Non-pharmacological Tactics for Managing Pain in the NICU.

Offering developmental support can help a neonate cope with its pain. Interventions that help an infant stay organized and transition to a change in its situation will also leave it better physiologically prepared for pain. Several non-pharmologic tactics can be used along with or without pharmacologic intervention:

• Whenever possible keep the baby in a tucked, flexed position.(3) Swaddling (with hands or blankets) can be used instead of using limb restraints (what I refer to as being 'drawn and quartered'). For umbilical catheter placement legs and arms can be swaddled separately, leaving the abdomen exposed; a diaper can be wrapped around a baby's lower extremities and buttocks (rather than through the legs) and taped to assist in swaddling while leaving the abdomen exposed for umbilical line placement. A blanket folded lengthwise can prevent the infant from raising his legs during the procedure. Lay the blanket across the legs and tuck it in under the sides of the mattress. For peripheral IV, arterial line placement, heel stick or venipuncture, leave the limb to be worked on out and place the baby on her side.
• Enlist the help of another nurse who can help soothe the infant, offer a pacifier and position the baby in a developmentally supportive manner.
• Maintain the environment that supports the infant (provide quiet, warmth, shield from light, etc.). When an infant becomes sick it is often those times when we focus on getting the job done which may include quickly repositioning the baby, putting on bright lights and increasing the noise level. Unfortunately, it is also the time when the infant is least able to handle this stimuli.
• Choose the less painful way to give care. For instance, endotracheal suctioning need not be done with every care time but only when needed; and, venipuncture is less painful than a heel stick (2) although when a sick infant is requiring frequent IVs these sites may need to be saved. Where feasible, transcutaneous monitoring may reduce the need for blood draws.
• Sucrose is given on the tip of the tongue a couple of minutes before minor procedures. Some references consider it pharmacologic and others consider sucrose non-pharmacologic. Regardless, it is an effective alternative to opiates and sedatives for acute pain. Sucrose may require a doctor's order and documentation on the patient's MAR. Typical dosing is 1-2mls. Experience shows that some babies will require only a drop or two on the tip of the tongue while others will require more. A swab soaked in sucrose can be used on the tip of the tongue of patients at risk for aspiration. Careful consideration should be taken before giving sucrose to infants with GI disturbances or micropremies (increased risk of necrotizing enterocolitis).(3) Infants who are not candidates for sucrose will still benefit from non-nutritive sucking.