Evaluating comfort measures for commonly performed painful procedures in pediatric patients

Sana Dastgheyb,1 Keith Fishlock,2 Constantine Daskalakis,1 Jami Kessel,3 Paul Rosen2 1Thomas Jefferson University, Philadelphia, PA, 2Nemours Children’s Health System, Wilmington, DE, 3Nationwide Children’s Hospital Columbus, OH, USA Introduction: Management of pediatric pain from medical procedures is of great importance for improving both patient care and experience. In this study, we investigated methods of managing acute pain in infants and children by studying the correlation between the number of attempts to complete painful procedures, given different comfort measures. Methods: The study is a retrospective review of 74,276 procedures performed at two pediatric hospitals in an integrated academic children’s health system between 2013 and 2016. We compared three comfort measures most frequently offered: positions of comfort (POC), distraction (DIST), and pharmacological (PHARM). These methods were compared in the setting of four procedures: peripheral intravenous (PIV) catheter insertion, gastrointestinal tube placement, incision procedures, and bladder catheterization. We used the number of attempts needed to complete a procedure as a measure of efficacy minimizing distressing experience in an acutely painful setting (single attempt vs repeat attempts). Results: Among younger children, DIST appears superior to the other two methods; it performs significantly better for three of the four procedures (PIV catheterization, incision wound, and urinary catheterization) among infants aged <1 year and for PIV catheterization among toddlers aged 1–3 years. For older children, POC tends to perform slightly better than the other two methods, although it is significantly better only for PIV catheterization among adolescents aged 13–21 years and urinary catheterization among children aged 9–12 years. Conclusion: Results from this study may be used to determine appropriate comfort measures for painful procedures in pediatric setting. Keywords: pediatric pain, pain management, comfort measures, acute pain, therapeuti