Intervention
pain
The whole procedure of this study is shown in Fig. Selection processThe nurse performing venipuncture had ten years of experience in the pediatric ward. The IV cannula used was a 19 gauge × 0.7-in. needle and the procedure adhered to standard IV cannulation procedures. The observer-reported pain, HR, and SpOFor the EMLA group, the specialist nurse who performed IV cannulation determined the puncture site. Next, a thick layer of EMLA emulsion (lidocaine and prilocaine 2.5%/2.5%) was applied on a 1 × 1 cmFor the distraction group, multiple distraction techniques, including toy whistles, cartoon books, cartoons, and video games were provided for the children to choose from and play with. They were also taught breathing exercises (i.e., inhaling through the nose for 3 s and exhaling for 5 s while they were counting) if they were willing. A play therapist played with the children for 5 min before and throughout the venipuncture procedure.For the combined group, both EMLA emulsion and distraction techniques were used. First, EMLA emulsion was applied on the pre-puncture site for 30 min to the EMLA group, then 5 min before the venipuncture, the play therapist encouraged them to choose their favorite toys to play with or to practice breathing exercises. During IV cannulation the play therapist also continued distracting the child with toys.