Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory

Abstract

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...

Development of a nursing outcome for a percutaneous procedure

“…It is one of the main clinical findings in the presence of hematoma, pseudoaneurysm and arterial occlusion (Bhatty et al., 2011). In a study that evaluated patients after an endovascular procedure, the access site was the second most common pain location, representing 18% of the pain complaints from the participants in the research (Hilário et al., 2017). Nurses play a fundamental role in pain monitoring, and pain management is an important care indicator in the scope of postprocedure care.…”

Estratégias não farmacológicas na analgesia de adultos e idosos em procedimentos endovasculares: revisão de escopo

“…E6 (1) Virar e posicionar na cama em apenas quatro pacientes (3% da amostra) E7 (18) Reflexologia podal durante 16 minutos, sendo oito minutos em cada pé. Foi exercida uma pressão suave estimulando as áreas do plexo solar e da coluna vertebral.…”

“…Podem ser realizados por meio da punção venosa ou arterial, com uso de cateteres radiopacos visando atingir o coração, vasos periféricos ou cerebrais. A dor é uma complicação decorrente desses procedimentos, podendo ser relatada no local do acesso, na região torácica ou lombar, seja devido ao posicionamento do paciente no leito, seja por causa da restrição quanto à movimentação do membro abordado ou complicações originadas durante sua realização (1) .…”

Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer

“…This may be because medical education and training on the effective management of acute pain focuses predominantly on pharmacological interventions for reducing pain intensity [104]. It is known that suboptimal knowledge of the pharmacodynamics and pharmacokinetics of pain medications leads to under-treatment of pain intensity [105]; therefore, it is likely that deficient knowledge of management options for other dimensions of pain similarly leads to sub-optimal pain management. If the administration of multidimensional acute pain assessment tools is to translate into improved pain outcomes and patient satisfaction, continuing professional development and healthcare education curriculums should include multimodal integrative management options, such as psychoeducation, distraction and other attentional techniques, mindfulness training, cognitive-behavioral interventions, and hypnotic techniques [106,107].…”