all heel sticks and consistently rated N-PASS scores at the defined time points. The second rater was the infant’s bedside nurse who independently entered N-PASS scores at the defined time points. All nurses who served as the second rater had received previous training in N-PASS scoring. α = 0.84-0.89). Interrater agreement was excellent (intraclass correlation coefficient = 0.86-0.93) and correlation of the N-PASS with Premature Infant Pain Profile scores showed good construct validity ( r s = 0.75). The N-PASS was also chosen over other neo- natal pain assessment tools because it was already in routine use in the unit where this study took place. Therefore, the staff already had a comfort level with the tool and interrater testing had taken place on the unit several months before the start of this pilot study. Study Procedure Written parental consent was obtained for all patients enrolled in our study. Enrolled patients were scheduled to have their next laboratory values drawn by the study team. All heel sticks performed were clinically necessary. Immediately before the heel stick procedure, participants were randomized using a block randomization schema to either the control or experimental group at a 1:1 ratio. To ensure equal distribution of previous experiences with pain, sur- gical and nonsurgical participants were randomized separately. Demographic and contextual data were collected before heel stick. Control Group Patients randomized to the control group were first swaddled with 1 leg exposed and a heel warmer placed on the exposed heel 3 to 5 minutes before the lance. Two minutes before the heel stick, the patient was given 0.1 to 0.2 mL of oral 24% sucrose with pacifier offered. Before the lance, the heel warmer was removed and site prepared with alcohol. Using the appropriate-sized Tenderfoot lancet, the outer edge of the lateral plantar surface was lanced, along the sural dermatome. A period of 10 seconds with- out squeezing was observed to estimate the response to the heel stick alone. After this undisturbed phase, blood was collected with intermittent squeezing and allowing for capillary refill. After 0.4 to 1 mL of capillary blood was collected, a small adhesive ban- dage was applied to the heel and the infant was reswaddled in a flexed, midline posture. Experimental Group The experimental group procedure was identical to the control except for the following: approximately 30 seconds before the heel stick, the vibrator was applied over the mid/lateral calf, just below the knee in accor- dance with the sural dermatome (see Figures 1 and 2 ) for a 30-second “test” vibration. During this period, the infant was observed carefully for any adverse responses. If the infant had any apnea, bradycardia, or desaturation, the vibrator was immediately removed and reaction documented. Similarly, if the infant dem- onstrated sustained heart rate elevation 20% above baseline or persistent crying, the mechanical vibration was immediately removed and not reapplied. If there FIGURE 2 Application of vibration in study protocol.
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- Fall '15
- Tammy Eades
- Heel Lance