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Analysis and Prevention of infusion pain for infants
Posted by:Fert  Published:2012-12-07  Views:7479


Analysis and Prevention of infusion pain for infants
Excerpts from Issue Six, Volume Eight, Journal of Modern Nursing
CLC Number: R473.72   WM: B Article ID: 1009-9689 (2002) 06-0423-02
Intravenous infusion has become an important way for children infusion. According to incomplete statistics, 70% to 80% of children at our hospital’s Pediatric Clinic receive treatment by infusion, while for those who require hospitalization, infusion accounts for a higher proportion of 90%. Phlebitis, caused by stimulant medication, children’s delicate blood vessels and children’s active nature resulting in repeating puncturing, leads to great pain, both physically and psychologically, or worse still, various mental problems. From June, 1998 to October, 2000, we conducted a research on reasons of infusion pain and we got satisfactory results.
1. Clinical information
1.1 Age   
      92 cases, 23 cases below age 1, 37 cases below age 3, 32 cases below age 6
1.2 Pain Causes  
      48 cases due to stimulant medication, which include fructose diphosphate, potassium chloride, salvia miltiorrhiza, Dopamine, amino acid with 20% of fat emulsion, 20% mannitol and some antibiotics. 34 cases of phlebitis are due to more than 24 hours of successive infusion, of which 28 cases are caused by Intravenous catheter. 8 cases are caused by medicine seepage. 31 cases had an experience that the very same vein received repeating puncturing.
1.3 Pain Assessment  
      Adopting Wong-Baker Facial Scale method, which uses 6 different facial expressions from smiling, sadness to crying. 0 stands for No Pain, 1 for A Little Painful, 2 for Slightly Painful, 3 for Obvious Pain, 4 Very Painful, 5 for Severely Painful. 6 for Painful & Crying.
1.4 Clinical Symptoms  
      Besides different facial expressions during painful infusion, there are reactions, say, transient facial spasm, lips biting, etc. For those little children who can’t speak, they would sob and cry that could’t be calmed. Some parts of skin receiving stimulant medication would turn into red color and then turn back to normal color when infusion is finished.
2. Factors that Lead to Pain During Infusion
2.1 Medicine
2.1.1 Due to acidity, density, osmotic pressure, medicine’s toxicity and medicine particles. 
For instance, 20% mannitol has many crystallization particles, which can lead to thrombus, blood vessel partially blocking and lack of blood flow when these particles enter vein in a very short time. Number of blood platelet declines due to particles collision which lead to bleeding and short of oxygeon. Hypertonicity medicine plus fast infusion speed would increase blood vessel pressure and lead to Vasoconstriction, spasm and exosmose that cause edema and inflammation.
2.1.2 Related to Pharmacological Effects
       When it’s a big dose of medicine or long-time infusion, dopamine would enter subcutaneous tissue because of permeability’s increasing and then lead to Chemical inflammation reaction, say, partial tissue denaturation, inflammatory cells’ soaking or necrosis.
2.2 Blood Factors  
      Medicine would take longer time to pass through blood vessel because children’s blood vessel is too thin, which inevitably increases medicine density and blood vessel stimulation
2.3 Infusion Speed and Time  
      Pain intensity has something to do with medicine density per unit time during clinical infusion. IV push cause more pain than rapid IV drip, while rapid IV drip causes more pain than normal speed drip. Pain intensity is also in proportion to infusion time. When being injected 0.3% potassium chloride liquid, there’s no such obvious pain.
2.4 Intravenous Catheter
      Phlebitis caused by intravenous catheter is related to indwelling time, puncturing technique, operation specifications as well as flow speed and materials.
2.5 Nurse’s Operation Techniques
      Some nurses haven’t paid enough attention to infusion pain caused by stimulant medications. And they fail to choose the right vein for each different child during infusion, which results in repeating puncturing on the same vein that has led to fibrosis of blood vessel, medicine residual and obliterative phlebitis. What’s more, nurses have ignored other pains during infusion.
3 Precautions
3.1 To Choose Suitable Wet-Compressing Medicine
      To prevent dopamine's vasoconstrictor effect and phlebitis, continuous wet compressing with 30% magnesium sulfate solution or phentolamine diluent (0.08%) is needed to dilate blood vessels; As for pain caused by PH or density, wet compressing with 2% lidocaine solution is needed 15 minutes before infusion to stop pain; continuous wet compressing with 30% magnesium sulfate solution is needed when being injected 0.3% potassium chloride solution. Further more, wet compressing plays the role of cold compressing to prevent partial cell activity so that pain could be alleviated. magnesium sulfate has anti-inflammatory properties.
3.2 Reduce Particle Number
      To heat solution temperature up to 35 Celsius Degrees before rapid IV dripping of 20% mannitol in order to minimize the amount of particles; make sure that antibiotics is totally dissolved in solvent without any crystallization .
3.3 Increase Partial Blood Flow Volume
      Please keep room temperature between 18 to 20 Celsius Degrees when temperature is low. Then take partial wet compressing to avoid peripheral vasoconstriction. And still, electronic infusion heater (without any adverse effects) could be used to raise liquid temperature.
3.4 Try to avoid continuous infusion or infusion with more than two kinds of stimulant medications at one time. When it is needed to receive infusion of several strong stimulant medications, it is recommended not to take two kinds of medicine through the same vein by three-way pipe under the circumstance that treatment is not affected. As for children, two-way pipe is recommended and alternated.
3.5 Prevention of Intravenous Catheter
      Firstly, try to choose a vein with inner diameter one time bigger than intravenous catheter.
      Secondly, try to choose soft pipe. Puncturing angle should be lesser than 30°to avoid mechanical injury.
3.6 Infusion Speed Setting and Vein Choosing
      It is better to choose a thick vein instead of thin and blood circulation part, and to set a suitable dripping speed when there’s no limit to infusion speed.
3.7 To Create Relaxing Environment for Children
      To choose beautiful music for children during infusion can relieve infusion pain and adjust their moods. By telling stories, playing games and watch TV or carton movies to distract children’s attention and to alleviate infusion pain as a result.
3.8 Successful Puncturing for Each Time
      To constantly observe children’s reactions and infusion device.
      Try to avoid repeatedly receiving medicine by same vein and several kinds of stimulant medication adding at the same time.
      To pull out needle,  the first step is to pull out needle, then press needle hole in order to alleviate or eliminate mechanical injury.
     To avoid infection after pulling out needle.

Authers: Wen Cheng, Jing Hu, Qun Huang

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