Topical anesthetics for Venipuncture

Last modified by Lisa Stromquist on 2017/09/15 15:54

Welcome to the toolkit about how procedural pain and distress can be minimized for children, by using topical anesthetics for skin-breaking procedures such as venipuncture. Current best evidence supports the use of these techniques for children aged 0 to 17 years.


Children undergo painful needle-related procedures such as blood collection and immunization. Provision of appropriate and effective analgesia for these procedures is important. Untreated pain as a result of medical procedures not only results in immediate pain, distress, and anxiety at the time of the procedure, but has the potential to lead to longer term sequelae, including increased pain at subsequent procedures and fears of needle pain.” (Harrison et al., CDSR, 2014).

Physical and psychological interventions can also be used in conjunction with pharmacological (ie topical anesthetic cream) pain management. Links to recommendations and resources for these techniques can be found through the main webpage for the CAPHC acute procedural pain toolboxes.

The purpose of this toolkit is to make the adoption of using topical anesthetics when performing painful skin-breaking procedures for children, easier in your clinical practice. We have seen topical anesthetics used successfully in many different settings, including neonatal intensive care units, wards, emergency department, clinics, and in labs. We strongly urge you to consider utilizing more than one complementary intervention, along with the topical anesthetic cream, for such skin-breaking procedures (ie distraction with bubble blowing, in addition to topical anesthetic). The contents, which have been provided by your clinical colleagues around the country, can help you move these interventions into your regular practice, help create a policy for use their use in your organization, support clinical education in pain minimizing techniques for venipuncture, and provide clinical resources to make these techniques easier to use. Use as many of the resources as you need and modify them to fit your organizational context.

Examples of policies are provided for reference purposes, only. We encourage all users of the toolbox who wish to adopt a similar policy at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created.


In this kit you’ll find:

  • Family resource, including a poster reminding their health care providers to apply the ‘numbing cream’.
  • An example of multiple hospital policies for the use of topical anesthetics. These policies can be used to create your own organizational policy based on your needs and context.
  • Clinical PowerPoint presentation developed by your clinical colleagues to support education about using topical anesthetics for skin-breaking procedures in children. These slides can be modified and delivered for your needs and context.
  • Two videos that support the use of topical anesthetics, and other supportive techniques, for skin-breaking procedures in children.
  • Background articles outlining the current best research evidence to support using topical anesthetics for skin-breaking procedures. 

If you have any comments, questions or additions for the box, please contact CAPHC at

Thank you for supporting the CAPHC Pain Community of Practice’s mission to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability. 

 Family resourceMaxilene Poster - Alberta Health Services 
 Clinical ResourcesTREKK Bottom Line Recommendations: Procedural Pain (Translating Emergency Knowledge for Kids
 Hospital PoliciesTopical, Local Anesthetic: Use and Application - AHS Protocol
Local Anesthetic Cream Application - BCCH Policy
Application of Topical Anesthetics Prior to Painful Procedures - CHEO Medical Directive
 Clinical PowerPointMaking venipuncture less painful and less distressing - PowerPoint
Making venipuncture less painful and less distressing - PDF file
VideosDeveloper: Christine Chambers, PhD
From: Centre for Pediatric Pain Research IWK Health Centre and Dalhousie University
Title and link: It Doesn’t Have to Hurt: Strategies for Helping Children with Shots and NeedlesTitle and link: Ça n’a pas besoin de faire mal – Conseils pour aider les enfants à recevoir une piqûre
 From: Global News
Title and link: Helping Kids Cope with Needles
 Background ArticlesList of Background Articles - PDF

Pharmacologic approaches for reducing venous access pain in children.Zempsky WT.Pediatrics. 2008 Nov;122 Suppl 3:S140-53. doi: 10.1542/peds.2008-1055g. Review.PMID: 18978008

Procedural pain management: a position statement with clinical practice recommendations.Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J.Pain Manag Nurs. 2011 Jun;12(2):95-111. doi: 10.1016/j.pmn.2011.02.003. Epub 2011 Apr 29.PMID: 21620311

A comparison of amethocaine and liposomal lidocaine cream as a pain reliever before venipuncture in children: a randomized control trial.Poonai N, Alawi K, Rieder M, Lynch T, Lim R.Pediatr Emerg Care. 2012 Feb;28(2):104-8. doi: 10.1097/PEC.0b013e3182442c3b.PMID: 22270502

Emergency nursing resource: needle-related procedural pain in pediatric patients in the emergency department.Crowley MA, Storer A, Heaton K, Naccarato MK, Proehl JA, Moretz JD, Li S; 2010 ENA Emergency Nursing Resources Development Committee.J Emerg Nurs. 2011 May;37(3):246-51. doi: 10.1016/j.jen.2011.02.013. Review. No abstract available.PMID: 21550457

Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized controlled trial.Taddio A, Soin HK, Schuh S, Koren G, Scolnik D.CMAJ. 2005 Jun 21;172(13):1691-5.PMID: 15967972

EMLA and amethocaine for reduction of children's pain associated with needle insertion.Lander JA, Weltman BJ, So SS.Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004236. Review. Update in: Cochrane Database Syst Rev. 2014;3:CD004236.PMID: 16856039

Does EMLA cream application interfere with the success of venipuncture or venous cannulation? A prospective multicenter observational study.Schreiber S, Ronfani L, Chiaffoni GP, Matarazzo L, Minute M, Panontin E, Poropat F, Germani C, Barbi E.Eur J Pediatr. 2013 Feb;172(2):265-8. doi: 10.1007/s00431-012-1866-6. Epub 2012 Oct 24.PMID: 23093138

An Evidence-Based Approach to Minimizing Acute Procedural Pain in the Emergency Department and Beyond.Ali S, McGrath T, Drendel AL.Pediatr Emerg Care. 2016 Jan;32(1):36-42; quiz 43-4. doi: 10.1097/PEC.0000000000000669.PMID: 26720064

Venepuncture versus heel lance for blood sampling in term neonates.Shah VS, Ohlsson A.Cochrane Database Syst Rev. 2011 Oct 5;(10):CD001452. doi: 10.1002/14651858.CD001452.pub4. Review.PMID: 21975734
Created by Lisa Stromquist on 2016/05/19 15:59