Atraumatic care: EMLA cream and application of heat to facilitate peripheral venous cannulation in children.

The purpose of this study was to investigate whether the application of heat placed to a child's potential intravenous (IV) site after the application of EMLA Cream™ decreases vasoconstriction, therefore promoting atraumatic care in the hospitalized pediatric patient. Venipuncture in children is a painful and frequently performed procedure. While use of EMLA Cream™ to reduce pain on insertion is a common practice with pediatric patients, no studies had measured venous size in relation to EMLA Cream™ and heat application. A descriptive quantitative design was used to examine the use of EMLA Cream™ and application of heat to facilitate venipuncture for peripheral venous cannulation. A convenience sample of 30 hospitalized Caucasian children, eight to twelve years old, participated. Vascular ultrasound directly measured the vein prior to and 1 hour after EMLA Cream™ application, as well as 2 minutes after heat application. Mean vein measurements were 0.243 cm prior to EMLA Cream™, 0.205 cm after EMLA Cream™ applied for 1 hour, and 0.253 cm after two minutes of heat. There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA Cream™ application, potentially increasing peripheral venous cannulation success rates.