Objective:To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. Method: Cross-sectional study with retrospective data collection. Results: Overall, 345 patients were included; 116 (34%) experienced postprocedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. Conclusion: The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions. DESCRIPTORSPain; Acute Pain; Pain Management; Endovascular Procedures; Nursing Care. Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratoryAvaliação e manejo da dor em pacientes submetidos a procedimentos endovasculares em laboratório de hemodinâmica Evaluación y tratamiento del dolor en pacientes sometidos a procedimientos endovasculares en el laboratorio de cateterismo INTRODUCTIONEndovascular procedures involve the insertion of radiopaque catheters, via percutaneous venous or arterial puncture (femoral, brachial, or radial) under fluoroscopy guidance, to arrive at the desired location (heart, peripheral vessels, cerebral vessels). These procedures are carried out in catheterization laboratories ("cath labs") for purposes both diagnostic (evaluation of blood flow) and therapeutic (treatment of obstructions, stenoses, or correction of aneurysmal lesions) (1) . A common complaint of patients undergoing endovascular procedures is acute pain at the vascular access site or discomfort in the chest and lower back area, which may be related to bedrest, restricted movement of the accessed limb, to the trauma of vascular puncture itself, or to the potential vascular complications that may develop during the procedure (2)(3)(4) . However, other pain complaints, such as back pain or headache, are also very common in this setting (2)(3)(4)(5)(6) . Considering that the high turnover and dynamics of cath lab work may hinder proper care of pain, staff must pay special attention to assessment, management, and systematic recording of pain levels.Despite substantial growth of endovascular procedures in recent decades (3)(4)(5) , assessment of pain in the post-procedural period does not appear to be a major concern of care teams. Few studies have addressed this topic as a primary outcome in this setting (6)(7)(8) ; in others, pain was assessed a secondary or less important outcome (2) . It is known that inadequate management of postoperative pain can prolong hospitalization, increase healthcare expenditures, and have several clinical repercussions, including changes in blood pr...
Objective The aim of this study was to compare the effect of 2 hemostasis devices on the incidence of radial artery occlusion (RAO) after transradial cardiac catheterization. Background Radial artery occlusion is the most prevalent ischemic complication after radial artery catheterization. There is still no predictive pattern of vessel patency assessment, and the comparative effectiveness of different hemostasis techniques has yet to be established. Methods This study used a randomized clinical trial of adult patients undergoing transradial cardiac catheterization. Participants were randomized into an intervention group (hemostasis with the TR Band device) and a control group (hemostasis with a conventional pressure dressing). The primary end point was the incidence of RAO (at discharge and at 30 days post catheterization). Results Among the 600 patients included (301 in the intervention group and 299 controls), immediate RAO occurred in 24 (8%) in the TR Band group and 19 (6%) in the pressure-dressing group; at 30 days, RAO was present in 5 patients (5%) in the TR Band group and 7 (6%) in the pressure-dressing group. On multivariate analysis, peripheral vascular disease was the only independent predictor of RAO at discharge and at 30 days. Conclusions The incidence of RAO was similar in patients who received hemostasis with a TR Band versus a pressure dressing after transradial cardiac catheterization.
OBJECTIVE Randomized clinical trial protocol to evaluate the incidence of radial artery occlusion with two different arterial compression devices after transradial procedures. METHODS Barbeau’s test will be performed in adults scheduled to undergo transradial interventional procedures. Those with A, B, or C plethysmographic patterns will be selected. At the end of the procedure, patients will be randomly assigned (1:1) to receive patent haemostasis with TR Band™ device or conventional haemostasis with an elastic adhesive bandage. The primary outcome is the incidence of radial artery occlusion. Secondary outcomes are Barbeau’s test curve change, additional time to achieve haemostasis, incidence of bleeding at the puncture site, pain severity, development of arteriovenous fistula, radial pseudo aneurysm, any access-site complication requiring vascular surgery intervention and costs between the two devices. DISCUSSION The results of this trial should provide valuable additional information on the best approach for haemostasis after transradial percutaneous cardiovascular interventions.
Objective: To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). Method: Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. Results:The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. Conclusion:The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.Objetivo: Descrever o processo de implantação da lista de verificação de segurança cirúrgica em laboratório de cateterismo (LC). Método: Estudo descritivo do tipo relato de experiência das estratégias de segurança desenvolvidas nos últimos seis anos em hospital universitário da região Sul do Brasil. Resultados:Foram incorporadas na prática assistencial as seis metas internacionais de segurança do paciente (MISP) em consonância com o programa de acreditação hospitalar pela Joint Comission International (JCI), por meio de um processo contínuo com caráter educativo. A lista de verificação foi adaptada considerando as características da unidade e os procedimentos realizados. Conclusões:A implantação da lista de verificação proporcionou a promoção da segurança do paciente, maior integração da equipe, avanços na comunicação entre os profissionais e no registro das informações da assistência em sala. Palavras-chave:Segurança do paciente. Lista de checagem. Acreditação hospitalar. RESUMEN Objetivo: Describir el proceso de implantación de la lista de verificación de seguridad quirúrgica en un laboratorio de cateterismo (LC). Método: Estudio descriptivo del tipo relato de experiencia sobre las estrategias de seguridad desarrolladas en los últimos seis años en un hospital universitario de la región Sur de Brasil.Resultados: Se incorporaron en la práctica asistencial las seis metas internacionales de seguridad del paciente (MISP) en consonancia con el programa de acreditación hospitalaria por la Joint Comission International (JCI), a través de un proceso continuo con carácter educativo. La lista de verificación fue adaptada considerando las características de la unidad y los procedimientos realizados.Conclusión: La implantación de la lista de verificación proporcionó la promoción de la seguridad del paciente, una mayor integración del equipo, avances en la comunicación entre los profesionales y en el registro de las informaciones de la asistencia en sala.Palabras clave: Seguridad del paciente. Lista de verificación. Acreditación de hospitales. How to cite this article: Reich R, Santos SM, Goes MGO, Romero PS, Casco MF, Kruger J, et al. Surgical safety in catheterization laboratory. Rev Gaúcha Enferm. 2019;40(esp):e...
Objective:To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories.Methods: Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. Results:One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. Resultados: Fueron incluidas 128 publicaciones que permitieron mapear los contextos de estudio de las complicaciones, la ocurrencia de acuerdo con las vías, así como la comprensión del diagnóstico y manejo clínico. Como síntesis del análisis se identificó tres categorías temáticas: Complicaciones, Factores predictores y Diagnóstico/tratamiento. Conclusion Conclusión:Las complicaciones en el sitio del acceso vascular son de ocurrencia variable de acuerdo con la vía de acceso utilizada. El conocimiento de los factores que están presentes en la ocurrencia de estos eventos puede auxiliar en el reconocimiento temprano, planeamiento y control de la atención implementados.Palabras clave: Procedimientos endovasculares. Hematoma. Hemorragia. Atención al paciente.
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