Buzzy is a vibrating palm-sized device with removable ice wings. Together, ice and vibration block sharp sensations on the arm. It desensitized directly where it is put, and for an inch or two "downstream" of where it is placed. It has been studied for injections, IVs, and phlebotomy and gives the same pain relief as numbing cream.
Vibration and ice create different sensations. The medical concept is called gate control [link]– when you send more motion information and cold information through the brain’s “gate”, only the strongest sensations get through. This is like when a dentist jiggles a jaw, or when you bang your hand with a hammer and shake it, or rub a bumped elbow. You’re sending more motion information to the brain, and the pain gets stopped at the gate.
Immediately before, get a fresh set of wings from the freezer. Wings must be frozen solid to work effectively. Slide the wings through the elastic band or slip on hook. For certain patients (i.e. under 6 months old, patients with cold sensitivity, Raynaud’s or sickle cell disease) it is best to avoid the ice pack. Use Buzzy® without the wings. If the ice pack is too cold, holding it in patients; hands provides a competing sensation. Show Buzzy® to your patient. Let her hold Buzzy® and turn it on and off, feel the vibration and cold. Tell the patient “Buzzy’s job is to make the straw [IV] more comfortable; your job is to hold still.” Assign the job of distraction – parent, nurse or Child Life Professional.
Place Buzzy® “between the pain and the brain. This means proximal (toward the central nervous system) with the larger round end (Buzzy’s bottom) as close as possible to where the needle stick will be. Enlist patients or parents to help hold Buzzy® in place so you have two hands free; alternatively, use the strap or tuck it under the tourniquet. The XL has a slot for a hands-free strap. For IV placement, leave Buzzy® on and in place at least until you have removed the needle. For blood draws, you can remove Buzzy® after the needle comes out.
For digital blocks or finger sticks, place Buzzy® in the palm of the hand, with Buzzy’s bottom at the base of the finger you'll poke. Press Buzzy® in place with your thumb, or instruct the parent/helper to hold it firmly in place into the child’s hand. For pad finger sticks, press against MP joint as shown. For side finger sticks, place just proximal. For digital blocks, press against the palm just below needle insertion in the webs or at the MP joint.
When finished, clean Buzzy® and the wings with your facility’s disinfecting wipes. Store folded wings in freezer.
HOW DOES BUZZY WORK? Buzzy® uses natural “gate control” pain relief by confusing the body's own nerves, thereby dulling or eliminating sharp pain. In the same way that rubbing a bumped elbow helps stop the hurt, or cool running water soothes a burn, Buzzy® controls sharp pain.
Using Buzzy® is simple, but a quick explanation can be helpful since the technology is new. Buzzy® was developed with nurse and doctor input to ensure that the medical procedure would not be compromised. Feedback from healthcare professionals has been overwhelmingly positive.
Buzzy® stops sharp pain, but light touch sensations are transmitted on different nerves. If the child is scared and focuses intently on the shot, they will be able to feel the touching sensation of the needle, and may translate this distress and fear as pain even though the sharp pain is controlled. Therefore, use various distraction methods with the child during the procedure. Your Child Life Specialist is an expert at distraction! Try paging one of these professionals to help. If Child Life is not available, ask your patient to blow out a puff of air (like blowing out your birthday candles), sing a song, count something in the room (lights, ceiling tiles), or visually search (e.g. “look for something blue/red/round/square/etc.”). Encourage parents to act as coaches for distraction.
If patient is immunocompromised, MRSA positive, or if injecting a laceration contaminated with blood, place Buzzy® + Wings into a Statlab or plastic bag before pressing on patient. In addition to controlling pain, always address fear and the patient’s focus using Child Life or DistrACTION® cards. Distraction can reduce pain 50%, and causes 97% of kids to remember the procedure as “better than before”. Use counting and finding DistrACTION® Badge cards for quick sources of distraction, with questions and brightly colored cartoon pictures for kids and teens to search and count.
The gate control theory is the basis for Buzzy®, a reusable device that provides natural injection pain relief. “Gate control” is the term used to describe pain relief by causing sensations other than pain, and then sending them down the same pathway where pain gets blocked at the “gate”. Sharp pain, itching, and burning are transmitted on the same Aδ nerve to a transmission system in the dorsal (sensory) horn of the spinal cord. Motion signals travel alongside pain fibers on Abeta nerves, as do temperature and pressure nerves (C fibers). A single summary signal is then transmitted up the spinal cord, thus excess vibration or cold can overwhelm or dilute the sharp pain from shots, itching, or burning from medications.
Using the body’s own nervous system, the gate control theory invokes the concept that the final common pathway for sharp pain to the brain can be shut out by the nerves that transmit cold and vibration senses. Just as running a burn under cold water stops the sharp pain, or rubbing a bumped elbow stops the pain, simultaneously stimulating vibration and cold receptors can dull or eliminate pain.
Certainly, cold applied directly over a vein can cause vasoconstriction; however, applying a cold pack proximal to the site of puncture (as with Buzzy) will delay or avoid development of vasoconstriction. With the application of the gate control theory, as with other areas of science and medicine, children are not just little adults. In a randomized controlled trial, Buzzy® with ice pack increased venipuncture success on the first try compared to vapocoolant (OR: 3.05, 95%CI 1.05 – 9.15).5 In a smaller study without ice packs, 81% of phlebotomists found access easier with Buzzy.6
Placing the pack as close as possible to the site of puncture is helpful. The pack needs to be in place during the stick, so make sure it is out of the way of the zone to be prepped. Leaving the pack in place longer than 1-2 minutes may be distressing to the child and likely will not improve pain management. In addition, prolonged cold can trigger cold agglutinins which can falsely lower white blood cell counts in approximately 10% of patients. Buzzy® applied appropriately uses the gate control theory without these side effects and has been proven effective for IV starts in adults and children ages 4+.
1. Mawhorter S, Daugherty L, Ford A, Hughes R, Metzger D, Easley K. Topical vapocoolant quickly and effectively reduces vaccine-associated pain: results of a randomized, single-blinded, placebo-controlled study. J Travel Med 2004;11(5):267-72.
2. Cohen Reis E, Holubkov R. Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children. Pediatrics 1997;100(6):E5.
3. Cohen LL, Blount RL, Cohen RJ, Schaen ER, Zaff JF. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol 1999;18(6):591-8.
4. Baxter AL, Cohen LL et al. An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department. Pediatric Emerg Care 2011 Dec;27(12):1151-6
5. Whelan HM, Kunselman AR et al. The Impact of a Locally Applied Vibrating Device on Outpatient Venipuncture in Children. Clin Pediatr 2014 Jun 12.
6. Canbulat N, Ayhan F, Inal S. Effectiveness of External Cold and Vibration for Procedural Pain Relief During Peripheral Intravenous Cannulation. Pain Management Nursing, 2014 Jun 6 S1524-9042.
7. Inal S, Kelleci M. Buzzy® relieves pediatric venipuncture pain during blood specimen collection. MCN Am J Matern Child Nurs 2012 Sep;37(5):339-45.