Peripherally Inserted Central Catheter (PICC) Maintenance Affects Pain and Comfort in Preterm Infants: Effectiveness of a Therapeutic Touch.

Background: Peripherally Inserted Central Catheter (PICC) maintenance may cause pain or trauma in preterm infants.

Purpose: To determine the pain and comfort levels of preterm infants during PICC maintenance and examine the effect of Palmar Grasp Reflex (PGR) stimulation on pain and comfort.

Methods: The population of this crossover randomized controlled trial consisted of infants being treated in the Neonatal Intensive Care Unit. Infants born before the 37th gestational week, who receive PICC maintenance for the first time, were included in the study. PGR stimulation was applied during the experimental condition. The study was completed with 61 observations (experimental: 30, control: 31). Data were collected via video recordings using Preterm Infant Pain Profile-Revision (PIPP-R) and Preterm Infant Comfort Scale (COMFORTneo). PIPP-R and COMFORTneo were evaluated before maintenance, during removal of the transparent film cover, during application of disinfectant, and after maintenance.

Results: The difference between conditions in the mean PIPP-R and COMFORTneo scores during removal of the transparent film cover during PICC maintenance, during application of disinfectant, and after maintenance was statistically significant in favor of the experimental condition. The effect of PGR stimulation on infants' crying duration was strong and significant (R2 = .519).

Implications for practice: Infants experienced moderate pain during PICC maintenance. PGR stimulation reduced pain, increased comfort and shortened crying time. Nurses can perform PGR stimulation, which is a therapeutic touch, during painful procedures.

Implications for research: The effectiveness of other nonpharmacological methods that reduce pain and increase comfort in PICC maintenance should be evaluated.