Pain and Satisfaction Perceptions of Ultrasound-Guided Versus Conventional Peripheral Intravenous Catheterization: A Randomized Controlled Trial.

BACKGROUND: While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA). AIMS: This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization. DESIGN: Randomized controlled clinical trial. METHODS: Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample. RESULTS: 120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction. CONCLUSION: US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure. CLINICAL IMPLICATIONS: US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.

A Qualitative Approach to Exploring the Impact of the Gay Identity Formation Process.

Background: Most gay men experience difficulty in coming to terms with their sexual orientation, with their health, wellbeing, and quality of life potentially affected by unpleasant experiences often associated with the formation of their gay identity. It is therefore important for nurses to understand the needs of gay men so that they can accompany them and provide quality care during and after the identity formation process. Objective: The aim of the study was to explore and describe the identity formation and coming out experiences of gay men. Methods: A qualitative design with a constructivist naturalist approach was used. Data were collected through in-depth semi-structured interviews with five gay men with experience of the gay identity formation process, and data were analyzed using a thematic analysis method. Results: The results show that the men needed support, as they reported feeling different and alone during the identity formation and coming out process, and that their mental health was affected. Fear of rejection, negative reactions, and disappointing people were the reasons that led the men not to disclose their sexual orientation to family, while those who had come out defined a feeling of liberation. Conclusions: The gay identity formation process has potential impacts on health, wellbeing, and quality of life. Nurses need cultural competence training to be able to understand the needs of gay men, accompany them in the identity formation process, and provide individualized and non-heteronormative care. Nurses also need to participate in dismantling a heterosexist social structure.

Development, Diagnostic Sensitivity, and Prognostic Accuracy of the Adult-Difficult Venous Catheterization Scale for Emergency Departments.

INTRODUCTION: Difficulty in accessing peripheral veins in emergency departments increases patients' discomfort and impedes their diagnosis. The objective of this study was to develop and test the prognostic accuracy of an easily applied scale to measure difficult venous access to peripheral veins in emergency departments, called the Adult-Difficult Venous Catheterization scale. METHODS: This prospective observational study was conducted in adults from the hospital catchment area attending the emergency department. Using the Delphi technique, 5 experts reached a consensus regarding a 3-item scale scored from 0 to 5. Concurrent validity and predictive validity were analyzed using a numeric rating scale and the number of access attempts, respectively. Internal consistency and interobserver reliability for 3 independent observers were analyzed using Cronbach alpha and Cohen kappa, respectively. RESULTS: In 392 participants, the concurrent and predictive validity scores pointed to positive relationships with the numeric rating scale (r = 0.82; P < 0.001) and the number of access attempts (r = 0.5; P < 0.001), respectively. The odds ratio for 1 to 2 access attempts versus more than 2 access attempts in relation to the Adult-Difficult Venous Catheterization scale score was 2.76 (95% confidence interval 1.86, 4.08; P < 0.001). Sensitivity and specificity values for the Adult-Difficult Venous Catheterization scale were good, at 93.75% and 78.99%, respectively, as were internal consistency (Cronbach alpha 0.81) and interobserver reliability (Cohen kappa 0.75). DISCUSSION: The Adult-Difficult Venous Catheterization scale is a valid and reliable instrument for predicting difficult venous access in emergency departments.

Evolution of Job Satisfaction and Burnout Levels of Emergency Department Professionals during a Period of Economic Recession.

Satisfaction at work has been found to be a predictive factor of permanency. On the other hand, burnout has been associated with financial loss. The purpose of this study was to analyse the levels of satisfaction and burnout of professionals in a hospital emergency department and make a comparison with results from the same service during the economic recession in 2012. An analytical, cross-sectional and descriptive study was undertaken during two time periods into the levels of satisfaction and burnout of the professionals of an emergency department. Consequently, 146 replies were received. The percentage of professionals who considered their salary to be unsatisfactory in 2012 diminished in comparison with 2018 (p = 0.034), while job stability was considered more satisfactory in 2018 (p = 0.039) and the timetable in 2018 as more unsatisfactory (p = 0.009). With regards to burnout, it was observed that in 2018 the score for depersonalisation had fallen (p = 0.029) in comparison with 2012. An improvement in the level of satisfaction is observed in 2018, and more positive scores have also been found in the depersonalisation subscale in 2018. An inverse association was observed between depersonalisation in 2018 and overall satisfaction.

Cateterización periférica ecoguiada frente a la técnica tradicional / Ultrasound-guided peripheral catheterization

INTRODUCCIÓN: La cateterización periférica es una técnica que puede ser difícil en algunos pacientes. Recientemente, algunos estudios describen la utilización de la ecografía para guiar la cateterización venosa. OBJETIVO: Describir la tasa de éxito, el tiempo requerido y las complicaciones de la cateterización venosa periférica guiada con ecografía así como satisfacción de los pacientes y profesionales. MÉTODO: La búsqueda se realizó en bases de datos (Medline vía Pubmed, Cochrane Library, CINAHL y Cuiden Plus) de estudios publicados sobre pacientes con cateterización venosa periférica guiada con ecografía y que aportaran resultados sobre éxito de la técnica, complicaciones, tiempo utilizado, satisfacción del paciente y tipo de profesional que realiza la técnica. RESULTADOS: Se incluyeron 21 estudios. La mayoría de ellos obtienen un éxito superior al 80% en la cateterización ecoguiada y el tiempo no es superior al de la técnica tradicional. Las complicaciones de la técnica analizadas fueron tasas de punción arterial y del nervio inferiores al 10%. En todos los estudios que miden y comparan la satisfacción del paciente, en la técnica ecoguiada es mayor. Diversos colectivos profesionales realizan la técnica. CONCLUSIÓN: La utilización de la ecografía para las canalizaciones periféricas tiene una elevada tasa de éxito, las complicaciones son poco frecuentes y el tiempo utilizado es similar al de la técnica tradicional. La técnica de inserción de catéteres a través de ecografía puede ser aprendida por cualquier grupo profesional que realice punciones venosas. Por último, se pone de relieve la alta satisfacción del paciente con el uso de esta técnica

BACKGROUND: Peripheral catheterization is a technique that can be difficult in some PATIENTS: Some studies have recently described the use of ultrasound to guide the venous catheterization. OBJECTIVE: To describe the success rate, time required, complications of ultrasound-guided peripheral venous catheterization. and patients and professionals satisfaction METHODS: The search was performed in databases (Medline-PubMed, Cochrane Library, CINAHL and Cuiden Plus) for studies published about ultrasound-guided peripheral venous catheterization performed on patients that provided results on the success of the technique, complications, time used, patient satisfaction and the type of professional who performed the technique. RESULTS: A total of 21 studies were included. Most of them get a higher success rate 80% in the catheterization ecoguide and time it is not higher than the traditional technique. The Technical complications analyzed were arterial puncture rates and lower nerve 10%. In all studies measuring and comparing patient satisfaction in the art ecoguide is greater. Various professional groups perform the technique. CONCLUSIONS: The use of ultrasound for peripheral pipes has a high success rate, complications are rare and the time used is similar to that of the traditional technique. The technique of inserting catheters through ultrasound may be learned by any professional group performing venipuncture. Finally, it gets underscores the high patient satisfaction with the use of this technique

[Ultrasound-guided peripheral catheterization]. / Cateterización periférica ecoguiada frente a la técnica tradicional.

BACKGROUND: Peripheral catheterization is a technique that can be difficult in some patients. Some studies have recently described the use of ultrasound to guide the venous catheterization. OBJECTIVE: To describe the success rate, time required, complications of ultrasound-guided peripheral venous catheterization. and patients and professionals satisfaction METHODS: The search was performed in databases (Medline-PubMed, Cochrane Library, CINAHL and Cuiden Plus) for studies published about ultrasound-guided peripheral venous catheterization performed on patients that provided results on the success of the technique, complications, time used, patient satisfaction and the type of professional who performed the technique. RESULTS: A total of 21 studies were included. Most of them get a higher success rate 80% in the catheterization ecoguide and time it is not higher than the traditional technique. The Technical complications analyzed were arterial puncture rates and lower nerve 10%. In all studies measuring and comparing patient satisfaction in the art ecoguide is greater. Various professional groups perform the technique. CONCLUSIONS: The use of ultrasound for peripheral pipes has a high success rate, complications are rare and the time used is similar to that of the traditional technique. The technique of inserting catheters through ultrasound may be learned by any professional group performing venipuncture. Finally, it gets underscores the high patient satisfaction with the use of this technique.