Purpose:
This study focused on exploring 30 adult patients' thoughts and opinions about the experience of having an intravenous (IV) catheter placed. Demographic data, past experience with an IV insertion, preferences for pain management strategies, patient involvement in the decision, pain ratings, and satisfaction with the procedure and process were measured. Patients were asked to choose between 2 options for pain management before IV insertion: intradermal injection of 1% lidocaine or listening to a guided imagery tape with headphones. Intradermal lidocaine was shown to significantly reduce pain perception during IV insertion. Subjects who chose lidocaine reported significantly higher satisfaction with their IV insertion than those who chose guided imagery or those who preferred neither pain management strategy. The purpose of the study was to ascertain whether patients wanted to be involved in decisions about pain management during IV insertion and which options they chose between. The objective of this study was to determine if offering patients pain management options before their IV insertions is a worthwhile nursing function.
Significance:
The significance of this study was to share the findings of patient pain management preferences, pain ratings, and satisfaction during IV insertion. The findings may stimulate professional nurses to more actively seek out pain management strategies for their patients during common painful procedures. Strategies for minimizing pain during IV insertion differ across care settings and range from premedicating with intradermal or topical lidocaine to no pain management strategies at all. The paucity of evidence on patient preferences and their desire for involvement regarding pain management during IV insertion led to this study.
Design:
A convenience sample of 30 adults preparing to undergo surgery chose intradermal lidocaine 1% or listening to a guided imagery tape at the time of their IV insertion as a potential pain management strategy.
Methods:
Understanding the importance of patient involvement in decisions about their own pain management dictated the method chosen. After presenting patients with a decision aid for lidocaine and guided imagery (pros and cons), the patient was asked to choose a strategy to be used during IV insertion.
Results:
Thirteen patients chose lidocaine, 13 chose guided imagery, and 4 chose no strategy at all. Almost all patients (93%) liked being involved in decisions about pain management during IV insertion. Those patients with a fear of needles (23%) chose lidocaine or guided imagery. All patients with a low pain tolerance (33%) chose either lidocaine or guided imagery.
Patients who chose lidocaine (43.3%) reported an average of 0.46 pain level on IV insertion. Patients choosing guided imagery as a pain management strategy (43.3%) reported an average pain level of 2.69. Patients who chose neither option reported an average pain rating of 2.5 reported a higher pain tolerance and reported that they were not afraid of needles (13.3%). All patients (100%) who chose lidocaine were very satisfied with the procedure compared with 77% who chose guided imagery and 50% who chose neither option.
Conclusion:
Patients appreciated the opportunity to be involved in decisions about their care. Satisfaction with a painful procedure such as an IV insertion can be positively impacted when simple options are offered to the patient to minimize the discomfort.
Implications for Practice:
Nursing care for patients undergoing painful procedures such as an IV insertion should include discussions about available pain management options. Intradermal lidocaine injections are a simple and inexpensive option (0.35 cents/30 mL multidose vial, 600 doses in 1 vial at 0.05 mL/dose) that may provide complete pain relief during IV insertion. Investing in a set of guided imagery tapes (at $10.00 a piece), tape recorders with headphones ($25.00 each) may provide patients with an alternative pain management strategy that may help them cope more effectively with a painful procedure. From a healthcare system perspective, the long-term benefit of a satisfied patient far outweighs the initial start-up costs of obtaining equipment. It is hoped that results of this study will stimulate discussions of the advantages and disadvantages of offering pain management during IV insertion among staff nurses. The clinical nurse specialist is responsible for promoting evidence-based practice through research studies. Most nurses whose patients were involved in this study showed enthusiasm about participating in nursing research and were supportive of the project. In addition, this study has sparked interest in potential pain management strategies during IV insertion in other areas of the hospital.