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Virtual Reality Reduces IV-Start Pain in Children

June 19, 2019

Written by Clay Smith

Spoon Feed
Use of virtual reality (VR) in children who need venipuncture or an IV reduced pain. Kids, caregivers, and proceduralists said they would use or recommend VR again.

Why does this matter?
Venipuncture in children is a common, painful, anxiety-provoking procedure. Distraction techniques may help. I have seen kids become minimally responsive to IV start after zoning out on Paw Patrol. Might an immersive visual distraction, such as that provided by VR help even more?

Don’t Forget the VR…and the Bubbles
This is a combined report of two clinical trials, one in the ED and one at an outpatient phlebotomy site (OPS). They enrolled children getting an IV or venipuncture. Each setting had just over 60 per group, randomized to VR or standard care and measured pain on a child-rated Faces Pain Scale-Revised. The VR scene was underwater with swimming fish (see image). There was a statistically significant pain reduction in the VR group in each setting, -1.78 in the ED; -1.39 in OPS (actually both had increased pain, but the VR group increased less). Topical anesthetic use was common in the ED, 85-89%, but uncommon in OPS, 13-14%. Also, the ED was predominately IV starts, vs no IV starts in OPS. As secondary outcomes, an objective measure of child anxiety and caregiver perception of the child’s distress were both significantly lower in the VR group. Even though this wasn’t a primary outcome, this is powerful: “Almost all children assigned to virtual reality wanted it for future needle procedures (ED, 60/64 [94%]; OPS, 57/63 [90%]). The majority of caregivers (ED, 52/56 [93%]; OPS, 51/55 [93%]) and proceduralists (ED, 49/57 [86%]; OPS, 48/55 [87%]) would recommend or consider using virtual reality in the future.” In essence, nearly all thought VR was great and would use it again. They used a Google Pixel XL phone and Google Daydream VR headset, which together costs about $250.

From cited article. I feel more serene just looking at this still image…

From cited article. I feel more serene just looking at this still image…

Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized Clinical Trials. J Pediatr. 2019 Jun;209:160-167.e4. doi: 10.1016/j.jpeds.2019.02.034. Epub 2019 Apr 29.

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Reviewed by Thomas Davis