The Effect of Facilitated Tucking During Venipuncture on Pain and Physiological Parameters in Preterm Infants

Document Type : Original Quantitative and Qualitative Research Paper


1 MSc, Instructor of pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, Iran

2 MSc student in Neonatal Intensive Nursing, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, Iran

3 Associate Professor in Neonatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 MSc, Instructor of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical sciences, Mashhad, Iran

5 MSc in Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Infants who hospitalized in Neonatal Intensive Care Unit are routinely undergoing painful procedures which perhaps has negative impacts on their CNS. Facilitated Tucking is one of the methods of pain relief for these neonates.
Aim: To examine the effect of Facilitated Tucking during Venipuncture on pain and physiological parameters in premature infants.
Method: In this experimental study, 70 preterm infants born at average 32-36 weeks' gestational age (GA), who needed routine blood collection, were allocated to two intervention (35 neonates) and control (35 neonates) groups. during a. In experimental group a nurse held the infant in the side-lying, flexed fetal-type position during blood collection. The infant's pain, HR and Spo2 were measured two minutes before, during and three minutes after the blood collection and their maximum level was recorded. Facial behaviors of pain were recorded independently through video recording. The control group did not receive any intervention for pain relief.
Results: The mean age of newborns were 34/45 ± 1/22 weeks. The results showed that the intervention group had less pain during blood collection than the control group (P = 0.017). But there was no significant difference between two groups in terms of pain score after blood collection. The mean changes in HR and SPo2 were significantly different between two groups (p = 0.001), i.e. were lower in the intervention group
Conclusion: The Facilitated Tucking could cause significant differences in fetal heart rate and arterial blood saturation and intensity of pain copared with the control group, Then it could be used as a procedure to reduce pain during Venipuncture.


  1. Liaw J-J, Yang L, Wang K-WK, Chen C-M, Chang Y-C, Yin T. Non-nutritive Sucking and Facilitated Tucking Relieve Preterm Infant Pain During Heel-stick Procedures: A Prospective, Randomised Controlled Crossover Trial. IJN. Mar; Epub 2011 Oct 14.49(3):300-9.
  2. Axelin A. Parents as Pain killers in the Pain Management of Preterm Infants. Early Human Development (2006) 82, 241-7.
  3. Obeidat H, Kahalaf  I, Callister  CL. Use of Facilitated Tucking for Nonpharmacological Pain Management in Preterm Infants. J Perinat Neonat Nurs Vol 23, No 4, pp 372–7. Accepted for publication: August 24, 2009.
  4. Grunau RE, Holsti L, Peters JWB. Long-term Consequences of Pain in Human Neonates. Seminars in Fetal & Neonatal Medicine (2006) 11, 268-75.
  5. Pickler RH. A Model of Feeding Readiness for Preterm Infants. Neonatal Intensive Care 2004 ; 17(4): 31–6.
  6. Lucas-Thompson R, Elise L. Townsend, Gunnar MR, Georgieff MK, Guiang SF, Ciffuentes RF, et al. Developmental Changes in the Responses of Preterm Infants to a Painful Stressor. Infant Behav Dev 2008 December. 2008 ; (4)31 : 614-23.
  7. Vignochi C, Teixeira PP, Nader SS. Effect of Aquatic Physical Therapy on Pain and State of Sleep andWakefulness Among Stable Preterm Newborns in Neonatal Intensive Care Units. Rev Bras Fisioter 2010;14(3):214-20.
  8. marlene walden cc. The Ten Commandments of Pain Assessment and Management in Preterm Neonates. Crit Care Nurs Clin 2009:235-52.
  9. Gallo A-M. The Fifth Vital Sign: Implementation of The Neonatal Infant Pain Scale. JOGNN, 32, 199–206; 2003.
  10. Anand KJS, Ennis M. Early Experience of Pain Has Lasting Effects. Memphis Commercial Appeal.  March 12, 2011:1-3
  11. Anand K. Assessment of Neonatal Pain. Paediatric and Perinatal Drug Therapy, 2004; 6 (2), 97-103
  12. Verklan M VM. Core Curriculum For Neonatal Intensive Care Nursing . Philadelphia: Sanders Elsevier Co; 2010. pp.333-45.
  13. Farhadi Abolfazl. Effect of 2% lidocaine Gel on The Pain of Testing and Bnzatyn Intramuscular Injection of Penicillin (1 / 200 / 000 unit) University of North Khorasan, Summer, Autumn 89 - 2 3 - Volume 2 , Number 41. 39-44 (Persian)
  14. Norouzi Davud, Feizi Iraj, Amani Firooz, Zamani Pune. Control of Pain in Hospitalized Patients After Appendectomy in Ardabil Fatemi hospital. Journal of Ardabil University of Medical Sciences. Volume 6, Number 4, Winter 1385, pages 417 – 20(Persian)
  15. Noghabi Asadi  Fariba, Kashani, Nia  Zahra , Sajedi  firozeh , Rahgozar M, Yousefi H. The Effect of Skin-to-skin Contact on The Pain Intensity of Intramuscular Injection in Newborns. Ofogh-e-Danesh; Journal of Gonabad University of Medical Sciences 2011;Vol 17, No 1.4-1.( Persian)
  16. Golestan Motahareh ,Sadr Bafghi Mahdokht, Akhavan Karbassi Sedigheh,
    Islami  Zia, Fallah Razieh, Hashemi Aazam. Comparison Pain Relieving Effects of Glucose and Water in Neonates. Iran J Pediatr, Vol 16, No 4, Dec 2006.441-6.( Persian)
  17. Grunau E R, Holsti L, Tim F. Oberlander M F. Does Prone or Supine Position Influence Pain Responses in Preterm Infants at 32 Weeks Gestational Age? Clin J Pain  2004;20(2):76-82
  18. Jonsdottir RB, Kristjansdottir G. The Sensitivity of The Premature Infant Pain Profile – PIPP to Measure Pain in Hospitalized Neonates. Journal of Evaluation in Clinical Practice, 11 (6), 2005. 598–605
  19. Pain Management and Sedation. 2004The Regents of the University of California:147-50.
  20. Bergqvist LL. Factors Modulating Neonatal Pain Responsiveness: Karolinska Institutet. Published by Karolinska Institutet. Karolinska University Press.ISBN 978-91-7409-223-3
  21. Sedigheh Fatimids, Mamdouh Nahid, Kamelia Rohani, Dr. Akbarzadeh, Tahereh tear Torab. Relation Between Blood Sampling Pain and Heart Rate of Newborns at Fatemieh Hospital in Hamedan. University of Shahid Beheshti, 85 - 16, Number 52, p 50-7.( Persian)
  22. Corff kE, Seideman R, Venkataraman PS, Med LL, Yates B. Facilitated Tucking: A Nonpharmacologic Comfort Measure for Pain in Preterm Neonates Journal of Obstetric, Gynecologic, & Neonatal Nursing Volume 24, Issue 2.  Article first published online: 28 JUL 2006.
  23. Huang CM, Tung WS, Kuo LL, Chang YJ. Com­parison of Pain Responses in Premature Infants to Heelstick Between Containment and Swaddling. J of Nurs Research 2004;12:31-9.