IV Starts Don't Have to Hurt

The sheer number of IV starts that are done in inpatient and outpatient hospital settings is greatly under-appreciated, except, of course, by patients, nurses, and the certified child life specialists (CCLS) who support patients during these procedures. It’s estimated that hundreds of millions of needle procedures are administered in the U.S. every year, and on average, an emergency room does 5,900+ IV starts in that time.

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Needle injections are the most painful procedure most kids will experience in their childhood, so it’s understandable that some develop a high level of fear, with subsequent needle procedures bringing even higher distress. It’s critical to prevent this distress and the development of needle phobias if we want to help children develop a positive relationship with healthcare providers, which will reduce the likelihood that they will avoid procedures as an adult. These reasons are why innovation around needle procedures is so important.

A sizable amount of the population holds a deep-seated fear of needles (trypanophobia). When kids experience fear during a needle procedure, they seek security from an adult, primarily a parent. But when that parent is anxious, fearful, or unsure about how to support the child, it’s critical that the child receives support from a CCLS. Other staff are not always well-equipped to support the child, and worse, when they don’t acknowledge the child’s fear, the situation can be exacerbated. When staff make light of a needle procedure, the child's trust in them may be affected.


Augmented reality (AR), a technology innovation used in hospitals in recent years, has already been clinically proven effective for pain management during burn dressing changes. For the last year, we have been gathering anecdotal evidence from clinicians and families which shows that AR provides effective pain and anxiety management for needle procedures like IV starts.

For example, a child life intern named Ashley Bain shared her experience using AR with an 8-year-old girl on her endoscopy surgery day. The patient had to receive an IV for her “sleepy medicine,” but after enduring poke after poke, the IV still wouldn’t take due to her being so dehydrated. While waiting for the nurse to try again, the patient selected SpellBound’s Pegasus Myth Tool to play with as they all headed into the surgical suite together. In a moment, the majestic white horse appeared to magically stand in the room with them. As the patient tapped quickly on the iPad screen, Pegasus flew high into the surgery room. The patient exclaimed how cool it was and asked if she could continue playing with Pegasus. She did it a few more times, and before she knew it, the IV was in place.

It doesn’t take long to recognize the value that these tools provide to patients and CCLSs. The first time Ana Aburto, CCLS at Providence Children’s Hospital, tried using AR was during an IV start with a 3-year-old girl who had a lot of anxiety. Ana says the parent was even more anxious than the child, and they were making their child’s anxiety increase as a result. When it came time to put in the IV, Ana pulled out SpellBound’s Mouse Journey Tool for the patient to use. Every time the girl felt something during the procedure, she’d touch the mouse to make it squeak so that the nurse would know she was hurting. Using the feedback from the patient, the nurses were able to get the IV started after a few minutes. When they were done, the girl left her procedure room to return to her family, and was excited to show them how she had managed to get through the procedure using the AR tool.

Another instance of using AR during an IV start was when Eriko Miura, CCLS at St. Luke’s International Hospital, assisted a 2-year-old boy during an IV injection. When Eriko pulled out SpellBound’s Fable Journey tools, both the patient and his mom (and the doctor and nurse) were fascinated. Each time the animals appeared on the screen, the patient shouted the names of each animal and then interacted with them. After the procedure was over, the patient wanted to continue playing with SpellBound and started crying because he had to stop. His mother laughed and pointed out how funny it was for him to be crying for a totally different reason than you’d expect in that situation.

AR is an effective tool during needle procedures because it’s immersive, quick to initiate, enables maintained contact with the CCLS, and fits well into clinician workflows. AR has been proven effective in the healthcare realm, but what makes it such an effective engagement tool?


1. AR is immersive.

Like virtual reality and video games, AR can produce the “zombie effect” where children are so engaged in the experience that they can block out all real-world input, such as a call to the dinner table. Harnessing this immersiveness is part of the magic of this technology for reducing the perception of pain and anxiety. The immersiveness is possible because the technology enables imaginative play--a key element of child development.

2. AR fits well into workflow and is quick to initiate.

Mobile augmented reality uses tablets and smartphones to deliver interactive 3D experiences--the same tablets and phones that hospitals already own and have sterilization protocols in place for. Because these devices are often carried by CCLSs, getting started is as simple as opening an app on the iPad. This speed of access makes AR tools easy to use during procedures like IV starts. We’ve heard clinicians say that they keep the cards tucked into their name badge or the cover of their iPad so that they are on-hand at all times, even when they’re called into a room to support a patient without any time to grab other tools.

3. AR tools allow the patient to stay in constant contact with parents and clinicians.

Because AR is a combination of the real world and the digital world, it allows patients to remain grounded in the situation and connected to parents and clinicians. We’ve heard from providers that trust issues can arise when patients feel like there is a “sneak attack” by clinicians. Because AR allows the patient to remain in visual contact and doesn’t cover up the reality of the situation, the technology can help build trust and foster relationship building in a painful situation.

For hospitals, providing good patient experience that includes pain and anxiety management for even simple procedures like IV starts will positively impact HCAHPS scores. The “pain management” section of HCAHPS is obvious for major procedures, post surgical, or for chronic pain patients. But improving all-around pain and anxiety management using non-pharmacological methods is a good way to ensure that patients don’t come away remembering only the painful PICC line or the multiple needle pokes they needed to have while an inpatient.

“Just a stick and then it’s over” doesn’t encompass the pain and anxiety these procedures can cause in young patients, and remembering that is important for advancing care. Why would we want to condition these young and vulnerable patients? Needle procedures are among the most challenging experiences in pediatric medical treatment, not only for the patient but also for the family, and reducing pain and anxiety in these procedures will improve satisfaction and patient experience.

Christina YorkComment