421 - Virtual Reality for Procedural Distress in Children Undergoing Port-a-Cath Access: A Randomized Controlled Trial

Publication Number: 4412.421

Naveen Poonai, The University of Western Ontario - Schulich School of Medicine & Dentistry, Dorchester, ON, Canada; Melissa Chiu, The University of Western Ontario - Schulich School of Medicine & Dentistry, Toronto, ON, Canada; Jennifer Stinson, The Hospital for Sick Children, Toronto, ON, Canada; Samina Ali, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Michael Miller, The University of Western Ontario - Schulich School of Medicine & Dentistry, London, ON, Canada; Alexandra Zorzi, Children's Hospital LHSC, London, ON, Canada

Background: Vascular access in children with cancer is often done with a needle inserted through the skin into an implanted venous access device or “port-a-cath”. This can be significantly distressing for a child, even with topical anesthetic use. Virtual reality (VR) has been shown to reduce pain and distress in numerous settings, but its benefit during port-a-cath access is unknown.

Objective: To determine if VR is effective in reducing procedural distress, pain, and anxiety during port-a-cath access.

Design/Methods: Open-label, randomized, three-arm, superiority trial of VR versus video distraction using a tablet and non-technologic distraction in children 5-17 years undergoing port-a-cath access with a Child Fear Scale (CFS) score > 1. Primary outcome was the Observational Scale of Behavioral Distress – Revised (OSBD-R; 0=no distress to 23.5=maximal distress). Secondary outcomes including the Children’s Fear Scale (CFS; 0=no anxiety to 4=maximal anxiety), Faces Pain Scale – Revised (FPS-R; 0=no pain to 10=maximal pain), and adverse events (AEs). Our study was powered to detect a minimum clinically important difference of 2.5 on the OSBD-R. Based on a power of 90% and a two-tailed test at 5% significance, 26 participants per arm were required.

Results: We enrolled 84 children (46 males; 55%) with a mean (SD) age of 9.9 (4) years. All received topical anesthetic. In the intention to treat analysis, there were no significant differences in the mean (SD) OSBD-R scores between VR [3 (5.8)], tablet [2.6 (6.6)], and non-technologic distraction [2.4 (3.5)], even after adjusting for age, months since port insertion, and parental distress (p=0.73). However, there was a significantly lower mean (SD) CFS score for VR [0.7 (1)] versus non-technologic distraction [1.6 (1.3)] (p=0.02). There was a significant overall difference in the FPS-R score between VR [1.4 (2.1)], tablet [2.9 (3.3)], and non-technologic distraction [2.9 (2.9)] (p=0.048) but no significant between group differences. AEs included vomiting (non-technologic distraction=1), headache (VR=3; non-technologic distration=2), and dizziness (VR=1; tablet=1).

Conclusion(s): VR is not more effective than tablet or non-technologic distraction at reducing procedural distress scores during port-a-cath access in children, although overall OSBD-R scores were low. However, VR reduced anxiety and pain scores more than tablet and non-technologic distraction.