UMEM Educational Pearls - By Christopher Lemon

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: 11/22/2024)
Click here to contact Christopher Lemon, MD

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) Sham: empty 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.

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Title: Color-Coded Code Drugs: A Novel Idea in Pediatric Resuscitation

Category: Pediatrics

Keywords: pediatric, code, resuscitation, medication error (PubMed Search)

Posted: 10/3/2015 by Christopher Lemon, MD
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A group from Colorado identified the high-stress of pediatric resuscitation as a high-risk setting for possible medication error. As such, they performed a prospective, block-randomized, crossover study with two mixed teams of docs (ABEM certified) and nurses, managing 2 simulated peds arrest scenarios using either:

1) conventional “draw-up and push” drug administration methods [control] or

2) prefilled medication syringes labeled with color-coded volumes correlating to the weight-based Broselow Tape dosing [intervention].

The objective was to compare the time of preparation and administration of a medication, as well as to assess dosing errors. Participants were blinded to the purpose during recruitment but unblinded just prior to running the scenarios.

The scenarios included advanced airway management and hemodynamic life support efforts to care for an 8-year-old or 8-month-old manikin. The intervention group received a standard 3-minute tutorial on the use of prefilled color-coded syringes just prior to their scenario. After completing the first scenario, the groups switched, utilizing the other sim with the other method of medication administration. After a 4-16 week “wash out” period, the groups reconvened to reverse the medication administration technique across the same 2 scenarios.

Each Broselow tape color zone corresponds to a narrow range of weights. The authors opted to designate medication dosing errors >10% above or below the correct range as critical dosing errors.

The results? Median time to delivery of all conventionally administered medication doses was 47 seconds versus the prefilled color-coded administration system-- 19 seconds. The conventional administration system saw 17% of doses with critical errors versus none for the prefilled color-coded syringe group.

These prefilled color-coded syringes are not currently manufactured. Should they go into commercial production, the hope is that such syringes would be longer and more narrow than conventional syringes to effectively elongate each color-coded section (the delineations for red and purple on a standard syringe differ by as little as 1/8-3/32 of an inch if you want to make your own!-- see picture).

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1510030139_syringes.jpg (255 Kb)