The Use of Vapocoolant in the Adult Population to Improve Patient Perception of Pain with Peripheral Intravascular Access
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IMPORTANCE: Patient anxiety and perception of pain during peripheral intravenous (PIV) cannulation can unfavorably impact both patients and treatment provided. Topical analgesics are rarely used due to a long time to effectiveness and treatment delay, but vapocoolant has a more immediate effect. OBJECTIVE: To investigate whether the use of a topical vapocoolant anesthetic spray at the site of intravenous access reduces pain and anxiety associated with PIV insertion in an adult emergency room population. DESIGN, SETTING AND PARTICIPANTS: A randomized, doubleblind, placebo-controlled, single-center trial, conducted from July 2014 to August 2014 in an emergency department with 72 patients with orders for PIV placement receiving either topical vapocoolant spray (n=38) or a placebo spray (n=34). INTERVENTIONS: Vapocoolant spray or placebo was applied to the IV site and allowed to evaporate prior to cleansing and needle insertion. MAIN OUTCOMES AND MEASURES: The primary outcome was patient perception of pain and anxiety with PIV needle insertion using a 0-10 Likert scale. Secondary outcomes included patient/staff preference for the use of the topical anesthetic for future procedures and staff perception of the procedure and patient anxiety. RESULTS: The patient groups did not vary significantly in previous history of IV placement (p>0.999) nor anxiety pre-procedure (p=0.785). Median scores for patient perception of pain did not vary significantly between vapocoolant (2.0) and placebo populations (2.5), nor did the scores vary significantly for patient-forecasted anxiety regarding the procedure should the same procedure be used again (0.5 for vapocoolant, 0.0 for placebo; p>0.05). Additionally, when asked if they desired the spray for future procedures, nurses and patients responded identically: 89% expressed the desire for vapocoolant, while 74% desired future use of placebo; however, the difference was not significant (p>0.05). Neither placebo nor vapocoolant affected the nurses' ability to obtain IV access (p<0.05). No skin blanching or lesions due to the spray were noted. CONCLUSION: Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a vapocoolant spray or placebo.
The 53rd Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 26, 2015, 2-5 p.m., D1.602)
SubjectClinical Research and Case Reports
Emergency Service, Hospital
Tausiani, J., Yau, A., Serrano, D., Youngman,T., Knepper, S., Noah, C., . . . Pease, J.P. (2015, January 26). The use of vapocoolant in the adult population to improve patient perception of pain with peripheral intravascular access. Poster presented at the 53rd Annual Medical Student Research Forum, Dallas,TX. Retrieved from https://hdl.handle.net/2152.5/1548