Distraction During

Radiology Procedures

By Kaitlyn Baldwin RN

Implications of untreated
pain and anxiety

A fear of painful needle pokes and uncomfortable

catheter insertions can decrease quality of life
Fear and anxiety can be severely emotionally disabling
Patients who become intensely fearful, anxious, and
hysterical may avoid medical care and be noncompliant
Stress response triggers antidiuretic hormone (ADH)
which is a powerful vasoconstrictor
In rare cases the vasovagal response can cause life
threatening hypotension, bradycardia, and shock
(Sokolowski, Giovannitti, Boynes, 2010)

Improve the Patient Experience

with Distraction
Customer dissatisfaction
Pain management is a patient
satisfaction issue

Fear of needles is increasing

Compliance is affected
Vasovagal Response
Genetic predisposition of
Approximately 5% of population
Stress from pain causes muscle
tension
(Sokolowski, Giovannitti, Boynes, 2010)

Essential Components of
Distraction and Pain Management
Topical Anesthetics

0-12 months: Sucrose

Positioning
Voiding Cystourethrogram (VCU) considerations

Distraction
Integrative
non-pharmacological therapies (toys)

Procedural Sedation

Topical Anesthetics
and Sucrose
Topical Anesthetics
Lidocaine Spray
Immediate
Safe to use for all ages

EMLA cream
Needs to be applied 1-2 hours prior to
needle poke

Approved for ages 3mo +

Ice
Have a barrier between ice and skin
Sucrose use for 0-12 months
Reduces pain and cry response
Effective Dose: 0.5ml 2 min prior to mild
to moderately painful procedure

(Friedrichsdorf, 2014)

Age Appropriate Positioning

Neonatal and infant 018mo.
Positioning on parents
lap

Toddler 18mo-3years
position on the parents
lap utilize distraction

Child 3years -5years

Have the child straddle
the parent so they are
face to face
Have the parent hold
the childs hand

Let the child pick what

distraction toy

(Friedrichsdorf, 2014)

Age Appropriate Positioning

School aged 6-12
Allow child to participate
in care to the greatest
extent possible; the child
may resent forced
dependence.

Adolescent 13-19
May be more comfortable
with same sex nurse
May not want parents to
be involved in care

(Friedrichsdorf, 2014)

Integrative Distraction Process

Talk about the plan with parent and/or patient

Determine if the child wishes to watch or be distracted

Young children: books, bubbles, and toys
Coaching roles for parents
Older children: video games and biofeedback

The benefit is the reduction of fear and anxiety

Distraction Cards with age appropriate Q & A
Caregiver or parent can ask questions provided on back of
card
Child can answer questions or just look at the pictures

Toys are appropriate for all ages

(Friedrichsdorf, n.d.)

Introducing the
Distraction Kit
Tools

Distraction for Voiding

Cystourethrogram VCU

A voiding cystourethrogram (VCU) uses a small amount of radiation to

make images of a person's urinary system

Supine position can cause anxiety

Distraction reduces pain and anxiety
Distraction helps to relax muscles and tension making it
easier to insert a urinary catheter
Distraction can help keep the child still reducing the
amount of radiation the child is exposed to
(Lee, 2013)

How to Use Distraction Buzzy Bee

Buzzy Bee
Buzzy needs to go between the pain and the brain
Fold wings in half and freeze, center frozen wings under band
Ice is 60% of numbing, do not use if wings are not frozen they
absorb vibration
Warm venous blood is flowing towards Buzzy and wont cause
vasoconstriction
In 15-30 seconds the brain sends blocking signals to inhibit
unpleasant sensations, like cold/vibration
After 30 seconds apply tourniquet
Buzzy Bee should be placed about proximally to the poke site
the head of buzzy should be towards the patients head

Research of effectiveness of
Buzzy with needle pokes
Buzzy and distraction cards together decreased
phlebotomy pain 88%

Buzzy alone in the first pediatric study showed a 69%

reduction in pain
Buzzy alone in second pediatric study showed a 58%
reduction in pain and a 52% reduction in fear
Buzzy with or without Lidocaine spray for older children
and adults showed a 54% reduction in pain
Buzzy alone versus Lidocaine spray alone, showed a
50% reduction in pain
(Inal & Kellici, 2011)

References
Friedrichsdorf, S.J. (2014). Its just a poke right? Procedural pain management in pediatrics. In
Pediatric pain management confrence
Furlow, B. (2011). Radiation protection in pediatric imaging. Journal of the American Society of
Radiologic Technologists. 82(5), 421-439.
Inal, S., Kelleci, M. (2012). Buzzy relieves pediatric venipuncture pain during blood specimine
collection. Journal Maternel Child Nursing. 37(5), 339-345
Kettwich, S.C., Sibbitt, W.L., Brandt, J.R., Johnson, C.R., Bankhurst, A.D. (2007). Needle
Phobia and stress-reducing medical devices in pediatrics and adult chemotherapy patients.
Journal of Pediatric Oncology Nursing. 24(1), (January-February) 20-28. Doi:
10.1177/1043454206296023
Lee, J.K. (2013). Peds rule my world. ASRT Scanner. (December 2012/January2013) 16-17.
Lisowska, P., Zoitopoulos, L. (2009). Cognitive behavioural therapy and severe needle phobia-a
case study. Journal of Disability and Oral Health. 10(3), 135-138. Doi 161.57.201.41
Sokolowski, C.J., Giovannitti, J.A., Boynes, S.G. (2010). Needle phobia: etiology, adverse
consequences, and patient management. Dental Clinics of North America. 54(4), 731-744.