Ask an answerable question (PICO)：
Intravenous injection is often an unavoidable medical treatment for hospitalized children. Sick children often show behavioral reactions such as crying, resisting, and kicking during the injection process. It can cause worry and tension for the parents, affect the relationship between nurses and the children, and increase the cost of medical personnel and time. Our pediatric ward received a total of 5 customer complaints about dissatisfaction with the intravenous injection on venipuncture site pain between January and March of 2019. This issue triggered the discussions on whether applying Lidocaine Jelly(Xylocaine Jelly) and EMLA to the skin before intravenous injection in hospitalized children could reduce the pain at the venipuncture site.
The Method and Analysis of Literature Review：
The PICO keywords include P:venipuncture of children, intravenous injection of pediatric, intravenous cannulation, I: local anesthesia, topical anesthesia, Lidocaine jelly, Xylocaine jelly, C: EMLA and O: pain. Boolean logic (AND and OR) with keywords were used to search Chinese and English articles related to systemic review (SR) and randomized controlled trial (RCT) in the past 10 years in Cochrane Library, PubMed, Medline , Nursing Reference Center, and Airiti Library. A total of 50 papers were found. , Studies were excluded 25 duplicate papers , 11 non-compliant with themes and 12 non-randomized controlled trials,After deleting irrelevant , and 2 RCT were eligible and included for appraisal.
Critical Appraisal：
2011 Oxford Centre for EBM Levels of Evidence was used to evaluate the level of evidence. 2 RCTs were Level 2. The 2020 Randomised Controlled Trial Checklist of the Critical Appraisal Skills Programme (CASP) was used to appraise 2 RCT papers. The methodological qualities of the 2 RCTs were good and the synthesis of the papers’ recommendations was used to develop the evidence-based intervention.
Clinical Application of Evidence：
The literature systhesis recommended application of Lidocaine Jelly
(Xylocaine Jelly) or EMLA cream to the venipuncture site before intravenous injectioncan be used as a complementary intervention for pain management of intravenous injection for children. There is no statistical difference between the effects of the two drugs (p=.87). The project considered the recommendations and developed evidence-based intervention and was conducted between April and July 2019. Sick children aged from 4 to 7 years weredevided to 3 groups. The Xylocaine group received the application of 2% Xylocaine Jelly to the venipuncture site 30 minutes before intravenous injection. The EMLA group received the application of 5% EMLA to the venipuncture site 60 minutes before intravenous injection. The no local anesthetic group did not apply any topical anesthetics before intravenous injection. Pain at the time of venipuncture was assessed by the FLACC Pain scale (Face, Leg, Activity, Cry, Consolation Pain Scale).
Evaluation of Effectiveness：
This project results showed that the mean pain score was 4.10 for Xylocaine group, 2.70 for ELMA group,and 7.65 for the no local anesthetic group after intravenous injections. Mean pain scores were significantly different between 3 groups, with the lowest mean score in the EMLA group (p＜.001). There was also a significant difference in the time spent on injection bwteen 3 groups (p < .001) with the shortest injection time in the EMLA group (Mean = 6.17 minutes), and the longest in the non local anesthetic group (Mean = 9.49 minutes). There was no significant difference in the success rate of needle placement among 3 groups (p= .421).
Conclusions and Recommendations：
This evidence-based project shows that applying topical anesthetics to the skin of hospitalized children before intravenous injection can help reduce the pain during intravenous puncture, the time needed, and the cost of nursing manpower and time.
