Abstract
Needle-related procedures are among the most feared and painful experiences reported by children and their parent. For this reason, use of effective methods of pain relief is very important during phlebotomy procedures in children. The aim of this study is to research two different distraction methods (external cold and vibration-Buzzy + virtual reality) on relief of procedural pain and anxiety in children during phlebotomy. This study is a prospective, randomized and controlled trial. Sample of the study consisted of a total of 119 children who met the sample selection criteria. Children aged 7 to 12 years who required phlebotomy were divided into three groups: buzzy (n = 40), virtual reality (n = 40), and control (n = 39). Data were collected using the information form, Wong–Baker FACES Pain Rating Scale, and Children’s Fear Scale. In the study, 119 children [girls n = 59 (49.6%), boys n = 60 (50.4%)] were included. The children’s pain levels were assessed and reported by the parents and observers and the children themselves who self-reported using Wong–Baker FACES. The children’s anxiety levels were also assessed using the Children’s Fear Scale. A significant difference was found between the groups in terms of the parent-reported and observer-reported assessments (p < 0.05). In the self-reported assessment, the pain levels of the VR and Buzzy group were lower than the control group, but were not statistically significant (p > 0.05). According to the parent-reported and observer-reported assessments, a significant difference was found between procedural anxiety levels. VR is more effective than external cold and vibration-Buzzy in reducing pain during phlebotomy and should be preferred as the first choice.




Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Arane K, Behboudi A, Goldman RD (2017) Virtual reality for pain and anxiety management in children. Canadian Family Physician Medecin De Famille Canadien 63(12):932–934
Aydin D, Şahiner NC, Çiftçi EK (2016) Comparison of the effectiveness of three different methods in decreasing pain during venipuncture in children: ball squeezing, balloon inflating and distraction cards. J Clin Nurs 25(15–16):2328–2335. https://doi.org/10.1111/jocn.13321
Ballard A, Khadra C, Adler S, Doyon-Trottier E, Le May S (2018) Efficacy of the Buzzy® device for pain management of children during needle-related procedures: a systematic review protocol. Syst Rev 7(1):78. https://doi.org/10.1186/s13643-018-0738-1
Bergomi P, Scudeller L, Pintaldi S, Dal Molin A (2018) Efficacy of Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a Pediatric Outpatient Clinic: A Randomized Controlled Trial of Audiovisual Distraction and External Cold and Vibration. J Pediatr Nurs 42:e66–e72. https://doi.org/10.1016/j.pedn.2018.04.011
Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA (2018) Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 10(10):CD005179. https://doi.org/10.1002/14651858.CD005179.pub4
Canbulat N, Ayhan F, Inal S (2015) Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs: off J Am Soc Pain Manag Nurses 16(1):33–39. https://doi.org/10.1016/j.pmn.2014.03.003
Canbulat Şahiner N, İnal S, Sevim Akbay A (2015) The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children. J Perianesthesia Nurs: off J Am Soc PeriAnesthesia Nurses 30(3):228–235. https://doi.org/10.1016/j.jopan.2014.05.011
CustÓdio NB, Cademartori MG, Azevedo MS, Mendes MA, Schardozim LR, Costa L, Goettems ML (2021) Efficacy of audiovisual distraction using eyeglasses during dental care: a randomized clinical trial. Braz Oral Res 35:e26. https://doi.org/10.1590/1807-3107bor-2021.vol35.0026
Czarnecki ML, Simon K, Thompson JJ et al. (2011) Barriers to pediatric pain management: a nursing perspective. Pain Manag Nurs: off J Am Soc Pain Manag Nurses 12(3):154–162. https://doi.org/10.1016/j.pmn.2010.07.001
Eijlers R, Utens E, Staals LM et al. (2019) Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg 129(5):1344–1353. https://doi.org/10.1213/ANE.0000000000004165
Erdogan B, Aytekin Ozdemir A (2021) The effect of three different methods on venipuncture pain and anxiety in children: distraction cards, virtual reality, and buzzy® (randomized controlled trial). J Pediatr Nurs 58:e54–e62. https://doi.org/10.1016/j.pedn.2021.01.001
Faul F (2014) G*power version 3.1.9.2. http://www.gpower.hhu.de/
Gerçeker GÖ, Binay Ş, Bilsin E, Kahraman A, Yılmaz HB (2018) Effects of virtual reality and external cold and vibration on pain in 7- to 12-year-old children during phlebotomy: a randomized controlled trial. J Perianesthesia Nurs: off J Am Soc PeriAnesthesia Nurses 33(6):981–989. https://doi.org/10.1016/j.jopan.2017.12.010
Gerçeker GÖ, Bektaş M, Aydınok Y, Ören H, Ellidokuz H, Olgun N (2021) The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: randomized controlled trial. Eur J Oncol Nurs: off J Eur Oncol Nurs Soc 50:101886. https://doi.org/10.1016/j.ejon.2020.101886
Gold JI, Mahrer NE (2018) Is virtual reality ready for prime time in the medical space? a randomized control trial of pediatric virtual reality for acute procedural pain management. J Pediatr Psychol 43(3):266–275. https://doi.org/10.1093/jpepsy/jsx129
Hur Y, Lee JE, Ahn H (2016) The effect of distraction using video glasses on anxiety of surgery patients under local anesthesia. Asia-pacific Proceedings of Applied Science and Engineering for Better Human Life 7:136–9. https://doi.org/10.21742/asehl.2016.7.31
Inal S, Canbulat N (2015) Using of distraction methods on procedural pain management of pediatric patients. J Health Sci Profess 2(3):372–378
Inal S, Kelleci M (2020) The effect of external thermomechanical stimulation and distraction on reducing pain experienced by children during blood drawing. Pediatric Emerg Care 36(2):66–69. https://doi.org/10.1097/PEC.0000000000001264
Jibb LA, Birnie KA, Nathan PC, Beran TN, Hum V, Victor JC, Stinson JN (2018) Using the MEDiPORT humanoid robot to reduce procedural pain and distress in children with cancer: a pilot randomized controlled trial. Pediatr Blood Cancer 65(9):e27242. https://doi.org/10.1002/pbc.27242
Kerimoglu B, Neuman A, Paul J, Stefanov DG, Twersky R (2013) Anesthesia induction using video glasses as a distraction tool for the management of preoperative anxiety in children. Anesth Analg 117(6):1373–1379. https://doi.org/10.1213/ANE.0b013e3182a8c18f
Khadra C, Ballard A, Déry J et al. (2018) Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: a pilot study. J Pain Res 11:343–353. https://doi.org/10.2147/JPR.S151084
Litwin SP, Nguyen C, Hundert A et al. (2021) Virtual reality to reduce procedural pain during IV insertion in the pediatric emergency department: a pilot randomized controlled trial. Clin J Pain 37(2):94–101. https://doi.org/10.1097/AJP.0000000000000894
Moadad N, Kozman K, Shahine R, Ohanian S, Badr LK (2016) Distraction using the buzzy for children during an IV insertion. J Pediatr Nurs 31(1):64–72. https://doi.org/10.1016/j.pedn.2015.07.010
Piskorz J, Czub M (2018) Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture. J Spec Pediatric Nurs JSPN. https://doi.org/10.1111/jspn.12201.10.1111/jspn.12201
Redfern RE, Chen JT, Sibrel S (2018) Effects of thermomechanical stimulation during vaccination on anxiety, pain, and satisfaction in pediatric patients: a randomized controlled trial. J Pediatr Nurs 38:1–7. https://doi.org/10.1016/j.pedn.2017.09.009
Scapin SQ, Echevarría-Guanilo ME, Fuculo P, Junior Martins JC, Barbosa M, Pereima M (2017) Use of virtual reality for treating burned children: case reports. Rev Bras Enferm 70(6):1291–1295. https://doi.org/10.1590/0034-7167-2016-0575
Schreiber S, Cozzi G, Rutigliano R et al. (2016) Analgesia by cooling vibration during venipuncture in children with cognitive impairment. Acta Paediatr 105(1):e12–e16. https://doi.org/10.1111/apa.13224
Semerci R, Akgün Kostak M, Eren T, Avci G (2021) Effects of virtual reality on pain during venous port access in pediatric oncology patients: a randomized controlled study. J Pediatric Oncol Nurs: off J Assoc Pediatric Oncol Nurses 38(2):142–151. https://doi.org/10.1177/1043454220975702
Susam V, Friedel M, Basile P, Ferri P, Bonetti L (2018) Efficacy of the buzzy system for pain relief during venipuncture in children: a randomized controlled trial. Acta Bio-Medica: Atenei Parmensis 89(6):6–16
Tork HM (2017) Comparison of the effectiveness of Buzzy, distracting cards and balloon inflating on mitigating pain and anxiety during venipuncture in a pediatric emergency department. Am J Nurs Sci 6(1):26–32
Wieland LS (2019) Psychological ınterventions for needle-related procedural pain and distress in children and adolescents: summary of a cochrane review. Explore 15(1):74–75. https://doi.org/10.1016/j.explore.2018.10.014
Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14(1):9–17
Acknowledgements
The authors would like to thank all administrators, patients, and staff nurses who helped the researcher to conduct this study.
Funding
No external or intramural funding was received.
Author information
Authors and Affiliations
Contributions
D.Y. and N.C.S. designed the concept, D.Y. collected the data, N.C.S. completed analysis, D.Y. and N.C.S. searched the literature, D.Y. and N.C.S. wrote the manuscript, and D.Y. involved in critical reviews. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflicts of Interest
The authors report no actual or potential conflicts of interests.
Ethical approval
The study was inspected and approved by the Ethical Committee of Balikesir University Faculty of Medicine (IRB number 2017/94, October 6th, 2017).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Yilmaz, D., Canbulat Sahiner, N. The effects of virtual reality glasses and external cold and vibration on procedural pain and anxiety in children during venous phlebotomy: randomized controlled trial. Virtual Reality 27, 3393–3401 (2023). https://doi.org/10.1007/s10055-022-00714-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10055-022-00714-7