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

• Aseptic technique needs to be maintained during VAD insertion, regardless of the type of pain management strategy used.
• The expert panel emphasized the importance of offering children, infants and parents/guardians the choice of a variety of pain management interventions.
• Some children do 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:
  
  • person and family 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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