Intradermal normal saline solution, self-selected music, and insertion difficulty effects on intravenous insertion pain

OBJECTIVE: To examine the effect of listening to self-selected music versus an intradermal injection of normal saline solution on the intensity and distress of intravenous (IV) catheter insertion pain. DESIGN: Prospective, randomized, controlled study. SETTING: Inpatient and outpatient units in 2 university-affiliated southwestern medical centers. PATENTS: One hundred ten adult inpatients and outpatients undergoing IV therapy. OUTCOME MEASURES: Pain intensity, pain distress, and IV insertion difficulty visual analog scales. INTERVENTION: Patients were randomly assigned to receive an intradermal injection of normal saline solution, listen with headphones to self-selected music, or-be in a control group far IV insertion. RESULTS: A MANOVA revealed no statistically significant multivariate or univariate differences in pain by treatment group, but significantly higher pain distress scores with failed IV insertions. The pain intensity and distress scores were significantly higher in the saline solution group when compared with the music and control groups combined. Insertion difficulty was significantly positively correlated with pain intensity and distress for the entire sample, with weak, nonsignificant correlations in the music group. CONCLUSION: Intradermal unpreserved saline solution contributes to greater pain intensity and distress, greater insertion difficulty, and a higher failure rate than the use of music or routine IV insertion. Listening to preferred music attenuates the effect of insertion difficulty on TV insertion pain. Intravenous insertion attempts were unsuccessful in more than one third of the subjects, resulting in higher pain distress scores. Further research is needed on interventions to reduce IV insertion pain and on factors contributing to IV insertion failure.