Venopuncture in Pediatric Emergency Department Using Koala's Distraction Method
Condition: Nursing Caries; Emergencies; Venous Puncture
MeSH terms: Emergencies
Study type: Interventional

Summary: 
      A randomized clinical trial will be performed. Patients aged 3 and 4 years who attend the
      pediatric emergency service of the Miguel Servet Hospital in Zaragoza and require
      venipuncture will be selected. In the control group, traditional venipuncture will be
      performed, placing the child in supine position on the stretcher with the limb to be
      punctured in decline. In the intervention group, the DAK method will be used, where the adult
      will hold the child simulating a hug. A professional will take care of immobilizing the
      chosen limb, and the nurse will perform the venipuncture. The researchers believe that 3 and
      4-year-old children subjected to venipuncture using the Koala Attachment Distraction method
      present a lower level of stress and pain, as well as their companions a lower level of
      anxiety, compared to those subjected to physical restraint.

      Condition of disease: Patients aged 3 and 4 years, who attend the pediatric emergency service
      of the Miguel Servet Hospital in Zaragoza and require venipuncture.

      Intervention: Traditional venipuncture, in supine position on the stretcher with the limb to
      be punctured in decline. + DAK method, simulating a hug.
    

Detailed description: 
      A randomized clinical trial will be performed. 220 participants between 3 and 4 years old
      will be selected and randomized to participate. Control group and experimental group will
      enrolled 110 participants each one. Control group will be venipunctured in the traditional
      way. Intervention group will be venipunctured using the DAK method. Before and during the
      venipuncture, three tests will be performed. To assess level's pain, before and during the
      technique, the Face, Legs, Activity and Consolability (FLACC) scale will be used, obtaining
      an assessment of maximum, severe, moderate, mild or no pain.

      To evaluate the child's stress, before and during the technique, the Groningen Anxiety Scale
      will be used, which assesses 3 items: the child's condition, muscle tension and crying,
      classifying them in 5 degrees from least to greatest stress. To assess the perceived anxiety
      of the companion, the State-Trait Anxiety Inventory (STAI) questionnaire will be used,
      classifying it in percentiles according to age and sex. In both groups, a trained observer
      will evaluate the child's pain and stress before and during the technique, and the companion
      will fill out the STAI questionnaire. Study participants will be required to read an
      information sheet and sign an informed consent.
    

Intervention name(s): Control group: Traditional venipuncture, on the stretcher.; Intervention group: DAK method venipuncture, simulating a hug
Intervention type(s): Procedure; Procedure
Intervention description(s): The companion will be given the State/Trait Anxiety Questionnaire(STAI) for the initial assessment of the companion's anxiety and will be asked to recall their perceived emotions during the venipuncture. The observer will assess child pain and stress using FLACC and Groningen scale and will record it. Next, the companion will place the child on the stretcher in supine position with the limb to be punctured in decline. During the technique, the companion will be present, being able to participate by establishing links of consolation or distraction, as is usually done in the hospital. Simultaneously, a professional from the service will be in charge of holding the chosen extremity, as well as the opposite one. The responsible nurse will perform the venipuncture and/or collecting samples. The observer will assess child's pain and stress and caregiver's STAI during the intervention with the same scales.; The companion will be given the State/Trait Anxiety Questionnaire(STAI) for the initial evaluation of the companion's anxiety and will be asked to recall their perceived emotions during the venipuncture. The observer will assess child's pain and stress using the FLACC and Groningen scale and record it. Subsequently, the caregiver will sit in a chair placing the child on top in front of him, with one leg on each side and the arms resting on the shoulders of the companion. The patient's head will rest on the adult's shoulder, contralateral to the limb to be punctured. Simultaneously, the responsible adult patient will hold the simulating a hug. A professional will take care of immobilizing the chosen limb. The responsible nurse performed the venipuncture and collecting samples. The observer will assess the child's pain and stress during the intervention, and will deliver the STAI to the caregiver, to be completed with their perceived sensations during the technique.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: Venipuncture; pain; anxiety; stress