Venipuncture in Children: Using Eutectic Mixture of Local Anesthetic Cream and Application of Heat to Facilitate Peripheral Venous Cannulation

Lori L. Huff, RN, BSN, CCRN, Nursing, Akron Children's Hospital, Akron, OH, USA, Annette S. Hamlin, BSN, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA, and Aris Beoglos, RN, PhD, Akron Children's Hospital, Akron, OH, USA.

This study investigated whether the use of heat after the application of Eutectic Mixture of Local Anesthetic (EMLA) cream decreased vasoconstriction. Background

Venipuncture in children is a painful and frequently performed procedure. Use of EMLA cream to reduce pain on insertion is a common practice with pediatric patients. Liu et al. (2003) studied impact of heat on the duration of onset of EMLA cream’s anesthesia effect and reported that heat did not lessen the application time to achieve the desired effect of EMLA cream. Lenhardt et al. (2002) found a reduction in peripheral insertion time and number of attempts when heat was applied with EMLA cream. No studies were found to have measured venous size in relation to heat application. Method

A descriptive, quantitative design was used to examine the use of EMLA cream and application of heat to facilitate venipuncture for peripheral venous cannulation. A convenience sample of 30 hospitalized Caucasian children ages eight to twelve years was sought. The Wong-Baker FACES Pain Rating Scale was used to obtain pain scores immediately prior to and at the conclusion of the venipuncture. A vascular doppler directly measured the vein prior to EMLA cream, after EMLA cream was in place for 1 hour and after heat application.

Pain scores indicated an increase from a mean pain score of 3.3 before venipuncture to 6.8 after venipuncture. Direct vein measurement by vascular doppler indicated a return to baseline after application of heat. Mean vein measurements were 0.25 cm before EMLA Cream (baseline), 0.20 cm after EMLA cream in place for 1 hour, 0.26 cm after two minutes of heat application.

Application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA cream. As a result, peripheral venous cannulation success rates may be improved.

Learning Objective #1: describe a study that examines methods to improve peripheral venous cannulation insertion.
Learning Objective #2: identify nursing implications of study results.