INTRODUCTION:

Children are the most important asset and wealth of a nation. Healthy children make a healthy nation. The children under 15 years of age constitute about 40% of the population in India. The child is not a miniature, but an individual in his own right.

The quality of childhood one has lived will determine the ultimate nature of the adulthood.¹ The promotion of healthy child development has become a major focus of world attention over the last three to four decades.²

Pediatrics is the only discipline dedicated to all aspects of the care and well-being of infants, children and adolescents including their health, their physical, mental, social and psychological growth and development and ability to achieve full potential as adults.³

Peripheral intravenous access is the mainstays of modern medicine. It allows blood sampling, administration of medicines, fluids, nutrients, blood and blood products.⁴ The widespread effects of pain signify effective pain management is essential. Some patients do not report pain hence they believe that it inconveniences others or if it signals loss of self-control. Others are enduring severe pain without asking for assistance.⁵

Cannulation causes moderate or severe pain in a substantial number of children. Some institutions have procedures for minimizing the predictable pain of cannulation, especially in children.⁶

Pain is the unpleasant sensory and emotional experience associated with actual or potential tissue damage or decrease in terms of such damage. Early pain experience may play a particularly important role in shaping an individual’s pain responses. In adequate relief of pain and distress painful medical procedures may have long-term negative effects on future pain tolerance and pain responses.⁷

Pain is inevitable but suffering is optional. It is a universal human experience. Procedure related pain could be worse than that of the illness itself. Nurses are in the key position to find out and utilize newer measures to reduce pain related procedures like IV cannulation.⁸

Perception of pain in pediatrics is complex and entails physiological, psychological, behavioral and developmental factors. However, in spite of its frequency, pain in infants, children and adolescents are often underestimated and under treated. It has also been shown that infants and children, who experience pain in early life, show long-term changes in terms of pain perception and related behavior. Professionals in health care settings have a responsibility to reduce pain and anxiety as much as possible to increase patient safety.⁹

Adequate pain management is a compelling and universal requirement in health care. Despite considerable advancements, the adverse physiological and psychological implications of unmanaged pain remain substantially unresolved. Ineffective pain management can lead to a marked decrease in desirable clinical and psychological outcomes and patients’ overall quality of life. Effective management of acute pain results in improved patient outcome and increased patient satisfaction. Although research and advanced treatments in improved practice protocols have documented progressive improvements in management of acute and postoperative pain, little awareness of the effectiveness of best practices persists. Improved interventions can enhance patients’ attitudes to and perceptions of pain. What a patient believes and understands about pain is critical in influencing the patient’s reaction to the pain therapy provided. Use of interdisciplinary pain teams can lead to improvements in patients’ pain management, pain education, outcomes and satisfaction.¹⁰

Cold or heat application relieves pain and prevents complications, by slowing down the ability of pain fibers to transmit pain impulses, decreasing edema and inflammation. The maximum vasoconstriction is achieved at a temperature of 15°C by cold application and at a temperature below 15°C the vessels begin to dilate.¹¹

NEED FOR THE STUDY:

Every individual wants to stay away from pain. During young age pain is frequent and inescapable phenomenon. Apart from a symptom of an acute, long-term illness or a result of hits, sudden falls, trauma and injuries when they adapt to their quickly developing body, pain is also a part of routine healthcare such as immunization and injections. Such experiences may disrupt a child’s life and can interfere with further normal development.

A nurse can prevent such negative effects by preventing or minimizing pain. Local cold application is a very commonly used technique to reduce the intensity of pain. Cold applications provide transient anesthesia to the skin within moments of application. Its effectiveness in preventing pain of pricking need to be evaluated.

Neonates frequently undergo various painful procedures without analgesia and routinely experienced pain in the Neonatal Intensive Care Unit. Administering sucrose before painful procedure like venipuncture has significantly reduced pain during venipuncture in neonates (p<0.001, t=9.38).¹²

In the field of midwifery, the cold application was used widely for the management of labour pain,¹³ episiotomy pain¹⁴ as a non-pharmacological technique.

STATEMENT OF THE PROBLEM:

A study to evaluate the effectiveness of local cold application on pain response during intravenous cannula insertion among children in a selected hospital at Trichy.

OBJECTIVES OF THE STUDY:

1. To assess the level of pain response during intravenous cannula insertion among children in experimental and control group.

2. To evaluate the effectiveness of local cold application on pain response during intravenous cannula insertion among children in the experimental group.

3. To find out the association between the pain response and selected demographic and clinical variables of children in the experimental group.

RESEARCH HYPOTHESES:

H1: There is a significant difference in the mean pain response score during intravenous cannula insertion among children between control group and experimental group who received local cold application.

H2: There is a significant association between the level of pain response during intravenous cannula insertion and selected demographic and clinical variables of children in experimental group.

MATERIALS AND METHODS:

True experimental post-test only control group design was adopted for the study. The independent variable was local cold application and the dependent variable was pain response. The study was conducted among the children in the age group of 3-6 years admitted at Maa Kauvery hospital, Trichy who have undergone intravenous cannula insertion. Using simple random sampling technique 41 samples were recruited to experimental and control group (82).

Sampling criteria:

Inclusion criteria:

· Children who are undergoing intra venous cannula insertion during the period of their hospitalization.

· Children who are at the age group of 3-6years.

· Children who are present during the time of data collection.

· Children who are willing to participate in the study.

· Children of mothers who are giving consent to participate in this study Exclusion criteria

· Children who are critically ill.

· Children who are having developmental delay.

· Children who are unconscious.

Description of data collection tool:

Section –A

· Demographic variables – Age, Gender, Past history of intravenous cannula insertion.

· Clinical variables –Size of cannula, site of cannulation

Section –B

· FLACC Pain rating scale

Description of the intervention:

50ml of water based gel was packed in 6×7.5cm zip lock cover, frozen and covered with 25×8cm of gauze piece. Before intravenous cannula insertion ice pack was applied on the cannula site intermittently with the interval of 15seconds for 3 minutes’ period.

Data collection procedure:

Formal permission was obtained from Medical Administrator, Maa Kauvery hospital and institutional ethics committee. The study was conducted for a period of 4 weeks. 82 children were recruited into experimental and control group with 41 children in each group using simple random sampling technique on the basis of selection criteria. The study purpose was explained and informed consent was obtained from the children and children of mothers. Necessary precautions were taken to provide privacy and confidentiality. Demographic and clinical variables were collected before intravenous cannula insertion by using Demographic proforma. Local cold application was done before intravenous cannula insertion. Post-test pain response were observed using FLACC pain rating scale.

Ethical considerations:

The proposed study was conducted after getting approval from the dissertation ethical committee of KMC College of Nursing, Trichy. Permission was sought from the authorities. Assurance was given to the study participants regarding the confidentiality of the data and it was maintained throughout the study.

RESULTS AND DISCUSSION:

Distribution of demographic and clinical variables:

Majority 21 (51.2%) of children were in the age group of 5-6 years in experimental group whereas majority 24 (58.5%) were falling under 3-4 years in the control group.23 (56.1%) and 22 (53.7%) of children were male in experimental and control group respectively. Majority 23 (56.1%) of children had a past history of intravenous cannula insertion in experimental group. Majority 23 (56.1%) did not have a past history of intravenous cannula insertion in control group. majority 33 (80.5%) children in experimental group and 34 (82.9%) in control group had been inserted with 24G cannula. 36 (87.8%) children in experimental group and 35 (85.4%) in control group underwent intravenous cannula insertion in dorsal vein site.

The first objective of the study was to assess the level of pain response during intravenous cannula insertion among children in experimental and control group:

In experimental group majority 53.7% children had moderate pain, 41.5% had mild pain and 4.9% had severe pain. In control group majority 53.7% children had moderate pain, 7.3% had mild pain and 39% had severe pain.

Second objective of the study was to evaluate the effectiveness of local cold application on pain response during intravenous cannula insertion among children in the experimental group:

Post-test mean score of pain response of experimental group 3.85±1.389 was lesser than that of control group 6.17±1.702 and calculated t value 6.756 was significant at p<0.001.

Hence, the stated research hypotheses H1: There is a significant difference in the mean pain response score during intravenous cannula insertion among children between control group and experimental group who received local cold application was accepted at p < 0.001 Level

The findings of the study were supported by Sushma oomen and Dr. Asha P Shetty, (2022) and the study found that cold application on the injection site was efficient in minimizing pain.¹⁷

Table 1: Comparison of mean score of pain response during intravenous cannula insertion among experimental and control group.

Group

Mean

Mean difference

Independent

‘t’ value

value

Experimental group

3.85

1.389

-2.317

6.756

<0.001

Control group

6.17

1.702

Third objective was to find out the association between the pain response and selected demographic and clinical variables of children in the experimental group:

There was significant association found between the level of pain response and age of the child. There was no significant association found between the level of pain response and their selected demographic variables such as gender and past history of intravenous cannula insertion. There was no significant association found between the level of pain response and their selected clinical variables such as size of cannula and site of cannula insertion.

Hence, the stated research hypotheses H2: There is a significant association between the level of pain response during intravenous cannula insertion and selected demographic and clinical variables of children in experimental group was not accepted except for age.

Limitations:

The study was limited to a sample size 82 (41 each in experimental and control group)

Quantitative research approach and True experimental post-test only control group design simple random sampling technique was adopted for the study.

The study was conducted in a private hospital setting. Hence, these factors reduced the generalization of findings.

CONCLUSION:

Pain response in children can be modified although painful procedures may not be avoidable. The present study had shown that the local cold application can be used as a non-pharmacological pain management technique. It is simple, easy, less expensive and effective intervention to use in clinical practice, providing the physical and emotional comfort in children. The study revealed that the local cold application on the site of intravenous cannula insertion had a strong significant effect on reducing the pain response from intravenous cannula insertion among children.

REFERENCES:

1. Effectiveness of Structured Teaching Programme on Knowledge Regarding Selected Sandeep Garg, Arpan Pandya, Ravindra H.N.. Common Behavioural Problems of Children. Asian J. Nur. Edu. and Research. 2017; 7(2): 198-202. doi: 10.5958/2349-2996.2017.00040.4

2. Minu Sharma,. Gurpreet Kaur,. Jhag Devi Pun, Ms. Jyoti Shukla,. Lalita Thakur,. Monika Sharma,. Mandip, Manpreet Kaur,. Mary Sonowal,. Manjot Kaur,. Rupashree Das Gupta. Knowledge of under five children's’ mothers regarding the six killer diseases. Asian J. Nursing Education and Research. 2018; 8(1): 159-162. doi: 10.5958/2349-2996.2018.00033.2

3. "Kliegman, R., Stanton, B., St Geme, J. W., Schor, N. F., Behrman, R. E., and Nelson, W. E. (2020). Nelson Textbook of Pediatrics (21st ed.). Elsevier Inc."

4. Parthasarathy, A., Menon, P., Gupta, A., Nair, M., and Gupta, P. (2020). IAP recent advances in pediatrics-1. Jaypee Brothers Medical Publishers.

5. Perry (2021). Potter and Perry’s fundamentals of nursing: third south Asia edition EBook. Elsevier health sciences.

6. Sudheendra. R. Mutalikdesai. A Study on Effectiveness of Virtual Reality as a Distraction in reducing the level of pain among children undergoing iv Cannulation in Selected Hospitals of Moodbidri and Karkala. Int. J.Adv. Nur. Management. 2016; 4(3): 279-281. Doi: 10.5958/2454-2660.2016. 00051.X

7. Neelam, Sunil Kumar Garg, Harshavardhan Gupta. Evaluate the Efficacy of Topical Anesthetic on Pain during Venipuncture among the Children. Int. J. Nur. Edu. And Research. 2017; 5(4): 415-419. doi: 10.5958/2524-2660.2017.00089.

8. Anila James. Effect of Vulsalva maneuver on perception of pain during Intravenous (IV) Cannulation. Int. J. Nur. Edu. And Research. 2019; 7(4): 493-496. doi: 10.5958/2454-2660.2019.00110.8

9. Ajin. R. S. A Study to assess the effectiveness of Topical Anesthetic Cream on pain experience among patients undergoing Intravenous Cannulation at selected Hospital Salem District. Int. J. Nur. Edu. And Research. 2018; 6(2): 197-199. doi: 10.5958/2454-2660.2018.00044.3ss

10. V. Indra. Effective Pain Management to Improve Patient Satisfaction- A Review. Int. J. Nur. Edu. And Research. 2019; 7(4): 613-615. doi: 10.5958/2454-2660.2019.00138.8

11. Munmun Roy. 2019. Effect of local cold application prior to venipuncture on pain related response among children in selected hospital burdwan, west Bengal. Journal of medical surgical nursing practice and research. http://doi.org /10.5281/zenodo.3240746.

12. 12.Rashmita Sethi, Geetarani Nayak. Effect of 24% Oral Sucrose in Pain Reduction during Venipuncture in Neonates. Asian J. Nur. Edu. and Research. 2015; 5(4): 457-460. doi: 10.5958/2349-2996.2015.00093.2

13. 13.Thakur R, Shrestha M, Pokharel N, Rai G, Rijal DP. Effect of Ice Pack Application on Pain Intensity among women in the Active Phase of Labor in BPKIHS. Asian Journal of Nursing Education and Research. 2024; 14(4): 299-5. doi: 10.52711/2349-2996.2024.00058

14. 14.Bini, Reeta Jebakumari Solomon, V. Ahitha. Effectiveness of Cold Application on Episiotomy Pain among Postnatal Mothers in selected Hospitals at Kanyakumari District. Asian J. Nursing Education and Research. 2019; 9(2): 188-192. doi: 10.5958/2349-2996.2019.00039.9

15. Sharma, K. (2018). Nursing Research and Statistics. Elsevier Publication.

16. Kothari, C. R. (2019). Research Methodology – Methods and Techniques. New international Publishers.

17. Oommen, S., Shetty, A. P. Effectiveness of local cold application on pain and behavioral distress during invasive intravenous procedures - A pilot study. International Journal of Research in Pediatric Nursing. 2022; 4(1): 01-04. https://doi.org/10.33545/26641291.2022.v4.i1a.77.

Received on 24.10.2025 Revised on 05.01.2026

Accepted on 12.02.2026 Published on 30.04.2026

Available online from May 02, 2026

Asian J. Nursing Education and Research. 2026;16(2):129-133.

DOI: 10.52711/2349-2996.2026.00026

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.