Pediatric perioperative measures of sleep, pain, anxiety and anesthesia emergence: A healing touch proof of concept randomized clinical trial.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the impact of healing touch (HT) on sleep, anxiety, anesthesia emergence and pain. METHODS: HT, sham HT, control with an aide (CP) and control groups without the presence of an aide (CNP), underwent polysomnography (PSG) preoperatively. The Yale Preoperative Anxiety Scale (YPAS) score was obtained preoperatively before medications were given and in the preoperative surgery area. Sedation score, anesthesia emergence score and vital signs were recorded. Pain scores were determined by the Observation Pain Assessment Scale (OPAS) postoperatively and at time of discharge. Preoperative laboratory blood was drawn for C-reactive protein (CRP), glucose, cortisol and vitamin D25 levels as indicators of stress and anxiety, and a HT satisfaction survey was given. RESULTS: Thirty-nine patients consented to participate and were randomly assigned to HT (9), HT sham (12), CP (7) and CNP (11) groups. Mean patient age was 13.0 years, and no significant group differences were found for age, sex, race or patient procedure, categorized as laser, burn reconstruction and plastic surgery reconstruction. Additionally, no significant group differences were detected for any of the PSG parameters, YPAS scores, OPAS scores, medications, anesthesia emergence score, bloodwork or satisfaction survey score. CRP, glucose and cortisol levels were higher in the CNP group, suggesting that pediatric patients undergoing elective surgeries may benefit from more pre-operative support, possibly by HT. CONCLUSIONS: Although no tracked parameters showed statistically significant findings, anecdotal HT benefits included enhanced relaxation and sounder sleep.

Enhancing patient safety: the effect of process improvement on bedside fluoroscopy time related to nasoduodenal feeding tube placement in pediatric burn patients.

Nutrition support is essential in the care of burn patients. Early in the course of treatment, postpyloric feeding tube placement permits initiation of enteral nutrition, minimizes risk of aspiration, and may also attenuate hypermetabolism. Fluoroscopy aids in postpyloric feeding tube placement, yet concerns remain about safety. The purpose of this study was to measure fluoroscopy-associated radiation exposure during bedside feeding tube placement in pediatric burn patients and to take appropriate action to improve hospital protocols that minimize radiation exposure. During a 19-year period, radiation doses were measured before and after performance improvement of radiation safety initiatives. This plan included mandatory training for surgical house officers, measurement of maximum midline dosage for each procedure, limitation of radiation exposure to 5 minutes, and development of standardized policies and protocols for feeding tube placement. Phase 1 of the study retrospectively determined fluoroscopy time required for enteral tube placement. Phase 2 used thermoluminescent chips to measure the amount of radiation during fluoroscopy to establish an acceptable midline radiation dose. Phase 3 evaluated fluoroscopy times following implementation of improved safety processes. There were 357 procedures in phase 1 and mean fluoroscopy time was 4.1 minutes. Of the 10 procedures in phase 2, mean fluoroscopy time decreased to 2.7 minutes. There were 1804 procedures in phase 3, and mean fluoroscopy time was 2.3 minutes. Mean radiation exposure was significantly reduced following implementation of standardized policies and the development of a clinical protocol for bedside fluoroscopy (P<.0001). With proper processes, fluoroscopy procedures result in minimal radiation exposure for patients and staff.