents.
        Psychosomatics. 1996; 37: 254-261
        • van Aken M.A.
        • van Lieshout C.F.
        • Katz E.R.
        • Heezen T.J.
        Development of behavioral distress reaction to acute pain in two cultures.
        Journal of Pediatric Psychology. 1989; 14: 421-432
        • Weisenberg M.
        • Aviram O.
        • Wolf Y.
        • Raphaeli N.
        Relevant and irrelevant anxiety in the reaction to pain.
        Pain. 1984; 20: 371-383