Virtual Reality-Based Breathing Exercise Before Angiography in Children

Children undergoing angiography frequently experience anxiety before the procedure because of unfamiliar hospital environments, uncertainty about the procedure, and fear of invasive interventions. Increased pre-procedural anxiety may negatively affect physiological parameters, procedural cooperation, and the overall treatment experience. Therefore, effective and safe non-pharmacological interventions are needed to improve children's psychological well-being before angiography.

Virtual reality (VR) has emerged as an effective non-pharmacological intervention for reducing anxiety by providing immersive distraction and promoting relaxation. Combining VR with guided breathing exercises may further enhance relaxation through activation of the parasympathetic nervous system and improvement of emotional regulation. Although VR and breathing exercises have separately demonstrated beneficial effects in pediatric populations, evidence regarding their combined use before pediatric angiography remains limited.

The aim of this randomized controlled trial is to evaluate the effect of a VR-based guided breathing exercise administered before angiography on anxiety and physiological parameters in children aged 9 to 18 years undergoing elective angiography.

A total of 60 participants will be randomly assigned to either the intervention group or the control group. Participants in the intervention group will receive a single session of an approximately 7-8-minute VR-based guided breathing exercise before angiography in addition to standard care. Participants in the control group will receive standard pre-procedural care alone.

The primary outcome will be state anxiety. Secondary outcomes will include heart rate, blood pressure, respiratory rate, oxygen saturation, body temperature, and self-reported relaxation/satisfaction. Outcomes will be assessed immediately before and immediately after the intervention.

The findings of this study are expected to provide evidence regarding the effectiveness of VR-based guided breathing exercises as a safe, feasible, and non-pharmacological nursing intervention for reducing anxiety and improving physiological responses in children undergoing angiography.

Inclusion criteria

Children aged 9 to 18 years. Diagnosed with congenital heart disease. Scheduled to undergo elective angiography. Able to understand and communicate in Turkish. Participant and parent/legal guardian willing to provide written informed assent and consent.

Clinically stable and able to participate in a virtual reality-based guided breathing exercise.

Exclusion criteria

Undergoing emergency angiography. Visual, hearing, cognitive, or neurological impairments that would interfere with participation in the virtual reality intervention or completion of study assessments.

Use of sedative, anxiolytic, hypnotic, or opioid medications before the intervention.

Inability to tolerate the virtual reality headset or development of significant cybersickness during the intervention.

Withdrawal of assent or parental/legal guardian consent.