Managing anxiety during preoperative peripheral IV insertion
Abstract:
Purpose: Peripheral intravenous (PIV) insertion is a routine preoperative procedure and a common trigger of procedural anxiety in adult surgical patients. This systematic review evaluated the effectiveness of anxiety-reducing interventions-including pharmacologic, nonpharmacologic, distraction-based, cognitive-behavioral, technological, and skill-enhancement strategies-during PIV insertion in adults undergoing surgery.
Design: Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered with International Prospective Register of Systematic Reviews (CRD42025648578).
Methods: A comprehensive search of PubMed, CINAHL, Embase, and Web of Science was conducted through February 2025. Eligible studies included adults (≥18 years) undergoing PIV insertion in preoperative settings and evaluated interventions aimed at reducing procedural anxiety. Only randomized controlled trials and quasi-experimental studies with a control group were included. Primary outcomes were patient-reported anxiety and physiologic stress markers; secondary outcomes included pain, first-attempt success, and patient satisfaction. Screening and data extraction were performed using Covidence.
Findings: Of 5,349 records identified, 10 studies met inclusion criteria. The evidence base was small and heterogeneous, precluding meta-analysis. Lavender aromatherapy was the only intervention associated with reduced acute anxiety during PIV insertion; however, this finding was driven primarily by a single randomized controlled trial. Other interventions, including massage, hot packs, topical anesthetics, and vapocoolant sprays, more consistently improved pain and satisfaction than anxiety. Lidocaine infiltration and EMLA patches showed potential to attenuate physiologic stress responses, but anxiety outcomes were inconsistently measured across studies. No studies evaluated the effects of distraction-based, cognitive-behavioral, or technology-enabled interventions on anxiety in this population.
Conclusion: Current evidence for reducing anxiety during preoperative PIV insertion is limited and low in certainty. Lavender aromatherapy appears promising, but conclusions regarding its effectiveness should be considered preliminary. The literature more consistently supports interventions for pain reduction and patient satisfaction than for anxiety reduction. Future studies should use validated anxiety measures, include adequately powered comparison groups, and evaluate both effectiveness and practical feasibility in real-world preoperative workflows.
Reference:
Majumdar JR, Rao DN, Oballe CC, Clancy ME, Massaro CD, Murphy EE, Vitale CM, Welch JC, O’Connor M. Managing Anxiety in Adult Surgical Patients During Preoperative Peripheral IV Insertion: A Systematic Review of Interventions and Outcomes. J Perianesth Nurs. 2026 Jun 30:S1089-9472(26)00104-8. doi: 10.1016/j.jopan.2026.04.004. Epub ahead of print. PMID: 42377287.