Virtual Reality vs Standard-of-Care for Comfort During Intravenous Catheterization

University of British Columbia64 enrolled

Overview

Children often need an intravenous catheter placement for delivery of fluids and medications, a procedure associated with pain and anxiety. In the Emergency Department topical anesthetics are frequently used. Virtual Reality (VR) is an immersive experience using sight, sound, and position sense. Using VR may enhance distraction during the painful procedure and may reduce attention to pain. This study will randomize children (6 - 16 years old) to receive Virtual Reality or standard of care in addition to topical anaesthetics during IV placement procedure. Investigators will measure pain, anxiety and satisfaction, amount of analgesics used and the level of success in placing the IV and compare between the two groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

Conditions

Intravenous Catheterization

Interventions

Eligibility

Sex: ALLMin age: 6 YearsMax age: 16 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Children age 6 - \<17 * The managing physician determines a need for an intravenous catheterization (IV) procedure * Parents will sign a consent form and children will sign an assent form Exclusion Criteria: * Children with conditions that may prohibit participation or evaluation of the procedure (such as developmental delay, autism, others) * Triage Category 1 (resuscitation) * Facial features or injury prohibiting wearing the VR goggles

Outcomes

Primary Outcomes

Pain using the Faces Pain Scale - Revised.

Level of pain as reported by children using Faces Pain Scale - Revised. The scale includes six faces that represent progressively more intense features of pain. Children point to the face that best represents their current level of pain. The minimum score is 0 (representing least pain) and the maximum score is 10 (representing greater pain). The scale increase in increments of 2.

Time frame: Pain is reported by children immediately following completion of the IV start

Secondary Outcomes

Anxiety using the Venham Situational Anxiety Score

Level of Situational Anxiety as reported by children using the Venham Situational Anxiety Score. This scale includes 8 sets of 2 images of children which represent differing levels of anxiety. Children point to the child that best represents them in that instance. In each set of 2 images of children, one represents greater anxiety (scored as 1) and one represents lesser anxiety (scored as 0). The points from each set of images are totaled. The minimum score is 0 (least anxious) and maximum score is 8 (most anxious).

Time frame: Anxiety is reported by children immediately following completion of the IV start

Patient Satisfaction determined by Global Rating Scale

Satisfaction from the procedure is determined by asking 4 questions on a global rating scale. This scale goes from 0-10 where 0 represents "not very much" and 10 represents "very much." Questions are developed from previous virtual reality research. "Overall, how satisfied are you with pain management during plastic surgery?" "Overall, how satisfied are you with anxiety management during plastic surgery?" "To what extent did you feel like you went into the virtual world?" "How much fun did you have while playing in the virtual world?" These questions will be analyzed individually not summed.

Time frame: Satisfaction questions are reported by children immediately following completion of the IV start

Patient Satisfaction determined qualitatively by an open ended question

Satisfaction from the procedure is determined qualitatively. Children are asked "What is your opinion on how the procedure went?" Answers will be recorded in writing and be assessed for themes (similar words, positive or negative language).

Time frame: Satisfaction questions are reported by children immediately following completion of the IV start

Parent Satisfaction determined qualitatively by an open ended question

Satisfaction from the procedure is determined qualitatively. Parents are asked "What is your opinion on how the procedure went?" Answers will be recorded in writing and be assessed for themes (similar words, positive or negative language).

Time frame: Satisfaction question is reported by parents immediately following completion of the IV start

Medication Dose

How much topical or local anesthetics are used and when they are used (24 hour time); how much sedatives are used and when they are used (24 hour time); how much analgesics are used and when they are used (24 hour time).

Time frame: These will be recorded during the procedure and immediately following the procedure using the patient chart and nursing notes

Number of IV Trials Until Success

How many attempts the nurses need to get a functional IV catheter (concealed objective to avoid a Hawthorne effect).

Time frame: This number will be collected during the procedure

Timing

Time in minutes from readiness for procedure (availability of child, staff and equipment) until completion of procedure (nurse does not need to touch the patient anymore) and until discharged from the emergency department (given discharge paperwork).

Time frame: Documented immediately after patient and family given discharge paperwork