title: Indwelling catheters used from the onset of diabetes decrease injection pain and pre-injection anxiety.
abstract: OBJECTIVE
  To investigate the use of indwelling catheters as injection aids at diabetes onset to reduce injection pain and pre-injection anxiety.
  
  
  METHODS
  Forty-one patients aged 8.1 +/- 3.7 years (range, 1-15) participated in this open, controlled randomized study. A 10-cm VAS with faces was used for scoring. A local anesthetic cream was used before all insertions. The control group used insulin pens with standard needles. After one week, the indwelling catheter group could choose regular injections but were included in the "intention to treat" analysis.
  
  
  RESULTS
  Injection pain and anxiety decreased from day 1 to 15 in both groups (average, 4.1 injections/day). Pain was significantly lower for indwelling catheter injections when scored by parents (median, 1.2 cm vs 2.7 cm; P =.002), children/teenagers (0.8 cm vs 1.5 cm; P =.006), and nurses (1.4 cm vs 3.0 cm; P =.002). Parental pre-injection anxiety was also lower (1.2 cm vs 2.9 cm; P =.016). Taking injections, including inserting catheters, was found to be less problematic with an indwelling catheter (1.6 cm vs 3.3 cm;P =.009). During the 6-month follow-up, injection pain and injection problems were significantly lower in the catheter group. Mean catheter indwelling time was 3.7 days. Median pain for catheter insertion was 2.1 cm and for glucose testing was 0.9 cm. Sixteen of 20 patients continued to use indwelling catheters after 2 weeks, and 9 of 20 after 6 months.
  
  
  CONCLUSIONS
  We found an evident relief of pre-injection anxiety and injection pain when using indwelling catheters for introducing insulin injections at the onset of diabetes.
authors.affiliation: Department of Pediatrics, Uddevalla Hospital, Uddevalla, Sweden. ragnar.hanas@bll.se
authors.forename: Ragnar
authors.initials: R
authors.lastname: Hanas
authors.forename: Peter
authors.initials: P
authors.lastname: Adolfsson
authors.forename: Karin
authors.initials: K
authors.lastname: Elfvin-Akesson
authors.forename: Lars
authors.initials: L
authors.lastname: Hammarén
authors.forename: Rosita
authors.initials: R
authors.lastname: Ilvered
authors.forename: Inger
authors.initials: I
authors.lastname: Jansson
authors.forename: Calle
authors.initials: C
authors.lastname: Johansson
authors.forename: Marianne
authors.initials: M
authors.lastname: Kroon
authors.forename: Jan
authors.initials: J
authors.lastname: Lindgren
authors.forename: Agne
authors.initials: A
authors.lastname: Lindh
authors.forename: Johnny
authors.initials: J
authors.lastname: Ludvigsson
authors.forename: Lars
authors.initials: L
authors.lastname: Sigström
authors.forename: Annica
authors.initials: A
authors.lastname: Wiik
authors.forename: Jan
authors.initials: J
authors.lastname: Aman
authors.forename: Iner
authors.initials: I
authors.lastname: Jansson
authors.forename: Annica
authors.initials: A
authors.lastname: Wilk
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control*; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous / Q000009:adverse effects* / Q000523:psychology; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic; D013997:Time Factors
chemical_list: D007328:Insulin