The effectiveness of superficial subcutaneous lidocaine administration prior to femoral artery sheath removal.

The dynamic world of healthcare requires continuous review of practice to ensure that patient care aligns with current evidence and best practice. Superficial subcutaneous lidocaine injection has been an order option at London Health Sciences Centre-University Hospital (LHSC-UH) for use in post-percutaneous coronary intervention (PCI) prior to femoral artery sheath removal (FASR). The purpose of administering lidocaine is to reduce pain during FASR, subsequently enhancing the patient's experience. A critical appraisal was performed by the Continuous Quality Improvement-Cardiac Care Council (CQI-CCC) at LHSC-UH, evaluating the effectiveness of superficial subcutaneous lidocaine for use in patients undergoing FASR. This paper details the process followed to evaluate this practice and reports on the subsequent findings and recommendations. A literature review, a retrospective chart audit, a blinded online survey and peer hospital polling were compiled, and a summary of findings was shared with the cardiac interventionists, with subsequent polling. No significant evidence for pain reduction was identified when lidocaine injections were administered prior to FASR. As such, a unanimous decision was reached to remove lidocaine from the LHSC Coronary Angioplasty Clinical Pathway order form.

Local anesthesia before IV catheterization.

BACKGROUND: Intradermal buffered lidocaine is known to be effective in producing local anesthesia prior to IV catheterization. Recently, intradermal bacteriostatic normal saline has been suggested as a possible alternative. OBJECTIVE: To compare the efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization. METHODS: In a randomized, double-blind, parallel-design, quasiexperimental study, we compared pain ratings of adult patients receiving either intradermal buffered lidocaine or intradermal bacteriostatic normal saline before IV catheterization. We measured pain at venipuncture through the use of a verbal numeric rating scale, used the test to compare group differences, and performed an analysis of covariance to test for outcome differences related to age, sex, and race or ethnicity. RESULTS: The final sample (N = 148) was 65% women and 82% white, with a mean age of 52 years (range, 19 to 80 years). Demographic characteristics between the two treatment groups were similar. Intradermal buffered lidocaine was demonstrated to be significantly superior to intradermal bacteriostatic normal saline in reducing the pain of IV catheterization (P = 0.007). Differences in pain ratings between the two groups were not associated with age, sex, race or ethnicity, catheter size, or location of the IV site. CONCLUSIONS: Intradermal buffered lidocaine was superior to intradermal bacteriostatic normal saline in providing local anesthesia prior to IV catheterization in this group of predominately white adults and should be the solution of choice for venipuncture pretreatment.

[Ethyl chloride]. / Cloruro de etilo.

The control of symptoms in general and pain in particular, remains a current topic in scientific conferences and meetings, and discussed the recommendations of the Scientific Societies. Do not suffer unnecessary pain because the treatment is a right of every patient and facilitating action to control it, by nurses, is an expression of respect for that right. A common procedure nursing care consists of venous and arterial puncture for blood samples or to place catheters for different purposes, these procedures are painful for the patient and sometimes unpleasant by the need to perform them repeatedly. There are different relaxation techniques that can help to reduce this effect in the body but also have pharmacological interventions to help decrease the pain associated with vascular punctures. One of them, easy to use, quick to act and no side effects is the use of topical anesthesia by cold ethyl chloride.

The effect of needle bevel position on pain for subcutaneous lidocaine injection.

It is a common practice for medical practitioners to use subcutaneous infiltration of lidocaine to alleviate the pain of intravenous cannulation or line insertion. Although previous studies have assessed several factors affecting the pain associated with local anesthetic infiltration, there is a paucity of data on the effects of needle bevel position. In this prospective, randomized, controlled trial, we compared the effect of two different needle bevel positions (bevel up versus bevel down) and the pain associated with the subcutaneous injection of 1% lidocaine in 50 adult volunteers. Significantly higher pain scores were observed when the needle was placed bevel down compared with bevel up (P = .02). No significant differences in pain scores were noted between the groups for age and gender.

Local anaesthetic cataract surgery: factors influencing perception of pain, anxiety and overall satisfaction.

To assess factors influencing perception of pain, anxiety and overall satisfaction during local anaesthetic cataract surgery an audit was carried out at the West of England Eye Unit. Patients receiving sub-Tenons after previous peribulbar anaesthesia had significantly higher pain scores. Patient satisfaction was significantly higher when a handholder was present in theatre. Finally, no difference was found in the three variables whether anaesthesia was administered by an anaesthetic practitioner or an anaesthetist.

Reflection on action: communication is the key.

This article will explore, by reflection, a critical incident by considering the positive and negative aspects. This will encourage me as a trainee surgical care practitioner to look at how and why the incident occurred and it will support me in exploring my emotions. Having experienced this incident, on reflection I can look back at my mixture of emotions--ranging from fear and annoyance to accomplishment--because no matter how able we are as practitioners there will always be new and challenging experiences. When we value our work we value ourselves as practitioners who can make important contributions to the care of patients.

Modelling emergency decisions: recognition-primed decision making. The literature in relation to an ophthalmic critical incident.

AIMS: To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. BACKGROUND: This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. DESIGN: Systematic literature review with critical incident reflection. METHODS: Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. RESULTS: A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. CONCLUSIONS: Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). RELEVANCE TO CLINICAL PRACTICE: Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety.

[Effects of hand massage and hand holding on the anxiety in patients with local infiltration anesthesia].

PURPOSE: This study was to examine the effects of hand massage and hand holding as nursing interventions on the anxiety in patients with local infiltration anesthesia. METHOD: The design of this study was a nonequivalent, control group, non- synchronized design. The subjects of this study consisted of 15 patients for the hand group, 15 patients for the hand holding group and 17 patients for the control group awaiting surgery in the operation room of a general hospital in Daegu. As an experimental treatment, hand massage was carried out by the Hand Massage Protocol developed by Snyder (1995) and interpreted by Cho (1998) and hand holding developed by Cho (1998). The data were analyzed by SPSS/WIN, T-test, ANOVA, Cronbach's alpha, and the Scheffe test. RESULTS: The hand massage group and hand holding group were more effective than the control group in reducing anxiety, VAS score, systolic blood pressure and pulse rate. CONCLUSION: Hand massage and hand holding are effective nursing interventions that alleviates the psychological and physiological anxiety of patients with local infiltration anesthesia. In particular, the simple contact of hand holding is regarded as an effective and easily accessible nursing intervention in the operating room.