UMEM Educational Pearls

Category: Pediatrics

Title: J-Tip: A Tool to Reduce Pain for Pediatric Venipuncture?

Keywords: Pediatrics, Venipuncture, J-Tip, Jet-Injected, Local anesthesia, Topical anesthesia (PubMed Search)

Posted: 1/2/2016 by Christopher Lemon, MD (Updated: 6/13/2024)
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Many providers may not be familiar with the "J-Tip" (National Medical Products Inc, Irvine, CA) which is a needle-free jet injection system that uses air to push buffered lidocaine into the skin. In theory, it provides quick local anesthesia without a needle, making it an ideal tool to reduce the pain of pediatric venipuncture. Maybe you will consider giving it a try?...but what is the data for it?

Studies on the subject to date are few in number and focus on older kids or adolescents. One such example is from Spanos et al, 2008. They conducted a randomized control trial comparing J-Tip buffered lidocaine versus topical ELA-Max for local anesthesia before venipuncture in children 8-15 years old (N=70). They utilized a self-reported pain scoring system and showed a statistically significant reduction of pain immediately after venipuncture for the J-Tip group. 
 
More recently, Lunoe et al sought to assess J-Tip usage in a younger population, ages 1-6 years old (N=205). An observation-based pain scoring system was applied to video playback of the procedure as participants were too young to self-report pain scores. At the study institution, usual care for venipuncture was not ELA-Max-- it was topical vapocoolant (i.e."freezie" spray). Thus, participants were randomized to one of three groups: 1) Control: vapocoolant spray alone, 2) Intervention: loaded J-Tip with buffered lidocaine + a spray of normal saline solution (to simulate vapocoolant spray) , 3) Shamempty J-Tip  + vapocoolant spray. The empty J-Tip was used in the sham group to control for the sound/presence of the device because the scoring system does not differentiate pain from anxiety. They found a statistically significant reduction in venipuncture pain score when using the loaded J-Tip compared to the control or sham. There was no difference across groups in terms of venipuncture success rates or adverse events.
 
The latter study cites the price for each J-tip device between $0.98-$4.10. 

References

Spanos S, Booth R, Koenig H, et al. Jet injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children. Pediatric Emerg Care. 2008; 24:511-515.
 
Lunoe M, Drendel A, Levas M, Weisman S, Dasgupta M, Hoffman R, Brousseau D. A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children. Annals of Emerg Med. 2015;66,5:466-474.

Attachments

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