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Journal of Pediatric Nursing (2016) 31, 64–72Distraction Using the BUZZY for Children Duringan IV InsertionNemat Moadad RN, BSN a , Katia Kozman RN, MSN a , Randa Shahine RN b ,Shake Ohanian RN, MS b , Lina Kurdahi Badr RN PhD, CPNP, FAAN c,⁎aPediatric unit, American University of Beirut Medical Center, Beirut, LebanonChildren's Cancer Center, Beirut, LebanoncAzusa Pacific University, CAbReceived 14 April 2015; revised 22 July 2015; accepted 24 July 2015Key words:Pain;IV insertion;Distraction;BUZZY;LebanonBackground Needle pricks are rated by children as their most feared medical event resulting in acutepain, anxiety and distress, which negatively affects both the child and his/her parents.Objectives: To investigate the effects of external cold and vibration via the “BUZZY” on pain ratings ofchildren, their parents and nurses during peripheral IV insertion, to measure the time to a successful IVinsertion and to assess the factors that are associated with pain perception of children.Methods: In this randomized control trial (RCT), children between the ages of 4 to 12 yearswere assigned to either an intervention or a control group. The intervention group (n 25) had the“BUZZY” applied during IV insertion while the control group (n 23) did not have the “BUZZY”.Children were asked to rate their pain along with their parents and nurses on the Wong-Baker FACESPain Rating Scale. Time to successful IV insertion and background characteristic of children wereassessed and compared.Results: Pain scores were significantly lower in the “BUZZY” group for children and the nurses.Time to a successful IV insertion did not differ between groups. Gender, age, previous hospitalization,diagnoses and analgesics were all factors associated with the children's pain scores. However, amultiple regression analysis found that only the “BUZZY” remained a significant predictor of painscores in children.Clinical Implications: The “BUZZY” may be an easily accessed, inexpensive ( 39.95 each at 0.09per 3 minute stick), and effective technique to control or reduce pain in young children undergoingIV insertion. 2016 Elsevier Inc. All rights reserved.CHILDREN WHO UNDERGO surgery or who havechronic conditions such as cancer often experience manypainful procedures, the most common are needle pricks thatare highly feared and are often accompanied by significantacute pain and distress (Gupta et al., 2014; Taddio et al.,2012; Windich-Biermeier, Sjoberg, Dale, Eshelman, &⁎ Corresponding author: Lina Kurdahi Badr, RN PhD, CPNP, FAAN.E-mail address: 5.07.0100882-5963/ 2016 Elsevier Inc. All rights reserved.Guzzetta, 2007). When a child is distressed, parents andhealth care providers often experience anxiety, helplessness,and guilt making any procedure more difficult and stressful(Von Baeyer, Marche, Rocha, & Salmon, 2004).The American Academy of Pediatrics et al. (2001)recommends that whenever possible, children shouldnot be exposed to painful procedures. When unavoidable,interventions should be provided to limit the painfulexperience. Despite the prevalence of pain stemmingfrom medical procedures and the distress associated with
Distraction Using the “BUZZY”this, research indicates that pain management continues tobe suboptimal (Uman et al., 2013). Several studieshave documented that infants and children who hadexperienced frequent painful events have enhanced painsensitivity, maladaptive pain responses, poor qualitycognitive and motor development, needle phobia andlong-term traumatic memories that may persist throughoutadolescence and adulthood (Buskila et al., 2003; Chen,Zeltzer, Craske, & Katz, 2000; Valeri, Holsti, & Linhares,2015). Therefore, reducing the emotional and physicalshort-and long-term negative effects of painful procedures inchildren through adequate management is an important partof nursing practice.Several interventions have been used to reduce painfulexperiences in children and to alleviate their distress during aneedle prick. Some of these interventions have utilizedpharmacological drugs, and some have focused on nonpharmacological methods. Pharmacological drugs thatinclude tropical anesthetics have often not been verysuccessful as they are costly, may require long periods oftime to achieve an analgesic effect (e.g., EMLA , Ametop )or are not found to be effective in all age groups (e.g.,vapocoolant sprays) (Cohen et al., 2009; Costello, Ramundo,Christopher, & Powell, 2006; Farion, Splinter, Newhook,Gaboury, & Splinter, 2008). Non-pharmacologic approachesthat have been found to be effective in reducing children'sacute pediatric pain include but are not limited to, hypnosis,cognitive behavioral therapy, guided imagery, and distraction(Badr, 2013; Gupta et al., 2014; Vetri- Buratti et al., 2015).The use of distracters, such as auditory or visual distracters,bubble blowing, touch, vibration or massage (Bagnasco,Pezzi, Rosa, Fornonil, & Sasso, 2012; Gupta et al., 2014;MacLaren & Cohen, 2005; Sahiner & Bal, 2015), have longbeen found to be effective in helping the child to cope notonly with the immediate medical procedure, but may alsobuffer memories of the experience (Uman, Chambers,McGrath, & Kisely, 2008). A recent Cochrane review of 39trials with 3394 children concluded that there is strongevidence supporting the efficacy of distraction in reducingneedle-related pain in children and adolescents, howeverthere is limited evidence to differentiate which aspects ofdistraction are most efficacious (Uman et al., 2013).Distraction is based on the gate control theory that positsthat nerve fibers that transmit sharp pain combine in the dorsalhorn as a final common pathway with thermaland mechanoreceptors. Stimulation of Ab mechanoreceptors“shuts the gate” on Ad fast pain receptors via presynapticinhibition.Vibration has been proposed recently to involve twocortical areas that are primarily involved in coding pain andtouch (Hollins, McDermott, & Harper, 2014). Vibrationappears to activate analgesic mechanisms which canpowerfully inhibit experimental pain. A major componentof vibro-tactile analgesia is proposed to be related to A-betamediated afferent inhibition of dorsal horn nociceptiveneurons (Staud, Robinson, Goldman, & Price, 2011).65Although, several distraction techniques have beenassessed, some have been found to be impractical andrequire time which is often not feasible or possible in aclinical setting. A relatively new devise the “BUZZY” (MMJLabs, Atlanta, GA, USA), combines a cooling ice-pack and avibrating motor, and has been found in four studies to date todecrease pain and to enhance patients' compliance duringvenous blood collection, venipuncture and IV insertion(Baxter, Cohen, McElvery, Lawson, & von Baeyer, 2011;Canbulat, Ayhan, & Inal, 2015; Inal & Kelleci, 2012;Whelan, Kunselman, Thomas, Moore, & Tamburro, 2014).The use of the “BUZZY” in the emergency department with81 children aged 4- to 18 years who were randomized to thedevice (n 41) or standard care (n 40), found that thepain scores assessed on the Faces Pain Scale–Revisedduring venipunture were lower in the intervention group forboth the children and their parents (Baxter et al., 2011). Arecent RCT in Turkey found that the “BUZZY” significantly reduced pediatric pain assessed on the Wong-BakerFACES scale during the peripheral IV insertion in 176children between the ages of 7–12 years (Canbulat et al.,2015). Likewise an RCT of 120 children between 6 and12 years of age also in Turkey noted that the “BUZZY”significantly reduced pediatric pain assessed on the FacesPain Scale-Revised (FPS-R) during blood specimencollection and there was no effect on the success of bloodcollection (Inal & Kelleci, 2012). In contrast, a qualityimprovement study with 64 children between the ages of 4to 18 years found that the “BUZZY” did not decrease thepain responses of children assessed on the Wong-BakerFACES during a venipuncture although the majority of thechildren (80%) indicated that they liked the device (Whelanet al., 2014). No published studies have assessed theefficacy of the “BUZZY” on younger children during anintravenous (IV) line insertion taking into considerationparental and nurses' reports of pain as well as the impact ofchildhood characteristics.The aim of this study was to investigate the effects ofexternal cold and vibration via the “BUZZY” on pain duringa peripheral IV insertion in children aged 4 to 12 years, toassess and compare the perceptions of parents and nurses andto measure the difference in the time for a successful IVinsertion between the “BUZZY” and “No BUZZY” groups.Finally the associations between child characteristics andpain perception were investigated. The following fourhypotheses were tested:Hypothesis 1. Children between the ages of 4 to 12 years whoundergo an IV insertion procedure using the “BUZZY” willexperience less pain measured by the Wong–Baker FACES PainRating Scale (WBFPS) than children not using the “BUZZY”.Hypothesis 2. Parents of children between the ages of 4 to12 years who undergo an IV insertion procedure using the“BUZZY” will report that their children have less pain measuredby the WBFPS than parents of children who are not using the“BUZZY”.
66N. Moadad et al.Hypothesis 3. Nurses will report that children using the “BUZZY”will have less pain measured by the WBFPS than children not usingthe “BUZZY” during an IV insertion.Hypotheses 4. There is a significant positive correlation betweenthe three assessment scores of pain measured by the WBFPS: thechild, the nurse and the parent.Hypotheses 5. There will be no difference in the time for a successfulIV insertion between the “BUZZY” and “No BUZZY” groups.MethodsThis randomized clinical trial (RCT) was conducted at theAmerican University Medical Center (AUBMC) fromJanuary 2013 to December 2014, which assessed the efficacyof the “BUZZY” on 48 children during an IV insertion.Participants: The participants included 4-to 12-year-oldchildren who required an IV insertion at either the pediatricunit of the AUBMC or the Children's Cancer Center ofLebanon (CCCL) affiliated with AUBMC. Lebanon is asmall middle-income country on the Eastern Mediterranean,with an estimated population of 4 million and a fertility rateof 1.7%. Its population is highly urbanized (87%) and highlyliterate (87%) (Traboulsi, 2012). AUBMC is a 350-bedtertiary care center providing all varieties of inpatient andoutpatient services to the people of Lebanon and the MiddleEast with around 30,000 admissions a year. AUBMC is JCIaccredited and a Magnet-designated hospital. Participantswere excluded if there was a break or abrasion on the skinwhere the “BUZZY” device would be placed; if they hadcritical, unstable health status; history of taking an analgesicwithin the last 4 hours, if they had a history of syncopedue to blood draws or if they had a neuro-developmentaldelay, or verbal difficulty which may prevent them fromindicating their pain level. Based on previous research, ourpower analysis was based on standard deviations between1.5 and 2.0 for the control and experimental groups usingthe Faces Pain Scale- Revised (WBFPS) as an outcomemeasure. With a power of 0.8 and an acceptable type I errorsize of 0.05, a sample size of 50 was required to achievesignificance using the following formula: N (Zα Zβ)2 x2 σ 2/mean difference 2.Ethical considerations: This study was approved by theInstitutional Review Board (IRB) of the American University of Beirut (protocol NUR.LB04). Informed consent wasobtained from the parents of each child undergoing an IVinsertion procedure. Assent was also obtained from children7 and above.Apparatus/Materials: The independent variable was the useof the “BUZZY”, a recently developed reusable device, (MMJLabs, Atlanta, GA), which combines cold and vibration and issecured with a tourniquet proximal to the site of an injection orvenipuncture to decrease pain sensation. The device is areusable 8 5 2.5-cm handheld plastic bee containing abattery-operated vibrating motor and a mechanism to attach anice pack underneath. It can be pressed in place or secured to alimb via a Velcro strap or tourniquet (Figure 1).Figure 1The Buzzy (www.buzzy4shots.com).The dependent variable was pain as assessed on the Wong–Baker FACES Pain Rating Scale (WBFPS). The WBFPS is afeasible, quick, and simple tool used to assess pain in childrenages 3 years and older (Wong, Hockenberry-Eaton, Wilson,Winkelstein, & Schwartz, 2001), and it has been used in over80 studies in different countries and has been translated to 10languages to assess pain-related interventions (e.g., Badr(Zahr), Puzantian, Abboud, Abdallah, and Shahine, 2006;Kennedy, Shaikh, Fardy, Evans, & Crean, 2004; Massimiet al., 2011; Tomlinson, von Baeyer, Stinson, & Sung, 2010).The WBFPS includes 6 cartoon faces that range from a smileyexpression (0—‘no pain’) to a crying face (10—‘severe pain’)(Figure 3). The construct, convergent and predictive validityhave been reported with Cronbach reliabilities between r .82and .92 (Tomlinson et al., 2010) (Figure 2).Procedure: Children and their parents were informedabout the purpose and content of the study by the researcherand the four nurses involved in the study. Interested parentsand children signed a consent form, and children above7 years signed assent forms. Children were then randomlyselected to be either in the control or experimental group byflipping a coin (heads control, tails experimental).Clinical decisions for the IV insertions are made by apediatrician attending to the child. The data were obtained bythe reports of pain on the WBFPS scale of the children, theirparents and the nurses during the procedure. If randomized tothe “BUZZY”, the nurse offered the parent and child theopportunity to hold the device, turn on vibration, and practiceapplication. Immediately before the first venous accessattempt, the nurse attached the ice pack under the device, andapplied it 5 to 10 cm proximal to the dorsum of the hand site.Nurses were then allowed to cannulate as they normallywould, provided the device remained in place and vibratingthroughout the attempt. The IV insertion was attempted onthe dorsum of the hand with a 24 gauge IV catheter. Asuccessful IV insertion was defined as blood returning to the
Distraction Using the “BUZZY”67Figure 2The Wong-Baker FACES Pain Rating Scale.IV needle insertion site. If the IV insertion was not successfulat the first attempt, the child was excluded from the study.Children were asked to concentrate on the sensations of the“BUZZY” rather than look at the needle insertion. Thenurses observing the procedure timed the duration for asuccessful IV insertion and scored the child's pain on theWBFPS. One nurse performed the IV insertion and appliedthe “BUZZY” for the intervention group while a secondnurse observed and asked the child and parent to evaluate thepain during the procedure using the WBFPS. Children,parents and the nurse observer were blinded to each other'sresponses. Since the perception of pain varies when parentsare present or not, parents were instructed to stay with thechildren during the procedure (Gupta et al., 2014).The WBFPS is routinely used at our institution to assesspain, and all the nurses are trained on its use. The four nurseswho were part of this study had a minimum of 4 yearsexperience with pediatric patients, were trained on the use ofthe “BUZZY” with the researcher (LKB) and the protocol ofthe study. Background characteristics of participants which60 Parents wereapproachedParents signed a consent form and children 7 years10 refused toparticipatesigned the assent form (n 50)Children were randomized (by throwing a coin) to one of 2 groups (n 50)1. No Buzzy 242. Buzzy 26IVwas attempted by one nurseSecond nurse assessed pain using the FPS-R scale, Parent and child also rated the pain on the FPS Rscale during the IV insertion2 children, one from eacharm had missing dataData on 23 infants was analyzedFigure 3Data on 25 children was analyzedSample flow and protocol.
68were noted to influence pain perception in previous studies(Nafiu, Shanks, Abdo, Taylo, & Tremper, 2013; Tüfekciet al., 2009) were obtained by a research assistant from themedical records. These included: age, gender, BMI, previoushospitalizations and recent analgesics intake (Figure 3).Data AnalysisStatistical analysis was performed using the SPSS forWindows version 22 (SPSS Inc., Chicago, IL). Sociodemographic and clinical characteristics of children weredescribed using frequency distributions for categorical variables and means/standard deviation for continuous variables.Comparisons of the child, parent and nurse scores on theWBFPS for the two groups were conducted using ANOVA.The time for a successful IV insertion was compared betweengroups using a t-test. Univariate analysis was done to assess thefactors that affect the child's pain scores, age was divided into2 groups; 4–7 years and 8–12 years and BMI was divided intoless than 23 and above 23. Finally a multiple regressionanalysis was used to assess the best predictor of pain inchildren taking into account their characteristics and whetherthey were in the intervention or control group.N. Moadad et al.To answer the research question related to the associationsbetween child characteristics and pain perception, univariateanalysis using ANOVA was used followed by multipleregression. The continuous variables were divided tosubgroups to facilitate comparisons. As seen in Table 3, allthe variables except the BMI had a significant relationshipwith pain scores rated by children on the WBFPS. Youngerchildren had significantly higher pain scores in the“No BUZZY” group compared to the “BUZZY” group,F (2/19) 8.96, p 0.007, females had significantly higherscores in the “No BUZZY” group compared to the “BUZZY”group, F(2/21) 14.59, p 0.00, and children with cancerhad significantly higher scores in the “No BUZZY” than the“BUZZY” group, F (2/13), 13.31, p 0.003. The“BUZZY” was significantly more effective in children withprevious hospitalization F (2/7) 4.72, p 0.04 andwhen they were not an analgesics 4 hours or more beforethe procedure F (2/32) 7/07, p 0.02.A multiple regression analysis found that only the“BUZZY” remained the only significant factor that predictedthe pain scores of children (Table 4). The equation explained58% of the variance in predicting pain scores on the WBFPSby children, F (7/40) 3.38, p 0.019.ResultsSeventy parents and children showed interest in the studyand were approached, of which 56 signed the consent andassent forms if applicable. Of the 56, two had missing dataand were not included in the analysis, and six did not have asuccessful IV insertion on the first attempt resulting in asample of 48 children and their parents (all mothers). Twentyfive children were in the intervention group, and 23 were inthe control group. The mean age was 8.48 ( 2.84) for theintervention group and 8.95 ( 2.74) for the control group.Gender was almost equally distributed among groups, themajority had a cardiac diagnoses or cancer, the average bodymass index (BMI) was 24.8 ( 7.83), 56% had a previoushospitalization and 73% were not on any analgesics 4 hoursprior to the procedure. The analgesics used at our institutionare paracetamol for pain scores up to 6 on the WBFPS andmorphine for scores above 6. There were no significantdifferences on any of the characteristics of children betweenthe control and intervention groups (Table 1).For Hypotheses 1, 2 and 3, ANOVAs were performed.The results indicated that children reported higher scores onthe WBFPS when they did not have the “BUZZY” applied,F (2/45 7.07, p 0.011, nurses also rated children's painhigher when the “BUZZY” was not applied, F (2/45 6.7,p 0.014. Pain ratings by mothers were not significantlydifferent between groups (Table 2).For Hypotheses 4, a Pearson correlation found that thechild ratings of pain correlated with the nurses' ratings at r 0.365, p 0.026, but not with the mothers' ratings.For research question 5, the t-test showed no difference inthe time for a successful IV insertion between the “BUZZY”and the “No BUZZY” groups (Table 1).DiscussionThe importance of managing pain in children has beenwell recognized for over 3 decades. While prior to the 1980s,it was a common assumption that infants and young childrenwere unable to perceive pain or remember painful experiences due to the immaturity of their nervous system (Unruh,1992), now there is ample evidence supporting the negativeand long-term consequences of pain. It is estimated that thelifetime prevalence of needle phobia in the Americanpopulation is 3.5% and the median age of onset at5.5 years (Bienvenu & Eaton, 1998). Children are especiallyvulnerable to needle phobia. Making needle pricks andvenous access procedures as pain free as possible is anethical obligation. Thus, finding an efficient and inexpensivedevice to decrease needle insertion pain is of paramountimportance to health providers caring for children. The costof the BUZZY is 39.95 and comes with replaceablebatteries that last 20 hours and a reusable ice pack whichresults in about 0.09 per 3 minute stick. This compares toabout 40– 50 per use for topical anesthetics (Canbulat,Şahiner, İnal, Sevim, & Akbay, 2015). Other distractiontechniques such as balloon inflation or distraction cards maybe likewise cost effective albeit, not applicable to all agegroups (Sahiner & Bal, 2015). This study assessed theperception of pain by 48 children, their mothers and nurseswho were either in a group that used the “BUZZY” or did notuse the “BUZZY” and found that the “BUZZY” was aneffective method to reduce pain during IV insertion.Both children and nurses rated pain as significantly lowerwhen the “BUZZY” was used. This is in line with four earlierstudies (Baxter et al., 2011; Canbulat et al., 2015; Inal &
Distraction Using the “BUZZY”Table 169Demographic Information of participants with or without the BUZZY. ⁎BUZZY N 25No BUZZY N 23Number Mean ( SD) or percent Number Mean ( SD) or percent t or χ2 valueVariableAge in herPrevious hospitalizationYesNoOn analgesicsYesNoHow many seconds did it take for the IV insertion8.48 ( 2.84)13128.95 ( 2.74)52%48%25.7 ( 9.89)111247.8%52.2%23.6 ( 52.17%47.83%52020%80%44.92 (48.68)81534.7%65.3%62.43 (60.05)0.260.480.220.560.200.531.04⁎ No significant differences between groups.Kelleci, 2012; Whelan et al., 2014), and supports the use ofthis simple intervention to decrease the pain during an IVinsertion. Mothers on the other hand did not show significantdifferences in their ratings of the child's pain with or without“BUZZY”. This finding may reflect their apprehension abouttheir child's pain and their inability to be objective in theirratings. In addition, the ratings by mothers did not correlatewith those of the child. Our results are supported by an earlierstudy with 78 children between the ages of 8 to 15 yearswhich found that parents' visual analogue scale score ratingsof their children's pain did not correlate with the children'sVAS pain scores (Kelly, Powell, & Williams, 2002). Incontrast, other studies note that parental pain scores show astrong correlation with children's scores and are reliableproxy to use especially when children are not able toverbalize their pain (Khin et al., 2014; Rajasagaram, Taylor,Braitberg, Pearsell, & Capp, 2009). The opposing findings inresearch maybe a reflection of the different age groups ofchildren assessed and the different settings, which warrantsfurther investigation.Table 2 Differences in pain ratings on the FRS-R for child,parent and nurse.BUZZYVariableNo BUZZYMean ( SD) Mean ( SD) F value pPain scale by the 2.31 ( 2.46) 4.38 ( 2.93) 7.07childPain scale by the 3.04( 2.62) 4.90 ( 2.22) 6.57nursePain scale by the 3.50 ( 2.86) 4.95 ( 3.22) 2.60parents0.0110.0140.114There was no difference in the time for a successful IVinsertion between the “BUZZY” and the “No BUZZY”groups. This is supported with two previous studies whichreported that the use of the “BUZZY” made the venipunctureeasier (Whelan et al., 2014) and did not cause a significantdifference in the success of a blood specimen collection (Inal& Kelleci, 2012).The “BUZZY” was more effective in the younger agegroup and in girls. While a few earlier studies assessed theeffect of age or gender on pain scores using distractionmethods (Sharar et al., 2007; Sparks, 2001; Tüfekci et al.,2009), none had assessed the effect of the “BUZZY” on thechildren of different genders and ages. It could well be thatthe “BUZZY” is more effective in the younger age groupwho are easily distractible. Older children on the other handmay be more focused on the needle which is supported by anearlier study that found that younger children benefit morefrom distraction methods (Downey & Zun, 2012). Sincechildren younger than 7 years report more distress, painintensity and unpleasantness following a needle prick thanolder children, distraction may be more beneficial to this agegroup (Caprilli et al., 2007; Vetri-Buratti et al., 2015). Giventhe significant developmental changes that occur throughoutearly childhood to late adolescence, and the limited studiesexamining the effect of distraction on different age groups, ithas been suggested that future trials should investigatepotential age and developmental differences (Birnie et al.,2014; Uman et al., 2013; Vetri- Buratti et al., 2015; Williamset al., 2012).The fact that distraction was more effective in girls isinteresting and supported in only one earlier study (Tüfekci,Celebioğlu, & Küçükoğlu, 2009). In this latter study, femalechildren felt less pain than the male children using akaleidoscope as a distraction method during a venipunture
70Table 3N. Moadad et al.Univariate analysis of the factors associated with pain reporting by the child on the FRS-R with or without the BUZZY.BUZZYVariableAge in years4–88–12GenderMaleFemaleBMIb 23N 23DiagnosisCardiacOncologyOtherPrevious hospitalizationYesNoOn analgesicsYesNoNumberMean ( SD)NumberMean ( SD)F value12132.11 ( 1.45)1.45 ( 1.78)10134.34 ( 3.67)2.88 ( 2.01)8.963.690.0070.06213121.25 ( 2.74)1.89 ( 1.60)11123.17 ( 3.60)5.22 ( 2.56)3.4714.590.0730.00114112.35 ( 1.26)3.22 ( 2.78)13103.68 ( 2.34)4.15 ( 3.45)3.470.470.0810.50011952.24 ( 1.67)1.01 ( 0.69)2.14 ( 1.23)9773.68 ( 3.01)3.02 ( 1.48)4.09 ( 2.97)1.8413.314.250.1930.0030.07710151.96 ( 1.87)2.40 ( 1.09)13123.75 ( 2.02)3.68 ( 2.344.723.550.0420.0715201.83 ( 1.68)1.22 ( 2.11)8153.20 ( 2.70)3.71 ( 2.01)1.727.070.2140.021procedure. In contrast, a recent study found no genderdifferences when audiovisual eyeglasses were used duringlocal anesthesia injections (Asvanund, Mitrakul, Juhong, &Arunakul, 2015). Although limited research has investigatedgender differences in terms of distraction, a few studies haveassessed gender differences in pain perception. While somestudies note that girls report less pain (Gauthier, Finley, &McGrath, 1998), others note that male children have higherpain tolerance. A recent systematic review indicated that, themajority of published accounts of sex differences in painratings of healthy children report no significant differencesbetween boys and girls (Boerner, Birnie, Caes, Schinkel, &Chambers, 2014). Nevertheless, it is worth noting thatdifferences in gender responses to pain may vary acrosscultures as some cultures may expect males to have high paintolerance (Tüfekci et al., 2009). The findings in this studywarrant further investigation, and researchers should contin-Table 4No BUZZYpue to include analyses of both gender, and age to betterunderstand how these variables can influence pain perception. There was no relationship between BMI and pain scoreswhich is in contrast to one previous study that found thatchildren with high BMI had significantly higher odds ofhaving moderate to severe pain post-tonsillectomy (Nafiuet al., 2013). The differences in results could be related to thekind of pain assessed and the ages of children. However,more research is needed to confirm the opposing results.Children with cancer benefited most from the “BUZZY”which could be explained by the fact that they have beensubjected to several earlier needle sticks and a distractionwas a welcome diversion. Similarly, children who werepreviously hospitalized had lower scores when the“BUZZY” was applied. It can be postulated, that childrenwith prior needle pricks may be more apprehensive about theprocedure and welcomed the “BUZZY” as a distracterMultiple regression of the factors that are best predictors of the FRS-R by the child.Unstandardized coefficientsConstantAge in yearsGenderDiagnosisPrevious hospitalizationChild on analgesicsBuzzy or no buzzyStandardized coefficientsBStd. error1.972 .471 .1561.2421.015 2.3622.3524.247.2771.292.7232.1821.3861.026Betatp .462 .027.369.143 .399.397.464 1.702 .1211.717.465 1.7042.292.648.107.905.104.648.107.035
Distraction Using the “BUZZY”whereas children with no prior hospitalization were not aslikely to be distracted. No earlier studies have assessed theimpact of distraction techniques on previous hospitalizationsor diagnoses. Nevertheless, studies have observed thatprevious negative or painful experiences lead to elevatedanxiety and pain experiences during future invasive medicalprocedures (Noel, Chambers, McGrath, Klein, & Stewart,2012; Noel, McMurtry, Chambers, & McGrath, 2010). Thismay suggest that exposure to painful experiences is relatedmore to anxiety and pain and thus the need for distraction.As expected children who were not on analgesics hadlower pain scores when using the “BUZZY”. Although weonly included children who had received analgesics 4 hoursprior to the procedure, the effect of analgesics for more than4 hours may have
Distraction Using the BUZZY for Children During an IV Insertion Nemat Moadad RN, BSNa, Katia Kozman RN, MSNa, Randa Shahine RNb, Shake Ohanian RN, MSb, Lina Kurdahi Badr RN PhD, CPNP, FAANc,⁎ aPediatric unit, American University of Beirut Medical Center, Beirut, Lebanon bChildren's Cancer Center, Beirut, Lebanon cAzusa Pacific University, CA Received 14 April 2015; revised 22 July 2015 .
