Acute Pain, Peripheral Intravenous Catheterization, Procedural Pain
Conditions
Keywords
venipuncture pain, intravenous cannulation, local cooling, alcohol evaporation, hand fan, non-pharmacological analgesia, emergency department, crossover trial, Cold Temperature, Cryotherapy
Brief summary
Inserting an intravenous (IV) cannula is one of the most frequently performed procedures in clinical practice, and it is commonly experienced as painful. Before the needle is inserted, the skin is routinely cleaned with alcohol. As alcohol evaporates it cools the skin, and cooled skin is less sensitive to pain. This study examined whether accelerating that evaporation with a simple portable hand fan reduces the pain of IV cannulation. One hundred volunteers aged 18 to 65 years who required elective IV cannulation took part in the emergency department of a tertiary care city hospital. Each participant underwent two cannulations, one in each arm, within a single session. On one arm the skin was prepared with 70% isopropyl alcohol in the usual way. On the other arm the same alcohol was applied and the site was then fanned for 15 seconds with a portable hand fan before the needle was inserted. The order of the two arms was assigned randomly, so each participant served as their own comparison. Within 30 seconds of each cannulation, participants rated their pain on a 0 to 10 numeric scale. The assessor who recorded these scores did not know which arm had received the fan. The researchers also recorded whether the vein was entered on the first attempt, any skin irritation at 5 and 30 minutes, and, after both cannulations were completed, how satisfied participants were with the fan-assisted method. The purpose of the study was to determine whether this low-cost, drug-free method can make IV cannulation less painful without making it harder to place the cannula.
Detailed description
A pre-planned pilot substudy was conducted under the same ethics committee approval in an independent sample of 20 adult volunteers who were not enrolled in the main trial. Antecubital skin temperature was measured with a non-contact infrared thermometer held at a fixed distance of 3 cm, immediately before and immediately after the 15-second fan-assisted alcohol application, to verify that the intervention produces the evaporative cooling proposed as its analgesic mechanism.
Interventions
OTHERFan-assisted local cooling
The cannulation site was cleaned with 2 mL of 70% isopropyl alcohol as part of standard aseptic preparation, immediately followed by 15 seconds of fanning with a portable hand fan (medium setting, airflow approximately 3 m/s) directed at the site from a distance of 10 to 15 cm, timed with a stopwatch. Cannulation was then performed with a standard 20G catheter in the antecubital fossa by a single emergency nurse with at least two years of experience. In both arms 70% isopropyl alcohol was used as routine aseptic preparation; the arms differed only in the addition of forced-air fanning.
OTHERStandard alcohol skin preparation
The skin over the selected vein was cleaned with 70% isopropyl alcohol and allowed to dry passively, without fanning, before needle insertion. This represents routine institutional practice and served as the comparator condition.
Sponsors
Antalya Health Sciences University
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Blinding of participants and the operator was not possible owing to the nature of the intervention. The assessor who recorded outcome measures was blinded to which arm was the intervention arm.
Intervention model description
Within-subject (paired) AB/BA crossover: each participant received both conditions on contralateral arms within a single session. Sequence denotes which arm was treated first.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 18 to 65 years * Scheduled peripheral intravenous cannulation at the antecubital region * Written informed consent provided
Exclusion criteria
* Severe peripheral vascular disease (chronic venous insufficiency or history of thrombophlebitis) * Alcohol intolerance or allergy * Active dermatological disease (eczema, psoriasis, contact dermatitis) * Neuropathic disease that may alter pain perception * Analgesic use within the previous 6 hours * Existing pain with NRS score of 4 or higher * Refusal to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity during intravenous cannulation | Day 1: within 30 seconds after completion of each cannulation | Self-reported pain intensity during needle insertion, measured with the Numeric Rating Scale (NRS) ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain. Each participant provided one score for the fan-assisted arm and one score for the standard preparation arm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| First-attempt cannulation success | Day 1: at the time of each cannulation attempt | Successful cannulation with a single skin puncture and without catheter repositioning, confirmed by free blood return and unobstructed saline flow. Compared between arms with the McNemar test for paired binary data. |
| Skin irritation at the cannulation site | Day 1: 5 minutes and 30 minutes after cannulation | Presence and grade of skin irritation at the cannulation site, assessed by clinical examination. |
| Participant satisfaction with the procedure | Day 1: immediately after completion of both cannulations | Participants rated their overall satisfaction with the fan-assisted (intervention) method on a single 0 to 10 scale, where 0 indicates not satisfied at all and 10 indicates completely satisfied. Higher scores indicate greater satisfaction. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORTaha Yaşar Kiraz, MD
Antalya City Hospital
Outcome results
None listed