Practice Considerations for Non-Pharmacological and Pharmacological Pain Management Strategies During VAD Insertion in Adults

• Time constraints experienced by health providers may be a barrier to providing pain management strategies. In these situations, pain management strategies should still be offered.
  
  • Health providers may consider faster acting strategies, such as thermotherapy or cryotherapy, while keeping in mind the preferences of persons and their families/caregivers.
• The expert panel noted that some individuals may not prefer topical anesthetic due to the increase in overall procedure time (i.e., topical anesthetic can take longer to take effect).
• A physician order may be required prior to administration of pharmacological pain management interventions.
• Decisions around pharmacological pain management interventions may require an individualized risk-benefit assessment, including (but not limited to) factors such as the following:
  
  • person preference;
  • presence of needle phobia, or fear/anxiety about the procedure;
  • DiVA score/history of DiVA; and
  • type of pharmacological intervention and potential side effects, such as vasoconstriction associated with some topical medications.
• It may not be possible to offer pharmacological or non-pharmacological pain management strategies to persons needing vascular access in an emergency care situation. Health providers should not delay the life-saving treatments of persons during emergency situations.

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