Effect of stress-ball play on pain and physiological responses during port-a-cath needle insertion in children undergoing chemotherapy: a randomized controlled trial

Port-A-Cath needle insertion in pediatric chemotherapy is often painful and stressing. Distraction is a non-pharmacological method of pain management in invasive procedures in children. The purpose of the study was to investigate the effect of playing with stress ball on pain and physiological indicators at port needle insertion in children undergoing chemotherapy. A randomized clinical trial was conducted with 60 children aged 3 to 7 years, who were randomly assigned to intervention group (n = 30) and control group (n = 30). Ten minutes before the port needle insertion, baseline physiological indicators were recorded and pain scores were measured by the FLACC and Wong-Baker FACES scales. In the intervention group, children played with a stress ball from ten minutes before and during the procedure, while the control group received routine care only. Physiological indicators and the FLACC score during needle insertion, as well as the Wong-Baker FACES self-reporting score immediately after the procedure, were recorded. Adjusted mean FLACC and Wong-Baker FACES pain scores were significantly lower in the intervention group compared to the control group (P = 0.043, F = 4.266; P = 0.031, F = 4.87 respectively). As for the physiological indicators, heart rate and systolic blood pressure during needle insertion were both significantly lower in intervention group (P < 0.001, F = 21.215; P < 0.001, F = 29.252 respectively). But there were no significant difference in diastolic blood pressure and arterial oxygen saturation (P = 0.051, F = 3.983; P = 0.724, F = 0.724 respectively). Playing with stress ball can decrease pain and improve heart rate and systolic blood pressure during port needle insertion in children. Pediatric nurses should consider the use of stress ball play as a simple, safe and inexpensive nonpharmacological approach for managing children’s pain during painful procedures, especially port needle insertion. Registration number IRCT20250318065123N1 on May 10, 2025 (https://www.irct.ir/).