Effectiveness of dry heat application on ease of venepuncture in children with difficult intravenous access: A randomized controlled trial

PURPOSE: To assess the efficacy of dry heat application in children with difficult intravenous (IV) access. DESIGN AND METHODS: A randomized controlled trial was conducted in the pediatric wards of a tertiary care hospital in a Metropolitan city in South India. Based on inclusion and exclusion criteria, children in the age group of 5-18 years were randomized into intervention and control groups of 42 children each. The intervention was an electric heating pad (40 degrees C) applied at the site of the identified IV access for 10 min before IV insertion. Outcomes included the number of IV attempts, the time required to access the IV line, and the discomfort level of the child expressed in terms of the Oucher scale. RESULTS: With respect to the number of attempts taken to achieve an IV access, all children in the intervention group only required one attempt, whereas only 29% of those in the control group required a single attempt (p < .001), X(2) (1, 84) = 43.67, p < .001. The mean time (in seconds) to insert an IV line was lower in the intervention group (M = 64.56, standard deviation [SD] = 28.32) than in the control group (M = 110.70, SD = 51.54), t (82) = 5.09, p < .001. Children in the intervention group were 45.2 percentage points more likely to experience a discomfort level of "little hurt" as compared to their counterparts in the control group, X(2) (1, 84) = 18.02, p < .001. Results from regression analyses supported the unadjusted outcomes comparisons between the two groups. PRACTICE IMPLICATIONS: Dry heat application before IV line insertion significantly improves the ease of venepuncture and reduces the pain perceived by the patient. This method of IV cannulation can be adopted in children with problematic IV access.