Vapocoolants are often used by healthcare practitioners in order to reduce pain in patients while performing such procedures as venipuncture and intravenous (IV) cannulation. These procedures can cause some discomfort, and the use of vapocoolants can potentially lead to reducing negative experiences of patients. However, the problem is in the fact that there are only a few studies that demonstrate positive results, and researchers and practitioners have no single idea regarding the appropriateness of using vapocoolants in adults and children. In their systematic review, Hogan, Smart, Shah, and Taddio (2014) concentrated on studying this problem in detail. The PICO(T) question that is formulated to focus on the problem is the following one: In adults and children, is the use of vapocoolants compared to no treatment or placebo effective in reducing pain before venipuncture and IV cannulation? The purpose of the systematic review was to examine the literature on the topic of using vapocoolants in order to analyze the results systematically and conclude regarding safety and effectiveness of this approach to be applied to the work with adult and young patients. The researchers searched such databases as EMBASE, CINAHL, MEDLINE, and Cochrane Central Register of Trials.
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While organizing the search of appropriate articles in four databases, the researchers reviewed 999 abstracts, and they also excluded 963 works. As a result, only 36 full papers were reviewed by Hogan et al. (2014) in order to assess their quality and include them in the final list of articles that were selected for the further analysis. After excluding 24 articles from 36 previously selected papers, only 12 articles were included by researchers in the final meta-analysis. Thus, in their search for the most appropriate articles, Hogan et al. (2014) used the set inclusion and exclusion criteria.
It is important to concentrate on three major findings of this study because they are helpful to answer the formulated research question and conclude about the effectiveness of using vapocoolants in adults and children. The first result of the systematic review conducted by Hogan et al. (2014) is that vapocoolants were found to be ineffective to reduce pain in children while comparing the outcomes with the use of placebo and no treatment. The second important result is related to using vapocoolants while performing procedures for adults. It was found that vapocoolants were ineffective to be applied to adults while comparing the effects with placebo. However, vapocoolants were more effective in reducing pain in adults while comparing the results to no treatment. The third main result is that the use of vapocoolants was found to be the more uncomfortable practice than the use of placebo sprays, as it was reported by adults. The problem was in pain associated with applying vapocoolants. Still, the data related to children’s experiences were not available.
Level of Evidence
Researchers identify five levels of evidence that are marked as Level I-Level V. These levels differ in terms of the type of evidence that is presented in articles. If a study is designed as an experiment, a randomized controlled trial, or a systematic review of randomized controlled trials, the evidence is discussed as belonging to Level I. It is important to note that Level I evidence is of the highest quality because these studies can be controlled effectively, and they test certain assumptions and hypotheses while using appropriate tools. Level II evidence is associated with quasi-experimental studies and systematic reviews where not all papers are randomized controlled trials, and there can be quasi-experimental studies that are included in a review. The quality of such evidence is lower.
Level III evidence is associated with such types of research design as non-experimental studies, qualitative studies, and systematic reviews that also include non-experimental studies. Level IV evidence is identified when articles present opinions of experts, or they are proposed as reports of authorities in a certain area. Level V evidence is associated with information collected with the help of literature reviews and case reports, as well as experts’ opinions of some type. Therefore, the stronger evidence is associated with Level I in contrast to Level V evidence. The systematic review conducted by Hogan et al. (2014) represents Level I evidence because it includes only randomized controlled trials and quasi-randomized controlled trials, but it does not mean that the study refers to quasi-experimental works.
In their paper, the researchers concluded that vapocoolants were ineffective means to change adults’ and children’s experiences and reduce pain that was associated with venipuncture and intravenous cannulation. Thus, the use of vapocoolants was absolutely ineffective with reference to children’s experiences, and it was partially effective with the focus on adults because the procedure was successful while comparing the results to no treatment, but there were no positive changes while comparing the results to placebo. Furthermore, the application of vapocoolants caused pain in adults. Therefore, this approach was not recommended by the researchers for the regular use in healthcare facilities.
While focusing on the proposition to make the use of vapocoolants a standard procedure to reduce pain, it is possible to state that such procedure can be ineffective, and it will not lead to expected positive changes in patients’ experiences. In order to conclude about the procedure’s effectiveness and make a decision, it is possible to refer to systematic reviews in the area in order to provide more reasonable arguments to support a personal position. However, while referring to the examined evidence, it is important to recommend the use of vapocoolants only in adults and in cases when patients ask healthcare providers to use some medications or means to reduce pain. In situations when there is no focus on reducing pain during venipuncture and intravenous cannulation procedures, it is preferable not to use vapocoolants because they can cause even more pain in adults. While providing the care to children, the use of vapocoolants should also be avoided. To assess all possible advantages and disadvantages of using vapocoolants, it is also important to recommend searching for more data on the problem.
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Hogan, M. E., Smart, S., Shah, V., & Taddio, A. (2014). A systematic review of vapocoolants for reducing pain from venipuncture and venous cannulation in children and adults. The Journal of Emergency Medicine, 47(6), 736-749.