 All children will receive EMLA. EMLA cream is the standard of care in our area and we feel that it would not be ethical to withhold EMLA for the purpose of the study. Ketamine will add to the incomplete analgesia of EMLA, and may be a better option than EMLA in children who are known to have difficult venous access. EMLA is not universally effective -- having been found to decrease VAS pain scores by only 61-- and causes vasoconstriction, which can increase the procedural fail rate. 