Development of atraumatic heel-stick procedures by combined treatment with non-nutritive sucking, oral sucrose, and facilitated tucking: A randomised, controlled trial. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Yin, Ti; Yang, Luke; Lee, Tsorng-Yeh; Li, Chia-Chi; Hua, Yi-Ming; Liaw, Jen-Jiuan
• Is Part Of: International journal of nursing studies. Volume 52:Issue 8(2015:Aug.)
• Page Start: 1288
• Page End: 1299
• Publication Date: 2015-08
• Subjects: Nursing -- Periodicals; Nursing -- Periodicals; Soins infirmiers -- Périodiques; Nursing; Periodicals; 610.73
• DOI: 10.1016/j.ijnurstu.2015.04.012
• Languages: English
• ISSNs: 0020-7489

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. non-nutritive sucking, oral sucrose, and facilitated tucking, on infants' behaviours across painful procedures.</p> </sec> <sec> <title id="sect0015">Objectives</title> <p id="spar0010">To explore the effects of combined use of three nonpharmacological interventions (non-nutritive sucking, oral sucrose, and facilitated tucking) on infants' pain- and stress-related behaviours during four assessment phases: baseline, intervention, heel stick, and recovery.</p> </sec> <sec> <title id="sect0020">Design</title> <p id="spar0015">Prospective, randomised controlled trial.</p> </sec> <sec> <title id="sect0025">Setting</title> <p id="spar0020">Level III neonatal intensive care unit in Taipei.</p> </sec> <sec> <title id="sect0030">Method</title> <p id="spar0025">A convenience sample of 110 infants (gestational age 27–37 weeks) needing heel sticks was randomly assigned to five combinations of nonpharmacological treatments: (1) routine care, (2) non-nutritive sucking + facilitated tucking, (3) oral sucrose + facilitated tucking, (4) non-nutritive sucking + oral sucrose, and (5) non-nutritive sucking + oral sucrose + facilitated tucking. Outcomes were infants' withdrawal or stress (<italic>grimace</italic>, <italic>limb and trunk extension or squirming</italic>) and approach or self-soothing (<italic>sucking, sucking search, or mouthing</italic>; <italic>hand holding or grasping</italic>; and <italic>hand to mouth, face</italic>) behaviours.</p> </sec> <sec> <title id="sect0035">Results</title> <p id="spar0030">The frequency of infants' withdrawal behaviours decreased significantly when they received combinations of nonpharmacological interventions before heel stick. Specifically, <italic>grimace</italic> frequency decreased by 32.2%, 30.6%, 19.7%, and 13.8% in infants receiving oral sucrose + non-nutritive sucking + facilitated tucking, non-nutritive sucking + oral sucrose, oral sucrose + facilitated tucking, and non-nutritive sucking + facilitated tucking, respectively, compared to those receiving routine care across assessment phases. Furthermore, infants' frequency of <italic>limb and trunk extension or squirming</italic> decreased by 24.0% when they received non-nutritive sucking + oral sucrose + facilitated tucking compared to those receiving routine care. Infants' frequency of approach behaviours did not change significantly across all phases when they received non-nutritive sucking + oral sucrose + facilitated tucking, non-nutritive sucking + oral sucrose, and oral sucrose + facilitated tucking compared to those receiving routine care.</p> </sec> <sec> <title id="sect0040">Conclusions</title> <p id="spar0035">The combined use of nonpharmacological interventions (non-nutritive sucking + oral sucrose + facilitated tucking) effectively reduced the frequencies of infants' withdrawal behaviours, i.e. <italic>grimace</italic> and <italic>limb and trunk extension or squirming</italic>. Our results provide evidence supporting clinicians' incorporation of the combined use of facilitated tucking, oral sucrose, and non-nutritive sucking into clinical practice during painful procedures. Heel-stick procedures can be atraumatic when conducted while infants are stable and quiet, appropriately positioned, and stabilised and by offering facilitated tucking, oral sucrose, and non-nutritive sucking before gently sticking the heel and squeezing blood.</p> </sec> </abstract>