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The purpose of this study is to determine whether or not the pain of IV catheter insertion in the Emergency Department can be reduced significantly with the use of a rapid acting topical anesthetic spray and to determine whether or not healthcare providers who undergo such treatment are likely to endorse its use in their future practice.
We recruited 38 emergency department healthcare providers (doctors, physician assistants, nurses and medics) to receive a total of two separate IV canulations - one in one arm and the other in the other. One IV canulation would be pretreated with Ethyl Chloride topical anesthetic (the study product) and the other would be pre-treated with a placebo (sterile water in an aerosol can). Both the participants and the nurses, PAs and medics who placed the IVs were blinded as to which was the Ethyl Chloride and which was the placebo. After the IVs were placed the participants were asked to rate the pain of IV canulation on a scale of 1 to 10 for each of the pre-treatments, to state which one they believed to be superior in reducing the pain of receiving the IV, to state whether or not they would like the intervention that they rated as superior to be used on themselves and finally how likely they were on a 5 point scale to incorporate the intervention they rated as superior into their future practice.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Topical Ethyl Chloride (Product B) | Active Comparator | Ethyl Chloride Topical Aerosol Anesthetic applied to arm |
|
| Topical Sterile Water (Product A) | Placebo Comparator | Nature's Tears Sterile water in an aerosol can |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ethyl Chloride Topical Aerosol Anesthetic | Drug | Sprayed on the skin for 5-8 seconds immediately before IV cannulation |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain | Ordinal pain scale (1-10) | 1 minute |
| Measure | Description | Time Frame |
|---|---|---|
| Preferred product | Categorical selection of preferred product for use on self prior to IV placement | 1 minute |
| Desire to use on self in future | Binary (yes, no) desire to use on self prior to IV placement in future |
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Inclusion Criteria:
Exclusion Criteria:
History of hypersensitivity to Ethyl Chloride.
Break, or swollen in the skin at the proposed IV site.
Pregnancy or lactating female.
Recent tattoo in either of the two proposed anatomical areas for IV cannulation.
Skin infection in either of the two proposed anatomical areas for IV cannulation.
Missing a contralateral limb to place the second IV.
Recent trauma to one of the upper extremities or any neuropathic or radicular condition that could affect the participant's perception of pain in the antecubital fossa of each arm.
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| Name | Affiliation | Role |
|---|---|---|
| Kurt Fossum, MPAS | Brooke Army Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brooke Army Medical Center | Fort Sam Houston | Texas | 78234 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22449552 | Background | Fung S, Phadke CP, Kam A, Ismail F, Boulias C. Effect of topical anesthetics on needle insertion pain during botulinum toxin type A injections for limb spasticity. Arch Phys Med Rehabil. 2012 Sep;93(9):1643-7. doi: 10.1016/j.apmr.2012.03.012. Epub 2012 Mar 23. | |
| 15544709 | Background | Mawhorter S, Daugherty L, Ford A, Hughes R, Metzger D, Easley K. Topical vapocoolant quickly and effectively reduces vaccine-associated pain: results of a randomized, single-blinded, placebo-controlled study. J Travel Med. 2004 Sep-Oct;11(5):267-72. doi: 10.2310/7060.2004.19101. |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Nature's Tears Sterile Water | Drug | Sprayed on the skin for 5-8 seconds immediately before IV cannulation |
|
|
| 1 minute |
| Desire to use on patients in future | Binary (yes, no) desire to use on patients prior to IV placement in future | 1 minute |
| Likelihood to use on patients in future | 5 point likert scale ranging from "very unlikely" to "very likely" | 1 minute |
| 18434455 | Background | Hartstein BH, Barry JD. Mitigation of pain during intravenous catheter placement using a topical skin coolant in the emergency department. Emerg Med J. 2008 May;25(5):257-61. doi: 10.1136/emj.2006.044776. |
| 18591524 | Background | Farion KJ, Splinter KL, Newhook K, Gaboury I, Splinter WM. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. CMAJ. 2008 Jul 1;179(1):31-6. doi: 10.1503/cmaj.070874. |
| 19208703 | Background | Hijazi R, Taylor D, Richardson J. Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial. BMJ. 2009 Feb 10;338:b215. doi: 10.1136/bmj.b215. |
| 16928840 | Background | Costello M, Ramundo M, Christopher NC, Powell KR. Ethyl vinyl chloride vapocoolant spray fails to decrease pain associated with intravenous cannulation in children. Clin Pediatr (Phila). 2006 Sep;45(7):628-32. doi: 10.1177/0009922806291013. |
| Background | Ducharme, J. (2011). Acute Pain Management in Adults. In J. E. Tintinalli, J. S. Stapczynski, O. J. Ma, D. M. Cline, R. K. Cydulka, & G. D. Meckler, Tintinalli |
| 26971823 | Derived | Fossum K, Love SL, April MD. Topical ethyl chloride to reduce pain associated with venous catheterization: a randomized crossover trial. Am J Emerg Med. 2016 May;34(5):845-50. doi: 10.1016/j.ajem.2016.01.039. Epub 2016 Feb 13. |