[Safety and monitoring of patient-controlled intravenous analgesia : Clinical practice in German hospitals]

Autor: M I, Emons, M, Maring, U M, Stamer, E, Pogatzki-Zahn, F, Petzke, J, Erlenwein
Jazyk: němčina
Rok vydání: 2020
Předmět:
Zdroj: Der Anaesthesist
ISSN: 1432-055X
Popis: Patient-controlled intravenous analgesia (PCIA) is a well-established technique in acute pain management and available in most German hospitals. Despite its widespread use, information on current clinical practice is limited. This investigation evaluated clinical practice and monitoring as well as PCIA-associated adverse events and critical incidents in German hospitals.An invitation to participate in this online-survey was sent to 995 heads of anesthesiology departments belonging to the "German Society of Anaesthesiology and Intensive Care Medicine".Of the departments receiving the link, 244 took part (response rate 25%). PCIA was used in 193 of these hospitals (79%). All the following statements relate to the hospitals in which PCIA was used. Piritramide was the most frequently used opioid. In parallel with PCIA, additional nonopioid analgesics were used in 94% of the hospitals, and in 38%, additional slow-release oral opioids were used. Parenteral opioids were administered by the ward staff in 4% of the hospitals. In 75% of hospitals, there were standardized indications for PCIA therapy, with almost two thirds of respondents stating that PCIA was the technique of second choice if regional procedures were contraindicated or failed. In all, 76% of the hospitals had an acute pain service. Twenty-four percent of the hospitals regularly used PCIA in non-surgical patients. In pediatric patients, PCIA was used in 62 hospitals (32%). Only 31% of the hospitals reported the use of standardized protocols for the specific monitoring of patients' vital signs on general wards, exceeding general care. Of the department, 158 (82%) reported adverse events in connection with the use of PCIA within the six-month period preceding the survey (most frequently due to patients' noncompliance [52%], dislocated intravenous lines [41%], communication errors [16%], administration of additional analgesics [16%] and/ or sedatives [14%], problems with the pump [16%], programming errors [9%], incorrect opioid concentration in the reservoir [8%], non-observance of contraindications [7%], incorrect dosing [6%] and self-dosing by the patient [4%] or by third parties [3%], filling the reservoir with thewrong medication [2%]; and other problems [5%]). Only 35 of the hospitals (18%) reported no problems associated with PCIA therapy. Seventy-five of the 193 respondents (39%) stated that at least one critical incident had occurred in the context of the use of PCIA. This resulted in a total of 335 cases out of an estimate of 50.000 patients treated with PCIA. The respondents classified these as follows: I) 273 incidents requiring a prolonged stay in the recovery room, but without further complications, II) 58 requiring transfer to the intensive care unit, but without further complications, III) three resulting in permanent harm to the patient and IV) one resulting in the death of the patient. A comparison of the monitoring standards for PCIA showed that critical incidents were reported less frequently in hospitals with less intensive monitoring, and more frequently in hospitals with higher monitoring standards.PCIA is a frequently used analgesic technique in German hospitals. There were many differences in how PCIA therapy was applied and monitored on general wards. Adverse events occurred to a significant extent, with a considerable part of them, which might be preventable. Critical incidents were perceived more often when standards for monitoring on general wards were higher. Consented current recommendations regarding treatment and monitoring standards as well as the systematic recording of complications when using PCIA are pending.HINTERGRUND: Die patientenkontrollierte intravenöse Analgesie („patient controlled intravenous analgesia“, PCIA) ist als Verfahren in der Akutschmerztherapie etabliert. Ziel dieser Untersuchung war es, Anwendungspraxis, Überwachung, unerwünschte Vorkommnisse und Komplikationen unter einer PCIA-Therapie an deutschen Krankenhäusern zu erfassen.Alle 995 bei der Deutschen Gesellschaft für Anästhesie und Intensivmedizin e. V. registrierten Chefärzte wurden zur Teilnahme an der elektronischen Umfrage eingeladen.Aus 244 Kliniken wurden Antworten zurückgesandt. In 193 (79 %) dieser Kliniken kam die PCIA zum Einsatz. Alle folgenden Angaben beziehen sich auf diese Krankenhäuser. Das am häufigsten genutzte Opioid war Piritramid. Bei Patienten mit PCIA setzten 94 % der Kliniken zusätzlich Nichtopioidanalgetika ein, 38 % retardierte orale Opioide sowie 4 % parenterale Opioide. Bei Anwendung der PCIA auf Normalstation lag lediglich in 31 % der Kliniken ein standardisiertes Überwachungskonzept vor, das über die Routineversorgung der Stationen hinausging. Insgesamt 82 % der befragten Kliniken berichteten von unerwünschten Vorkommnissen im Zusammenhang mit der PCIA. In 39 % der Kliniken war in den vorangegangenen 6 Monaten mindestens eine potenziell vital bedrohliche Komplikation aufgetreten, insgesamt wurden 335 Einzelfälle berichtet (bei ca. 50.000 durchgeführten PCIAs). Kliniken, die über Komplikationen berichteten, hatten einen höheren Überwachungsstandard als Kliniken, die über keine Komplikationen berichteten.Die PCIA ist ein verbreitetes, aber durchaus mit Risiken verbundenes Analgesieverfahren. Anwendungs- und Überwachungspraxis sind heterogen. Konsentierte, aktuelle Empfehlungen hinsichtlich Behandlungs- und Überwachungsstandards sowie der systematischen Erfassung von Komplikationen bei Anwendung der PCIA stehen aus.
Databáze: OpenAIRE
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