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.

La extrusión del dacron subcutáneo como tratamiento de la infección crónica del orificio de salida del catéter de diálisis peritoneal / No disponible

No disponible

¿Qué opinan las enfermeras sobre el dolor asociado a las punciones vasculares? / What do nurses on pain associated With vascular functions?

Una de las técnicas más frecuentemente utilizadas por las enfermeras en el desempeño de su práctica clínica es la punción vascular, asociada comúnmente a un dolor soportable por el paciente en mayor o menor medida. Desde hace unos años ha ido apareciendo en la industria farmacéutica una serie de anestésicos locales que pueden ser utilizados durante la punción vascular para minimizar o mitigar este dolor. El interés creciente de las enfermeras en este campo queda demostrado por los cada vez más numerosos artículos científicos publicados en esta disciplina, englobada en la terapia intravenosa. Durante el IV Congreso Nacional de la Asociación de Equipos de Terapia Intravenosa, celebrado en 2010 en Valencia, se pasó a los congresistas una encuesta con el objetivo de evaluar sus conocimientos e inquietudes sobre el control del dolor en las punciones y la utilización de anestésicos locales (AU)

One of the most common techniques used by nurses in carrying out their clinical practice is the vascular puncture, commonly associated with pain bearable for the patient to a greater or lesser extent. For the past few years have been appearing in the pharmaceutical industry a series of local anesthetics can be used for vascular puncture to minimize or alleviate the pain. The increasing interest by nurses in this field is evidenced by the growing number of scientific articles published in this discipline, included in the Intravenous Therapy. During the Fourth National Congress of the Association of Intravenous Therapy Teams held in 2010 in Valencia went over to the Congress a survey to assess their knowledge and concerns about pain control in the punctures and the use of local anesthetics in the same (AU)

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.

Evaluación de una acción formativa sobre anestesia local / Assessment of a training action on local anaesthesia

Objetivos: evaluar un conjunto de acciones formativas para enfermeras sobre la anestesia local.Material y método: estudio observacional, descriptivo y transversal.La población la formaron 417 enfermeras colegidasque realizaban una formación de postgrado. Para la recogidade los datos se utilizó un cuestionario autoadministrado específicodiseñado para tal fin y aplicado al finalizar la ActividadFormativa (AF). Se realizó un análisis univariante y bivariante(Chi-cuadrado y t de Student).Resultados: se obtuvieron 369 cuestionarios válidos en cincoaños. Se daba una asociación significativa entre el nivel deconocimientos y considerar adecuada la formación específica.Un 78,1% de las enfermeras se consideraban preparadas paraaplicar los conocimientos recibidos tras la acción formativaen su práctica clínica. Se evidenció una relación significativaentre la adquisición de un nivel de conocimientos alto (71,74%)y reflejar “totalmente” respecto a que el equipo docente habíatransmitido eficazmente los contenidos, así como con percibirque la metodología empleada había favorecido la participación(65,57%) y opinar que la metodología empleada se adaptabalos contenidos de la AF (70,32%).Conclusiones: si bien la formación previa es escasa, con laactividad formativa se produjo un importante aumento de conocimientos.Por otra parte, las enfermeras consideraban aplicableel contenido a su práctica clínica. Los resultados muestranque existen factores de influencia en la adquisición deconocimientos, unos directamente relacionados con las expectativasy motivaciones de los profesionales y otros ligadosa la estructura y planteamiento docente y metodológico (AU)

Objectives: to assess a series of training actions for nurseson local anaesthesia.Material and method: observational, descriptive and crosssectionalstudy. The study population was comprised of 417 registerednurses that were enrolled in a postgraduate course.A self-administered, specifically designed questionnaire waselaborated and administered at completion of the training action(TA). Univariate and bivariate analyses were carried out(Chi-square and Student t test).Results: 369 valid questionnaires were obtained in five years.A significant association existed between the level of knowledgeand the adequacy of specific training. A 78,1% of the nursesconsidered themselves to be prepared to apply the knowledgelearnt into their clinical practice after the training action.A significant relationship was evidenced between the acquisitionof a high level knowledge (71,74%) and a clear recognitionof the ability of the academic team to transmit the contents inan effective manner and also to confirm that the methods usedhad fostered participation (65,57%) and were adapted to thecontents of the TA (70,32%).Conclusions: even though prior training was scarce, the trainingaction was successful in significantly increasing the levelof knowledge. On the other hand, nurses were of the opinionthat the contents of the action were applicable to theirclinical practice. Results show that there are factors that influencethe acquisition of knowledge, some of which are directlyrelated to the expectations and motivations of the professionalswhilst others are associated with the structure and the academicand methodological approach used (AU)

Anestesia local en la punción arterial: actitudes y conocimientos de enfermería / Local anesthesia in arterial puncture: nurses' knowledge and attitudes

OBJETIVO: Aunque se recomienda el uso de anestesia local para la realización de la punción arterial, su empleo es muy escaso. El propósito del estudio ha sido conocer la actitud y los prejuicios sobre el empleo de la anestesia local para la realización de la punción arterial entre los profesionales de enfermería y alumnos de tercer curso de la diplomatura de enfermería en prácticas hospitalarias en nuestro hospital, así como el grado de conocimiento de la técnica. MATERIAL Y MÉTODOS: Se pasó a enfermeros y estudiantes de enfermería un cuestionario que constaba de 15 preguntas, divididas en 2 partes: una hacía referencia al uso de la anestesia local en la extracción de una gasometría arterial, y en la segunda se preguntaba por conocimientos técnicos de la prueba. Se compararon los resultados de los enfermeros de la Unidad de Neumología con el resto de profesionales del hospital, así como de los profesionales y estudiantes de enfermería. RESULTADOS: Contestaron el cuestionario los 131 enfermeros encuestados. De los 19 alumnos de tercer curso de enfermería, fueron válidas 17 encuestas. Del total de profesionales se separó a los enfermeros/as de la Unidad de Neumología (n = 11). Utilizaban habitualmente anestesia local 7 profesionales (5%), de los que 3 (27%) pertenecían a la Unidad de Neumología, mientras que ningún alumno de enfermería la usaba. Entre los profesionales, los principales motivos para no utilizar la anestesia fueron: desconocimiento (54%), necesidad de realizar 2 punciones si se usa anestesia (11%), por considerar que produce el mismo dolor con anestesia (8%) y por acertar en la primera punción (7%). En cuanto a los motivos de los alumnos de enfermería, el principal fue, al igual que entre los profesionales, el desconocimiento (53%), seguido de la falta de uso por éstos (24%). La mayoría de los encuestados (63%) querría que a ellos sí se les aplicase anestesia en la punción arterial. CONCLUSIONES: El uso de la anestesia local es muy escaso. Los conocimientos sobre la realización de la gasometría arterial no son óptimos y deben mejorar tanto entre los profesionales como entre los estudiantes de enfermería. Sin embargo, es de destacar que la mayoría de los entrevistados prefería que a ellos se les realizara la punción arterial con anestesia local. Estos datos deben tenerse en cuenta en el proceso formativo de los profesionales de enfermería sobre la punción arterial

OBJECTIVE: Local anesthesia is rarely used in arterial puncture, even though it is recommended. The aim of this study was to examine attitudes and beliefs among nurses and third-year undergraduate nursing students in hospital training regarding the use of local anesthesia when performing arterial puncture and to assess their knowledge of the technique. MATERIAL AND METHODS: Nurses and nursing students were issued a 15-item questionnaire consisting of 2 parts. The first part contained questions on the nurse's use of local anesthesia when extracting arterial blood for analysis and the second part involved questions regarding technical knowledge of this test. The results of nurses from the respiratory medicine department, nurses from the rest of the hospital, and nursing students were compared. RESULTS: The questionnaire was answered by the 131 the nurses surveyed. Valid questionnaires were returned by 17 of the 19 nursing students surveyed. Questionnaires returned by nurses from the respiratory medicine department (n=11) were separated from those returned by the rest of nurses. Local anesthesia was used routinely by 7 nurses (5%), of whom 3 (27%) belonged to the respiratory medicine department; local anesthesia was not used by any of the nursing students. The main reasons given by nurses for not using local anesthesia were lack of knowledge (54%), need to perform 2 punctures when anesthesia is used (11%), belief that the same amount of pain is caused with anesthesia (8%), and success on the first attempt at arterial puncture (7%). The main reason given by student nurses for not using local anesthesia was also lack of knowledge (53%), followed by the fact that it was not used by the nurses (24%). Most of those surveyed (63%) indicated a desire to receive anesthesia should they undergo arterial puncture. CONCLUSIONS: Local anesthesia is used very little in arterial puncture. Knowledge about how to perform arterial blood extraction for blood gas analysis is insufficient and needs to be improved among both nurses and nursing students. Nonetheless it is noteworthy that most of those surveyed indicated a preference for receiving local anesthesia if they were to undergo the procedure. These data should be taken into consideration when training nurses to perform arterial puncture

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.