Cannulation causes moderate or severe pain in a substantial number of children and adults. Some institutions have procedures for minimising the predictable pain of cannulation, especially in children. However, a survey from the United States reported that emergency departments rarely use drugs to reduce pain during insertion of intravenous catheters in children.1 In less predictable situations, such as emergency departments, non-pharmacological alternatives, like distraction, may be more appropriate. A recent review of pharmacological interventions to reduce the pain of cannulation in children highlights the increasing number of options, and the complexity of deciding which one to choose in a particular situation.2

In the linked randomised controlled trial (doi:10.1136/bmj.b215), Hijazi and colleagues assess the effect of vapocoolant spray during intravenous cannulation in 201 adults in an emergency department.3 Vapocoolant spray significantly reduced moderate or severe cannulation pain compared …