Factors Associated With High Pain Scores During Paediatric Peripherous Intravenous Cannulation Insertion: A Secondary Analysis of a Prospective Cohort Study in Children

AIM: PIVC insertion can be a painful procedure, but limited research focuses on contributors and alleviators of pain. This study aimed to determine participant, proceduralist, and/or situational factors associated with a high pain score in children. METHODS: This was a secondary analysis of a previously published single-centre prospective observational study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children aged under 16 years and recorded data relating to the patient, proceduralist, and event. Pain scores during each attempt were determined observationally using the Faces Pain Score Revised (FPS-R) scale, which ranges 0-10. A score of 7-10 was categorised as high pain. Multivariable logistic regression modelling was performed to identify factors associated with a high pain score. RESULTS: A total of 198 attempts for 130 participants were evaluated. About half of the children were male (n = 64, 49.2%) and median age was 5.7 years (2.0-11.0). Fifty-five children (42.3%) had high pain scores during PIVC insertion. Factors that independently increased the likelihood of a high pain score during PIVC insertion were younger age Odds ratio, 95% confidence interval (OR [95% CI]) = 0.83 [0.72-0.95], three or more attempts (OR 17.3 [1.8-163.8]), history of negative PIVC experience (7.0 [1.4-36.1]), a combative child (10.7 [2.3-50.3]), and antecubital fossa site as first attempt (3.37 [1.07-10.66]). CONCLUSIONS: High pain during PIVC insertion is common and associated with repeated attempts. Optimising the first attempt-and employing strategies shown to mitigate pain are recommended, particularly in younger children and/or those with prior negative experiences.