Registered Nurses' Association of Ontario

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.

To view Practice Notes from the Evidence click here

Clinical Management
Assessment and Device Selection for Vascular Access
Point of Care Resources