Procedural Pain in the Adult Neurological Intensive Care Unit: A Retrospective Study Examining Arterial Line Insertion
| Autor: | Kaylee Bray, Chris Winkelman, Esther I. Bernhofer, Jane F. Marek |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Analgesic Psychological intervention Pain Procedural Catheterization 03 medical and health sciences 0302 clinical medicine Neuroscience Nursing Pain assessment medicine Humans Pain Management 030212 general & internal medicine Aged Retrospective Studies Advanced and Specialized Nursing Licensure 030504 nursing business.industry Medical record Arterial line insertion Retrospective cohort study Middle Aged Intensive Care Units Emergency medicine Female Neurological intensive care unit 0305 other medical science business Vascular Access Devices |
| Zdroj: | Pain Management Nursing. 21:323-330 |
| ISSN: | 1524-9042 |
| Popis: | Background This was a retrospective chart review of procedural pain assessments and interventions during arterial catheter insertion in an adult neurological intensive care unit where patients with impaired consciousness are common. Overall, pain assessment was well documented (100%) by Registered Nurses, but not specific to arterial line insertion. Nurse practitioners commonly placed arterial lines and used local analgesia in over 75% of the documented procedures. Aims The purpose of this study was to examine healthcare providers’ pain-related practices documented during arterial catheter insertion, one of the most painful procedures in a neurological intensive care unit. Secondary purposes were determining whether patient characteristics, procedure-related factors, or provider licensure were associated with pain assessment or procedural pain interventions. Design A retrospective records review design was used. Methods 120 electronic patient medical records were reviewed during a one-year period. Results 100 charts met inclusion criteria. Nurses assessed all pain within 4 hours following the procedure in all charts but procedure-specific pain assessments were documented in 4% of charts. Pain-related interventions for arterial line insertion were local analgesic (76% of charts) and other procedure-specific interventions (10%). Significant associations occurred between procedure specific pain assessments and decreased number of insertion attempts (p = .006) and between pain interventions and number of insertion attempts (p = .003). No provider documented procedural pain assessment regarding arterial line insertion. Associations between patient characteristics and pain interventions were significant for patient ethnicity (F = 8.967, p = .007). Conclusions Overall pain assessment was documented (100%) but not specific to arterial line insertion. Although arterial line insertion can be extremely painful, patients were rarely assessed for such pain by any clinician; 14% did not receive any preprocedural analgesia. Clinical Implications The lack of procedural pain assessment in this vulnerable population indicates a need for increased pain management education for clinicians and further investigations to determine whether sufficient analgesia is provided to reduce procedural pain during arterial line insertion. |
| Databáze: | OpenAIRE |
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