Hospitals are taking the hurt out of common medical procedures.
Needle sticks in the vein, known as venipuncture, are performed about 2.7 million times a day in the U.S., and are often cited by adults and children as among the most negative experiences during hospitalization. Severe pain from broken bones can make it hard for clinicians to manipulate limbs for accurate X-rays. And just the anticipation of stitches and other invasive procedures can cause anxiety, especially for younger patients.
Now, new approaches are making it easier to avoid acute pain, including a needle-less blood-drawing device and topical medications that numb skin before a needle goes in. There are hand-held illuminated “vein finders” that project a map of veins under the skin to avoid painful repeat pokes and fast-acting nasal spray pain control drugs for fractures and other injuries.
With pain control ranked high on patient satisfaction surveys, hospitals are training staffers to make it a bigger priority than the past. That includes formal policies for assessing and treating pain immediately in the ER, and helping patients cope with pre-procedure stress and anxiety.
“If we are the ones inflicting pain, we need to do something proactively to minimize it,” says Sergey Kunkov, director of the pediatric emergency department at Stony Brook Children’s Hospital, part of Stony Brook Medicine in New York.
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Stony Brook is one of a growing number of children’s hospitals adopting an “ouchless” approach to pediatric medicine. As part of the triage process in the ER, nurses identify children with conditions such as dehydration that will require intravenous fluids, and apply numbing agents that use the anesthetic lidocaine right away so they take effect before it is time for a needle stick. In the case of broken bones, they quickly deliver a nasal pain medication spray that takes the edge off so it is easier to manipulate a limb for an accurate X-ray.
Steven Pinto, 15, was brought by ambulance to the Stony Brook Children’s ER earlier this month after another player rammed into his leg while he was playing football. He says he was in extreme pain, and knew he was badly hurt when he saw his foot was facing the wrong direction. Before he went for X-rays, a nurse gave him a nasal spray of the pain drug fentanyl. “My pain was 10 on a scale of one to 10 and that immediately brought it down to five,” he says.