Pain Assessment in Venepuncture among Children: experience from a single centre study in Sri Lanka

Abstract

Introduction: Venepuncture is the commonest and feared painful experience in hospitalized children.

Objectives: To assess the venepuncture pain (VP) status and associated factors among children admitted to paediatric units in Teaching Hospital Karapitiya (THK).

Method: A cross-sectional study was conducted among 300 children aged 2 months to 8 years, who underwent venepuncture in above setting in 2021. Data were collected by direct observation of the procedure and by administering a questionnaire to primary caregivers. Pain scores were documented using the Face, Legs, Activity, Cry and Consolability (FLACC) pain scoring system on an ordinal scale (0-10). The median pain scores among groups were compared using Mann Whitney U test. The level of significance was considered as 0.05.

Results:Of the observed 300 venepunctures, 71 (23.6%) were blood samples and 229 (76.3%) were intravenous cannulations. The median (IQR) VP score was 6 (2). There was zero practice of assessment and documentation of VP using a pain scale. The practice of multimodal pain management (MPM) was observed only in 9 (3%), while 24 (8%) children did not receive any VP management. Two hundred and sixty (86.7%) parents were not satisfied with existing pain management, while 239 (79.7%) parents expected more actions to improve the practice, including MPM (80%, n=192). Of suggested methods, anaesthetic gel application before venepuncture (87.7%, n=263) was identified as the highest expected method. Statistically significant higher pain scores were associated with younger age groups (p = 0.000), being a single child (p = 0.002), increased number of attempts (p = 0.000) and longer duration of procedure (p = 0.000) in Mann Whitney U test.

Conclusions: In this study, statistically significant higher pain scores were associated with younger age groups, being a single child, increased number of attempts and longer duration of procedure.