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J Pediatr Nurs. 2017 Nov - Dec;37:91-96. doi: 10.1016/j.pedn.2017.08.025. Epub 2017 Aug 18.

Comparison of Children's Venipuncture Fear and Pain: Randomized Controlled Trial of EMLA® and J-Tip Needleless Injection System®.

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Division of Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT, United States; Division of Pediatric Neurosurgery, Connecticut Children's Medical Center, Hartford, CT, United States. Electronic address:
Nursing Research & Professional Practice, Posey and Fred Love Chair in Nursing Research, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; (d)Northwestern University Feinberg School of Medicine, United States. Electronic address:



Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA® or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System® (J-Tip®).


In this prospective, randomized trial, 150 consecutive pediatric patients 8 to 18years of age undergoing IV insertion were randomly assigned 1:1 to treatment group. Participants self-reported procedural pain using a Visual Analog Scale, and procedural fear using the Children's Fear Scale.


Procedural pain scores were significantly lower in the EMLA® group (mean score 1.63+1.659) vs. the J-Tip® group (2.99±2.586; p<0.001). Post-procedure fear scores were significantly lower than pre-procedure fear scores in both treatment groups (p<0.002), but there was no difference in fear scores between the two treatment groups (p=0.314).


EMLA® provided superior pain relief for IV insertion compared to J-Tip®.


Although EMLA® use resulted in lower self-reported pain scores compared to J-Tip®, pain scores for both treatments were low and fear scores did not differ. When IV insertion can be delayed for 60-90min, EMLA® should be used. When a delay is contraindicated, J-Tip® may be a reasonable alternative to minimize procedural pain of IV insertion.


EMLA® topical local anesthetic; IV; J-Tip® Needle-free device; Procedural fear; Procedural pain management

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