Effect of intradermal normal saline, listening to music, and insertion difficulty on pain of IV insertion

Abstract

Insertion of IV catheters is the most frequently performed invasive procedure by nurses, affecting 25 million people in the U.S. each year. This study used a post-test only control group design to compare the effects of listening to music and intradermal saline injection on the sensory and affective components of pain of IV catheter insertion. The relationships among the difficulty of IV insertion and pain were also examined. Ninety four hospitalized patients requiring insertion of an IV catheter were randomly assigned to one of three groups. One group received an intradermal injection of unpreserved normal saline at the IV insertion site. The other group listened to preferred music during the insertion, and the control group received no extra treatment. Pain intensity and distress were measured with two visual analogue scales, and insertion difficulty was measured with the IV Catheter Insertion Rating Scale. Of the 94 insertion attempts, 60 were successful. Multivariate analysis of variance (MANOVA) of data from the 60 successful IV insertions demonstrated no significant treatment effect on pain intensity and pain distress. Multiple correlation showed a significant relationship between difficulty of IV insertion and pain intensity and pain distress in the control group. Analysis of data pooled from the success and failure groups demonstrated no multivariate difference among the groups in pain intensity and distress, with univariate tests showing that the saline treatment group scored significantly higher on pain intensity (mean = 31.3) than did the music group (mean = 16.9). The saline group was also significantly higher on mean pain distress score (mean = 26.6) than the music group (mean = 9.4). Pain intensity and pain distress were weakly positively correlated with insertion difficulty. No significant difference in the relationship between difficulty and pain intensity and distress was demonstrated among the three treatment groups. Overall, the use of intradermal unpreserved saline as a pain management strategy for insertion of IV catheters was not supported. On the other hand, listening to preferred music via headphones appears promising.