Pin prick

New technique makes IV starts less painful

Nobody likes needles — especially little kids.

Robert M. (Bo) Kennedy
Robert M. (Bo) Kennedy

The sharp sting of the insertion of an IV catheter can be a painful and anxiety-provoking experience for both children and adults.

Fortunately, the 10,000 pediatric patients who annually receive IV starts in the emergency department at St. Louis Children’s Hospital can avoid much of the pain thanks to a procedure called the “ouchless” IV technique.

The procedure, developed by Robert M. Kennedy, M.D., associate professor of pediatrics at Washington University School of Medicine, and his colleagues, is one of several innovative methods that aim to reduce the pain and distress of pediatric patients who visit the emergency department (ED).

“The ouchless IV has had a huge impact on the comfort of our pediatric patients — it’s our gold standard,” Kennedy says. “I’ve started ouchless IVs on sleeping infants who never woke up during the IV insertion. That’s how painless it can be.”

A broken wrist recently landed Michael Williams in the emergency department. The 9-year-old’s arm needed to be set in a cast, a procedure that requires IV sedation. Although the splint his father had creatively crafted out of Home Depot paint stirrers and duct tape rreduced some of Michael’s discomfort, he still was in pain. The last thing he wanted was to have a needle stuck in his hand to help with an IV insertion.

Dr. Robert Kennedy delivers an
Dr. Robert Kennedy delivers an “ouchless” IV to patient Michael Williams in the Emergency Department at St. Louis Children’s Hospital.”

“I didn’t even feel anything,” Michael said after receiving an ouchless IV start. “I watched the big needle move around in my hand, but it didn’t hurt at all!”

The nearly pain-free procedure entails first using a tiny 30-guage needle to inject buffered lidocaine, which is barely felt, to numb the area. When the site is completely numb, the much larger, and potentially much more painful, IV needle is injected — but its sting isn’t felt.

It’s hard to believe that when Kennedy introduced the technique several years ago, the idea was met with resistance. “People were skeptical of the two pricks, but in this case, two sticks are better than one. You hardly feel the first one and you don’t feel the second stick at all,” he says.

To appease critics of the two-stick procedure, Kennedy led a randomized study in which third-year medical students and pediatric interns, received the ouchless technique and the standard start. The ouchless technique rated a 1.7 on a pain scale of 1-10 (high). The standard IV start scored a much more painful: 6.1. The nurses who start most of the IVs in the ED also have participated in these workshops and have become believers, too.

“Once you’ve experienced the difference, the point is really driven home,” Kennedy says. “We wanted our nurses and medical students to experience how much less painful it is, thereby encouraging them to use it.”

Kennedy and his team are now trying to export the ouchless technique.

“Nobody should have to experience unnecessary pain,” he says. “By implementing innovative ways to safely address procedure-related pain and anxiety, we hope to change the current culture of ignoring our patients’ pain by showing there’s a better way.”