Comparing the use of colored Trace Images in Kids' Books with passive distractions to decrease pain and fear during cannulation in children: A randomized clinical trial

• Published in: European journal of integrative medicine 2024-08, Vol.69, p.102379, Article 102379
• Main Authors: Suleman, Sherzad Khudeida, BakirYahya, Nizar, Nilsson, Stefan, Enskär, Karin
• Format: Article
• Language: English
• Subjects: Cannulation; Cartoon; Fear; Music; Pain; Pediatrics; Pediatrik; Randomized controlled trial; TICK -B
• ISSN: 1876-3820; 1876-3839; 1876-3839
• DOI: 10.1016/j.eujim.2024.102379

•Cannulation can be a source of pain and fear in children.•Pre-cannulation fear may lead to higher post-cannulation pain.•Trace Image and Coloring for Kids-Book (TICK-B), reduces pain and fear in children.•Passive distractions, such as cartoons and music, reduce pain and fear in children.•TICK-B manages cannulation's adverse effects better than passive distractions. Cannulation can be frightening and a source of pain and fear for pediatric patients. The study evaluated the effectiveness of Trace Image and Coloring for Kids-Book (TICK-B) as active distraction with two passive distractions in reducing children's pain and fear during cannulation. This study employed a prospective, controlled, randomized experiment conducted from January 2023 to April 2023 at Heevi Pediatric hospital in the Kurdistan region of Iraq. A total of 176 participants were randomly assigned in to one of four study groups, with 44 participants assigned to each group. The interventions were administered 2–3 min before continued until the cannulation procedure finished. Data were collected through interviews conducted before and after the procedure. Children reported pain using Wong-Baker FACES® scale, and fear evaluated with the Child Fear Scale as an outcome after the cannulation procedure. Children's outcomes during and after procedure were measured 2–3 min after completed procedure. All distraction methods significantly reduced children's pain and fear compared to the control group. TICK-B showed large effects in reducing average pain (mean difference = -4.65, 95 % CI: -5.67 to -3.65) and fear (mean difference = -2.18, 95 % CI: -2.67 to -1.69) during cannulation. Post-procedure, TICK-B maintained large pain relief (mean difference = -4.10, 95 % CI: -4.98 to -3.22) and fear reduction (mean difference = -1.89, 95 % CI: -2.39 to -1.39) effects. Music listening and cartoon watching both showed improvements compared to the control group, with minimal differences between them in terms of pain and fear during the procedure. Also, the differences were the same after the procedure. No adverse events were reported. All distraction techniques effectively and safely decreased children's pain and fear during cannulation. The TICK-B technique most effectively reduced children's pain and fear during cannulation procedures compared to music-listening and cartoon-watching techniques. NCT04977323.