Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial

Charles Lamy (1) , Valérie Loizeau , Catherine Couquet (1) , Caroline Sturtzer , Coralie Fluteau (1) , Manon Dugas (1) , Anaïs Labrunie (2, 3) , Benoît Marin (2, 3) , Jean-Luc Desfougères (3) , Claire Bahans (1) , Vincent Guigonis (1) , Pascale Beloni (2)

1 Service de Pédiatrie médicale [CHU Limoges]
2 NET - Neuroépidémiologie Tropicale
3 CEBIMER - Plate forme de bioinformatique et biostatistique

BACKGROUND:In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience.OBJECTIVE:Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children.METHODS:This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale.FINDINGS:135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%.CONCLUSION:Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.

Mots clés: Urineanalysis; Bag collection; Pain; Precontinent children; Urinary tract infection

Domaines: Santé publique et épidémiologie

Charles Lamy, Valérie Loizeau, Catherine Couquet, Caroline Sturtzer, Coralie Fluteau, et al.. Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial. International Journal of Nursing Studies, 2019, 95, pp.1-6. ⟨10.1016/j.ijnurstu.2019.03.014⟩. ⟨hal-02305749⟩