A Comparison of a Needle-Free Injection System for Local Anesthesia Versus EMLA® for Intravenous Catheter Insertion in the Pediatric Patient

Abstract

Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7-19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip (n = 57) or 2.5 g of EMLA (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0-10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA (median = 3) and the J-Tip (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

“…[115][116][117][118][119] Needlefree injection systems using either powder or liquid jet injection reduce the onset time even more. 106,[120][121][122][123] Vapocoolant sprays that have immediate onset of action have been found to be effective in reducing venipuncture pain in adults; however, they are less effective in children, likely because of their intolerance of the unpleasant cold feeling resulting from the required administration time. 124,125 Recent innovations include a vibrating device that, when applied to the proximal extremity over a cold pack, may decrease the pain of venipuncture and immunizations by taking advantage of the "gate" theory of pain.…”

Pharmacologic Approaches for Reducing Venous Access Pain in Children

“…The device contains a small syringe and a CO 2 cartridge. 12,[32][33][34] To operate it, a lidocaine solution is loaded into the syringe and the device is placed tightly against the skin where the venous access procedure is to occur. Pressing a lever on the syringe releases the CO 2 and drives a piston to eject the lidocaine solution under high pressure via a micro-orifice at the end of the device.…”

Comparison of the Effectiveness of Buzzy, Distracting Cards and Balloon Inflating on Mitigating Pain and Anxiety During Venipuncture in a Pediatric Emergency Department

“…Moreover, fear of pain experienced due to medicalprocedures in childhood usually continues up to adulthood [8]. Although pain may be reduced by behavioral and pharmacologic interventions (e.g., age appropriate patient preparation, parental presence, distraction techniques, vapocoolant cold spray, vibration near the site, subcutaneous local anesthetics, topical anesthetic and systemic anesthetics) and there are data to support each of these individual treatments most of these preparations are impractical in nonelective settings because they are too time consuming and there is no single integrated intervention to optimize pain relief [9]. Furthermore, most current options require excessive cost, or staff training, which are formidable barriers to practice change [4].…”