Effect of virtual reality on pain, anxiety and fear during peripheral venous catheterisation: a systematic review and meta-analysis of randomised controlled trials

Abstract

Abstract Objective Patients frequently experience pain, anxiety and fear during peripheral intravenous catheterisation (PIVC), and the pooled effect of virtual reality (VR) intervention on these three-related symptoms remains inconclusive. We aimed to determine the effectiveness of VR interventions on pain, anxiety and fear among patients undergoing PIVC. Design Systematic review and meta-analysis of randomised controlled trials. Data sources PubMed, Web of Science, Embase, CINAHL and Cochrane Central Register of Controlled Trials for published studies; relevant clinical trial registries for registered ongoing studies were searched from database inception to March 2026. Eligibility criteria We included randomised controlled trials of adult and paediatric patients undergoing PIVC that reported pain, anxiety or fear outcomes following VR-based distraction intervention. Data extraction and synthesis This study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) checklist. Two independent reviewers used standardised methods to search, screen and select included studies. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised controlled trials. Additionally, strength and certainty of the evidence were assessed by the Grading of Recommendations Assessment, Development and Evaluation system. Meta-analysis was conducted using random-effects models where substantial heterogeneity existed; otherwise fixed-effects models were adopted. Subgroup analyses were performed according to patient age and VR device types. Results Of 339 titles and abstracts screened, 14 randomised controlled trials with 1405 participants met the inclusion criteria. Meta-analysis suggested VR interventions may reduce pain (standardised mean difference (SMD)=−0.66; 95% CI −0.91 to −0.40; p<0.00001), anxiety (SMD=−0.95; 95% CI −1.34 to −0.56; p<0.00001) and fear (mean difference=−0.36; 95% CI −0.50 to −0.21; p<0.00001) during PIVC insertion. The certainty of evidence was low for pain and anxiety outcomes and moderate for the fear outcome. Conclusions Evidence from available randomised controlled trials suggests VR may alleviate pain, anxiety and fear in patients receiving PIVC. However, substantial heterogeneity exists among included studies, and the certainty of evidence for pain and anxiety is low. Further well-designed randomised controlled trials are required to consolidate evidence and explore influential subgroup factors. PROSPERO registration number CRD420261288938.