Dolor asociado a las técnicas de inserción de catéteres venosos y extracción de sangre arterial en el área de urgencias

doi:10.1016/j.enfcli.2017.11.002

Enfermería Clínica

Volume 28, Issue 6, November–December 2018, Pages 359-364

https://doi.org/10.1016/j.enfcli.2017.11.002 Get rights and content

Resumen

Objetivos

Analizar el dolor asociado a la inserción de catéteres venosos y extracción de sangre arterial en pacientes adultos que acuden a urgencias, y explorar posibles factores relacionados con su intensidad.

Método

Estudio observacional multicéntrico. Se incluyeron consecutivamente pacientes que requerían un catéter venoso periférico y/o una extracción de sangre arterial para gasometría. Se preguntó por el dolor experimentado después de cada técnica, empleando la escala NRS-11.

Resultados

Se evaluaron 780 canalizaciones venosas y 101 gasometrías. Las venopunciones obtuvieron una puntuación media de 2,8 (IC 95%: 2,6-3) y las gasometrías de 3,6 (IC 95%: 3,1-4). El nivel de dolor iatrogénico se asoció a la dificultad técnica media o alta del procedimiento (p < 0,001), a la elección de la arteria humeral en lugar de la radial (p = 0,02) en las gasometrías y se correlacionó con el dolor basal en las venopunciones (p < 0,001). El nivel de dolor en función de otras variables como el sexo, la procedencia o el calibre de la aguja no presentó diferencias estadísticamente significativas.

Conclusiones

El dolor derivado de la cateterización venosa y la punción arterial para gasometría es leve-moderado y moderado, respectivamente, y su intensidad se asocia a variables como la dificultad del procedimiento, el lugar de punción o el dolor basal.

Un mayor conocimiento de los efectos dolorosos derivados de cada procedimiento de enfermería durante la asistencia en urgencias y de los factores que se asocian a la autopercepción del mismo podría ayudar a determinar cuándo y cómo debería intervenirse para mitigar este efecto indeseado.

Abstract

Objectives

To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors.

Method

An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11.

Results

780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P < .001); with the choice of the humeral rather than the radial artery (P = .02) in the gas test and correlated to baseline pain in venipunctures (P < .001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences.

Conclusions

Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain.

A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect.

Section snippets

Introducción

La extracción de muestras de sangre o la canalización de accesos vasculares periféricos para la administración de fármacos, entre otros procedimientos habituales, son algunas de las formas más comunes de inducción de dolor iatrogénico, y su realización corresponde a los profesionales de enfermería.

El dolor se ha convertido en el quinto signo vital¹ y debería ser evaluado tanto en el contexto de una afección fisiopatológica como de una intervención sanitaria. Sin embargo, y aunque actualmente no

Método

Estudio transversal desarrollado en los servicios de urgencias de los hospitales terciarios de Galdakao-Usansolo y Basurto (Vizcaya) durante 6 meses. Previo a su inicio se obtuvo el informe favorable del Comité Ético de Investigación Clínica de Euskadi.

Fueron incluidos los pacientes con edad comprendida entre 18 y 85 años que acudían a urgencias, con niveles de prioridad iii, iv o v según el triaje Manchester o ubicados en el área de observación, a los que se les había indicado la inserción de

Resultados

En el estudio participaron 820 pacientes y se registraron 780 canalizaciones de catéteres venosos periféricos y 101 gasometrías arteriales.

Las características de los pacientes y de las condiciones de realización de cada técnica se reflejan en la tabla 1. Los pacientes a los que se les canalizó un acceso vascular periférico presentaban una media de edad de 56,3 (IC 95%: 55-57,6) años y se emplearon preferentemente catéteres de calibre 20 G (67,1%) en la fosa antecubital. Las gasometrías fueron

Discusión

Las técnicas evaluadas en nuestro estudio provocan un dolor iatrogénico de carácter leve y moderado y se aprecia una asociación entre la intensidad de dolor experimentado y algunas variables, como la dificultad técnica del procedimiento. Esta característica podría relacionarse estrechamente con la habilidad de la enfermera, puesto que resulta razonable pensar que una mayor experiencia profesional implica una menor dificultad autopercibida en el desarrollo del procedimiento.

Aunque, al igual que

Conflicto de intereses

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Cited by (14)

Pain and Satisfaction Perceptions of Ultrasound-Guided Versus Conventional Peripheral Intravenous Catheterization: A Randomized Controlled Trial
2024, Pain Management Nursing
While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA).
This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization.
Randomized controlled clinical trial.
Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample.
120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction.
US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure.
US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.
Ultrasound-guided puncture vs. conventional technique for arterial blood gas analysis sampling in adults: A systematic review
2024, Enfermeria Intensiva
Comparar la eficacia de la punción convencional frente a la ecoguiada para la extracción de gasometrías arteriales en adultos.
Se elaboró un protocolo de búsqueda que se empleó en 3 bases de datos (Medline, Cochrane y Dialnet). Se consideraron ensayos clínicos publicados entre enero del 2013 y enero del 2023, en español o inglés. Se recabaron resultados en términos de éxito en el primer intento, número de intentos necesarios hasta el éxito, tiempo empleado, dolor iatrogénico autorreportado y experiencia de paciente o profesional. Se evaluó el riesgo de sesgo de cada estudio incluido.
Fueron seleccionados 5 ensayos clínicos aleatorizados, con tamaños muestrales comprendidos entre 50 y 238 pacientes adultos atendidos en Urgencias. Tres de 4 estudios mostraron mayores tasas de éxito al primer intento cuando se emplearon el ecógrafo y 2 de 4 estudios objetivaron un descenso del dolor iatrogénico. Se encontraron resultados discordantes entre los estudios en las variables de tiempo empleado y número de intentos necesario hasta el éxito.
A pesar de que la evidencia actual es limitada y los resultados heterogéneos, la punción arterial ecoguiada podría tener ventajas frente a la punción clásica en términos de éxito en el primer intento y en la reducción del dolor iatrogénico.
To compare the efficacy of conventional puncture versus ultrasound-guided puncture for arterial blood gas sampling in adults.
A search protocol was developed and applied to 3 databases (Medline, Cochrane, and Dialnet). Clinical trials published between January 2013 and January 2023, in Spanish or English, were considered. Outcomes in terms of first-attempt success, number of attempts until success, time taken, self-reported iatrogenic pain, and patient or professional experience were collected. The risk of bias for each included study was assessed.
Five randomized clinical trials were selected, with sample sizes ranging from 50 to 238 adult patients treated in emergency settings. Three out of 4 studies showed higher first-attempt success rates when using ultrasound, and 2 out of 4 studies reported a decrease in iatrogenic pain. Discrepant findings were observed among the studies in terms of time taken and the number of attempts required for success.
Although current evidence is limited and the findings are heterogeneous, ultrasound-guided arterial puncture may have advantages over conventional puncture in terms of first-attempt success and in reducing iatrogenic pain.
Patient discomfort in relation to thyroid nodule fine-needle aspiration (FNA) performed with or without parenteral and/or topical anesthetic
2020, Endocrine Practice
Citation Excerpt :
Although there were 2 categories of operators (staff only or staff and fellow) in Group 1, the discomfort score during (P =.369) and following (P =.822) FNA were not significantly different between these 2 groups (Table 5). With the necessary penetration of skin and subcutaneous tissue, nearly all kinds of percutaneous punctures have the potential to induce discomfort (11–13). However, the discomfort for FNA is typically mild to moderate (14).
Objective: There is much reported variation in the impact of local anesthesia on thyroid fine-needle aspiration (FNA) related discomfort. We compare patients undergoing thyroid FNA with subcutaneous injection or topical anesthetic to no anesthetic.
Methods: We conducted a retrospective review of 585 sequential ultrasound guided thyroid FNA procedures in Mayo Clinic. Group 1 (n = 200), no anesthetic; Group 2 (n = 185), subcutaneous injection anesthetic; and Group 3 (n = 200), topical anesthetic. Patient demographics, number of FNA passes, needle gauge, and cytopathology were recorded plus a discomfort score (0 to 10) before and immediately post procedure in all 3 groups and peak discomfort during the FNA in Groups 1 and 2.
Results: There were no differences among the 3 groups in age, sex, FNA sufficiency rate, cytopathology, and FNA passes number. There was no significant difference between Groups 1 and 2 in peak discomfort score during the FNA: 0 (45%, 42.2%), 1 to 2 (19%, 24.9%), 3 to 5 (23.5%, 20.5%), 6 to 8 (9.5%, 10.8%), 9 to 10 (3%, 1.6%), respectively. Discomfort score post procedure: 0 (78.5%, 77.8%, 53.5%), 1 to 2 (13%, 13%, 36.5%), 3 to 5 (7%, 7%, 9%), 6 to 8 (1.5%, 2.2%, 1%), 9 to 10 (0%, 0%, 0%) for groups 1, 2, and 3, respectively. There were no significant differences among the 3 groups for a discomfort score ≥3.
Conclusion: FNA associated patient discomfort was comparable during and after the procedure regardless of the use of anesthetic or the type utilized. Approximately 90% of patients experienced mild to moderate discomfort during the procedure. And 90% reported no more than a level 2 discomfort post procedure.
Abbreviations: End = endocrinology; FNA = fine-needle aspiration; MCF = Mayo Clinic Florida; MCR = Mayo Clinic Rochester
Attitudes and Perceptions Surrounding Arterial Puncture for Blood Gas Testing: Differences Between Nurses in the Emergency Department and the Pulmonology Department
2020, Archivos de Bronconeumologia
Sensors for Neonatal Monitoring
2022, Encyclopedia of Sensors and Biosensors: Volume 1-4, First Edition
Respiratory Monitoring: Current State of the Art and Future Roads
2022, IEEE Reviews in Biomedical Engineering

View all citing articles on Scopus

^◊: Los nombres de los investigadores colaboradores del Grupo de trabajo DIASURE se relacionan en el Anexo 1

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OriginalDolor asociado a las técnicas de inserción de catéteres venosos y extracción de sangre arterial en el área de urgenciasPain scores for intravenous cannulation and arterial blood gas test among emergency department patients

Resumen

Objetivos

Método

Resultados

Conclusiones

Abstract

Objectives

Method

Results

Conclusions

Section snippets

Introducción

Método

Resultados

Discusión

Conflicto de intereses

Nurs Clin North Am

J Pain

Crit Care Nurs Clin North Am

Am J Emerg Med

J Pain Symptom Manage

Am J Emerg Med

Neurosci Biobehav Rev

Br J Anaesthesia

J Emerg Med

Neurosci Lett

Aten Primaria

Geriatr Nurs

Original
Dolor asociado a las técnicas de inserción de catéteres venosos y extracción de sangre arterial en el área de urgenciasPain scores for intravenous cannulation and arterial blood gas test among emergency department patients