Construção de um bundle para alívio da dor na punção arterial norteado pela Tradução do Conhecimento / Elaboración de un paquete de atención para aliviar el dolor en la punción arterial guiado por Traducción del conocimiento / Elaboration of a bundle for pain relief in arterial puncture guided by Knowledge Translation

RESUMO Objetivo descrever o processo de construção e estratégias de implementação de um bundle para alívio da dor durante a punção arterial do bebê hospitalizado. Métodos estudo de abordagem qualitativa feito em uma unidade de terapia intensiva neonatal, por meio de rodas de conversa realizadas com a equipe de enfermagem. A coleta dos dados ocorreu de fevereiro a maio de 2019. Resultados os encontros levaram à construção de um bundle composto por quatro itens, formatado ludicamente e que deveria ser anexado à incubadora, previamente à realização da punção. Conclusões e Implicações para a prática o processo estimulou a reflexão crítica acerca da própria prática e os profissionais referiram ao uso do bundle como algo possível dentro da unidade, mediante um planejamento para sua inclusão na rotina assistencial. O estudo é pioneiro e apresenta caráter de inovação ao utilizar o bundle para aliviar algo multifacetado como a dor no período neonatal. Apesar de ser algo criado especificamente para a punção arterial, o mesmo pode ser aplicado em demais procedimentos que potencialmente geram dor aguda, uma vez que o foco principal é sempre minimizar o desconforto sentido pelo bebê.

RESUMEN Objetivo describir el proceso de elaboración y las estrategias de implementación de un paquete de atención para aliviar el dolor durante la punción arterial de bebés internados. Métodos estudio de enfoque cualitativo realizado en una unidad de cuidados intensivos neonatales a través de rondas de conversación realizadas con el equipo de Enfermería. La recolección de datos tuvo lugar de febrero a mayo de 2019. Resultados las reuniones derivaron en la elaboración de un paquete de atención que consta de cuatro elementos, formateados en forma lúdica y que deben adjuntarse a la incubadora antes de la punción. Conclusiones e Implicaciones para la práctica El proceso estimuló la reflexión crítica sobre la propia práctica y los profesionales mencionaron el uso del paquete de atención como algo viable dentro de la unidad, a través de la planificación para su inclusión en la rutina de atención. El estudio es pionero y presenta un carácter innovador al utilizar el paquete de atención para aliviar algo multifacético como el dolor en el período neonatal. A pesar de haber sido creado específicamente para la punción arterial, también puede aplicarse en otros procedimientos con potencial para generar dolor agudo, ya que el enfoque principal siempre es minimizar las molestias que siente el bebé.

ABSTRACT Objective to describe the elaboration process and implementation strategies of a bundle for pain relief during arterial puncture in hospitalized infants. Methods a qualitative approach study carried out in a neonatal intensive care unit, through conversation circles held with the Nursing team. Data collection took place from February to May 2019. Results the meetings led to the elaboration of a bundle consisting of four items, in a playful format, and which should be attached to the incubator prior to the puncture. Conclusion and Implications for the practice The process stimulated critical reflection about the practice itself and the professionals mentioned use of the bundle as something feasible within the unit, through planning for its inclusion in the care routine. The study is pioneering and presents an innovative character when using the bundle to relieve a multifaceted issue such as pain in the neonatal period. Despite having been specifically created for arterial puncture, it can also be applied in other procedures that potentially generate acute pain, as the main focus is always to minimize the discomfort felt by the infant.

Manejo da dor durante a punção arterial no neonato: estudo descritivo / Manejo del dolor durante la punción arterial en neonatos: estudio descriptivo / Pain management during arterial puncture in newborns: a descriptive study

RESUMO Objetivo descrever as medidas de alívio da dor aplicadas pela equipe de enfermagem durante a punção arterial no neonato e os escores de dor no momento do procedimento. Método estudo descritivo, quantitativo, realizado entre outubro de 2018 e janeiro de 2019, em uma unidade de terapia intensiva neonatal no Noroeste do Paraná, por meio da observação não participantes de 192 punções arteriais, com respectiva mensuração dos escores de dor. O estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos. Resultados das 192 punções somente 34 foram analisadas quanto às medidas de alívio e escores de dor, os quais se mostraram elevados. As demais punções foram excluídas, devido perda da monitorização durante o procedimento. Conclusão evidenciou-se pouco uso de intervenções relacionadas ao alívio da dor por parte da equipe. O processo de observação constatou a presença de dor intensa.

RESUMEN Objetivo describir las medidas de alivio del dolor aplicadas por el equipo de enfermería durante la punción arterial en neonatos y las escalas de puntuación de dolor en el momento del procedimiento. Método estudio descriptivo, cuantitativo, realizado entre octubre de 2018 y enero de 2019, en una unidad de cuidados intensivos neonatales del noroeste de Paraná, mediante observación no participante de 192 punciones arteriales, con medición respectiva de puntuaciones de dolor. El estudio fue aprobado por el Comité de Ética para la Investigación con Seres Humanos. Resultados de las 192 punciones, solo 34 fueron analizadas en cuanto a las medidas de alivio y puntuaciones de dolor que fueron elevadas. Se excluyeron las otras punciones debido a la pérdida del monitoreo durante el procedimiento. Conclusión el equipo utilizó poco las intervenciones relacionadas con el alivio del dolor. El proceso de observación verificó la presencia de dolor intenso.

ABSTRACT Objective to describe pain relief measures applied by the nursing team during arterial puncture in neonates, and pain scores during the procedure. Method this descriptive, quantitative study was conducted between October 2018 and January 2019 at a neonatal intensive care unit in northwestern Paraná, by non-participant observation of 192 arterial punctures and measurement of the respective pain scores. The study was approved by the human research ethics committee. Results of the 192 punctures, only 34 were examined for relief measures and pain scores; the latter were found to be high. The other punctures were excluded for loss of monitoring during the procedure. Conclusion pain-relief interventions were little used by the team. The observation process found intense pain.

Complicaciones derivadas de la inserción periférica de catéter central con punción ciega o ecoguiada / Complications derived of Peripherally-Inserted Central Catheters with blind or ultra-sound guided puncture

OBJETIVO: determinar la influencia de la técnica de colocación de catéteres centrales de inserción periférica (PICC), ecoguiada frente a punción ciega, sobre la incidencia de flebitis y otras complicaciones en pacientes oncológicos. MÉTODO: estudio analítico observacional de cohorte retrospectivo (grupo punción ciega versus grupo con técnica ecoguiada). Se incluyeron, 168 pacientes a los que se les colocó un PICC durante los años 2013 a 2015 (seleccionados por muestreo aleatorio simple), con punción ciega (n= 114) o ecoguiada (n= 54) en el Hospital de Día del ICO-Hospital Duran I Reynals (Barcelona). Las variables estudiadas fueron la incidencia de flebitis y otras complicaciones asociadas al catéter, el tiempo hasta la aparición de las complicaciones, el motivo de retirada y el tiempo de duración del catéter. RESULTADOS: la edad media de los pacientes en ambos grupos fue similar (59,3 en grupo punción ciega y 59,7 años en grupo con técnica ecoguiada). El tumor más habitual fue el cáncer de cabeza y cuello, aunque con diferencias significativas en la distribución de los mismos entre ambos grupos. La flebitis fue la complicación más incidente. Ocurrió en el 16,7% del grupo con punción ciega frente al 1,8% en colocación ecoguiada (RR= 0,11; p= 0,012). La flebitis apareció de media a los 30 días (DE: 6,93) en los catéteres ecoguiados y a los 11 días (DE: 8,58) en los insertados sin ecógrafo (p= 0,002). CONCLUSIONES: la implantación de la técnica ecoguiada para la inserción de PICC frente a la punción ciega se asocia a una reducción en la incidencia y en el tiempo de aparición de la flebitis

OBJECTIVE: to determine the impact of the ultrasound-guided technique for peripherally-inserted central catheters (PICCs) vs. blind puncture, on the incidence of phlebitis and other complications in oncology patients. METHOD: an observational, analytical, retrospective cohort study (blind puncture arm vs. arm with ultrasound-guided technique). The study included 168 patients with a PICC inserted from 2013 to 2015 (selected through simple random sampling), with blind (n= 114) or ultrasound-guided puncture (n= 54) at the Day Hospital of the ICO-Hospital Duran I Reynals (Barcelona). The variables studied were: incidence of phlebitis and other catheter-related complications, time until the development of complications, reason for removal, and time of catheter duration. RESULTS: the mean age of patients in both arms was similar (59.3 years in the blind puncture arm and 59.7 years in the arm with ultrasound-guided technique). The most frequent tumour was head and neck, though with significant differences in distribution between both arms. Phlebitis was the complication with the highest incidence, which occurred in 16.7% of the blind puncture arm vs. 1.8% with ultrasound-guided insertion (RR= 0.11; p= 0.012). The mean time for phlebitis development was 30 days (SD: 6.93) for ultrasound-guided catheters, and 11 days (SD: 8.58) for those inserted without ultrasound (p= 0.002). CONCLUSIONS: the implementation of the ultrasound-guided technique for PICC insertion vs. blind puncture was associated with a reduction in the incidence of phlebitis and the time to its development

Cómo reducir los riesgos de la punción venosa periférica con un nuevo catéter de sistema cerrado / How to reduce the risks of the peripheral venous puncture with a new closed system catheter

En el presente artículo se exponen algunas de las complicaciones asociadas a la terapia endovenosa por vía periférica y se describen las características de un catéter de sistema cerrado, que consigue mejorar la seguridad tanto de los pacientes como de los profesionales sanitarios. El catéter dispone en su interior de una membrana antirreflujo que mejora su manipulación, y un novedoso sistema de conexión, con una gran plataforma de fijación, que reduce las complicaciones relacionadas con una sujeción deficiente. Además, está dotado de un dispositivo de seguridad de activación automática que protege de forma inmediata y eficaz, lo que elimina el riesgo de pinchazos accidentales (AU)

This article explains some complications associated with peripheral intravenous venipuncture and also describes the characteristics of a closed system catheter providing an improved safety, both for patient and health care professional. The catheter is designed with a multi-access septum providing a closed-system and with a new hub including a stabilisation platform for better fixation in order to reduce any complication resulting from insufficient fixation. Additionally it is a passive safety device that automatically protects from the risk of needle stick injuries (AU)

Actuación ante una lesión percutanea contaminada con sangre / Managemetn of blood-contaminated percutaneous injury

Analizamos en este artículo las normas fundamentales para la prevención de las punciones accidentales por parte de los trabajadores sanitarios, así como los pasos a seguir una vez que se ha producido la punción accidental

In the current paper we have assessed the main guidelines for prevention of accidental puntures by helthcare workers as well s the recommended steps to follow once the punture has occurred

Medidas de bioseguridad que aplica el profesional de enfermería durante la venopunción en el Servicio de Emergencia del Hospital Dos de Mayo 2013 / Biosecurity measures applied by the nurse during the venipuncture in the Emergency Service at the Hospital Dos de Mayo 2013

Objetivo: Determinar las medidas de bioseguridad que aplica el profesional de enfermería durante la venopunción en el servicio de emergencia del Hospital Dos de Mayo 2013. Diseño: transversal, descriptivo. Población: 40 profesionales de enfermería que laboran en el servicio de Emergencia del Hospital Dos de Mayo. Técnica e Instrumento: observación directa en 3 oportunidades, por un promedio de 9 horas a las enfermeras asistenciales del servicio de emergencia, durante su guardia diurna y el instrumento fue la guía de observación estructurada con respuesta dicotómica. Resultados: Se ha determinado que de los observados el mayor porcentaje de enfermeros(as) no aplican las medidas de bioseguridad durante la venopunción. Conclusiones: Según el indicador Lavado de manos, de un total de 40 (100 por ciento) enfermeras(os) observados, 25 (62.5 por ciento) no aplican el indicador en mención y sólo 15 (37.5 por ciento) si aplican. Según el indicador Uso de barreras protectoras, de un total de 40 (100 por ciento) enfermeras(os) 35 (87.5 por ciento) no aplican el indicador en mención y solo 5 (12.5 por ciento) si aplican. Según el indicador Manejo de residuos, de un total de 40 (100 por ciento) enfermeros observados, 35 (87.5 por ciento) si aplica el indicador en mención y 5 (12.5 por ciento) no aplican.

Objective: To determine the biosecurity measures applied by the nurse during venipuncture in the emergency service of Hospital Dos de Mayo 2013. Design: Cross-sectional, descriptive. Population: 40 nurses working in the emergency room of Hospital Dos de Mayo. Techniques and instruments: direct observation in 3 opportunities for an average of 9 hours practicing nurseÆs emergency service during the day watch and instrument was structured observation guide with dichotomous response. Results: It has been observed that the highest percentage of nurses do not apply biosecurity measures during venipuncture. Conclusions: According to the indicator wash hands, a total of 40 (100 per cent) nurses observed, 25 (62.5 per cent) do not apply the indicator in question and only 15 (37.5 per cent) if applicable. According to the use of protective barriers indicator, a total of 40 (100 per cent) nurses 35 (87.5 per cent) do not apply the indicator in question and only five (12.5 per cent) if applicable. According to the waste management indicator, a total of 40 (100 per cent) observed nurses, 35 (87.5 per cent) if you apply the indicator in question and 5 (12.5 per cent) do not apply.

Protocolo para la punción arterial con anestesia local / Protocol for arterial puncture with local anaesthesia

La punción arterial es una técnica habitual en Atención Especializada y realmente dolorosa para los pacientes. Existen diversos procedimientos para hacerla más confortable, pero solamente la inyección de anestesia local se ha mostrado efectiva. No obstante, esta no se emplea por diversos motivos: falta de formación, ideas erróneas y ausencia de protocolos que ayuden a desempeñar una práctica basada en evidencias. Con el objetivo de conocer las recomendaciones más actuales de forma estructurada se ha realizado una revisión bibliográfica, buscando las últimas evidencias en este sentido y, a partir de ahí, se ha elaborado una propuesta en forma de protocolo. Existe suficiente evidencia para incluir la anestesia en el procedimiento de la punción arterial. Elaborar un protocolo actualizado se considera un elemento de mejora en la calidad de los cuidados y reducir la variabilidad en la prestación de los mismos

Arterial puncture is a common technique in Specialized Care, and really painful for patients. There are various procedures in order to make it more comfortable, but only the injection of local anaesthesia has shown to be effective. However, this is not used due to different reasons: lack of training, wrong ideas, and absence of protocols to help conducting an evidence-based practice. With the aim to learn about the most recent recommendations in a structured manner, a bibliographic review has been conducted, looking for the latest evidence in this matter; and based on this, a protocol-like proposal has been prepared. There is enough evidence to include anaesthesia within the arterial puncture procedure. To prepare an updated protocol is considered an element of improvement in the quality of patient care, and to reduce variability in said care

The use of oral sucrose for procedural pain relief in infants up to six months of age: a randomized controlled trial.

The aim of this study was to evaluate the effectiveness of oral sucrose in decreasing pain during minor procedures in infants of 1-6 months corrected age. A blinded randomized controlled trial with infants aged 4-26 weeks who underwent venipuncture, heel lance or intravenous cannulation were stratified by corrected age into > 4-12 weeks and > 12-26 weeks. They received 2 mL of either 25% sucrose or sterile water orally 2 minutes before the painful procedure. Nonnutritional sucking and parental comfort, provided in adherence to hospital guidelines, were recorded. Pain behavior was recorded using a validated 10 point scale at baseline, during and following the procedure. Data collectors were blinded to the intervention. A total of 21 and 20 infants received sucrose and water, respectively, in the > 4-12-week age group, and 21 and 22, respectively, in the > 12-26-week age group. No statistical differences were found in pain scores between treatment and control groups at any data collection points in either age group. Infants aged > 4-12 weeks who did nonnutritional sucking showed statistically significantly lower median pain scores at 1, 2, and 3 minutes after the procedure than those who did not suck. Infants aged > 4-26 weeks exhibited pain behavior scores that indicated moderate to large pain during painful procedures; however, there was insufficient evidence to show that 2 mL 25% sucrose had a statistically significant effect in decreasing pain. Infants should be offered nonnutritional sucking in compliance with the Baby Friendly Health Initiative during painful procedures.

Comparación de la anticoagulación medida con el dispositivo Inratio®, en muestras obtenidasde la fístula arteriovenosa frente a muestras capilares / Comparison of anticoagulation measured using the Inratio® device in samples obtained fromthe arteriovenous fistula compared to capillary samples

Los controles a pacientes tratados con Sintrom® han evolucionado hacia métodos de determinación en sangre capilar por ser más fácil de extraer, menos cruento, más barato y tener resultados inmediatos. En cada sesión de hemodiálisis extraemos sangre de una fístula arteriovenosa lo que facilita una muestra para el control del tratamiento con Sintrom® disminuyendo el número de punciones venosas sin aumentar la carga de trabajo de enfermería. Objetivo Comparar los resultados de INR determinados con el método INRatio® en muestras sanguíneas capilares y arteriovenosa. Material y métodos Se estudiaron 7 pacientes anticoagulados con Sintrom ®, portadores de fístula arteriovenosa. Se compararon 3 muestras, una periférica, analizada en el laboratorio y otras 2 utilizando el método INRATIO® para análisis de INR en sangre capilar. Una de las muestras fue extraída según recomendaciones del fabricante, y otra extraída del acceso vascular según protocolo de la unidad. Resultados El INR medio determinado en la muestra capilar fue 2.5 ±1; Fístula arteriovenosa 2.1 ±0.4 y laboratorio 2.1 ±0.4. No existieron diferencias ni estadísticas ni clínicas significativas. Conclusión La utilización del método INRatio® de determinación de INR capilar con muestras del acceso vascular sería adecuado en hemodiálisis al ser igual de fiable que los métodos tradicionales. El uso del medidor INRATIO con muestra extraída de la fístula arteriovenosa presenta unos beneficios de facilidad de acceso a la muestra, sencillez en la determinación, inmediatez en los resultados, comodidad y un ahorro económico para el sistema sanitario(AU)

Monitoring of patients treated with Sintrom® has evolved towards capillary blood testing as it is easier to draw blood, less painful, cheaper and immediate results are available. In each haemodialysis session we draw blood from an arteriovenous fistula, which provides a sample for monitoring treatment with Sintrom®, reducing the number of venous punctures without increasing the nursing workload. Objective To compare the INR results determined using the INRatio® method in capillary and arteriorvenous blood samples. Material and methods Seven patients with an arteriovenous fi stula and on Sintrom® anticoagulation were studied. Three samples were compared: one peripheral, analysed in the laboratory, and the other two using the INRATIO ® method for INR analysis in capillary blood. One of the samples was drawn according to the manufacturer’s recommendations, and the other was drawn from the vascular access according to the unit’s protocol. Results The mean INR determined in the capillary sample was 2.5 ±1; arteriovenous fistula 2.1 ±0.4 and laboratory 2.1 ±0.4. There were no significant statistical or clinical differences. Conclusion The use of the INRatio® method for determining capillary INR with vascular access samples would be appropriate in haemodialysis as it is equally reliable as the traditional methods. The use of INRATIO measurement device with samples drawn from the arteriovenous fistula presents benefi ts of facility of access to the sample, simplicity in determining and immediacy in obtaining results, convenience and an economic saving for the healthcare system(AU)

O cuidado pelo enfermeiro ao recém-nascido prematuro frente à punção venosa / Care by nurses for premature newborns undergoing venous puncture / El cuidado por el enfermero al recién nacido prematuro frente a la punción venosa

Este estudo objetivou descrever de que forma o enfermeiro realiza os cuidados para minimizar a dor antes, durante e após a punção venosa em recém-nascidos prematuros. Os sujeitos foram 12 enfermeiros da unidade de terapia intensiva neonatal de um hospital universitário situado no município do Rio de Janeiro. A coleta de dados se deu através de uma entrevista semiestruturada, no período de março a abril de 2011. O método aplicado foi a análise de conteúdo de Bardin. Neste sentido, emergiram quatro categorias: realizando a sucção e o uso da glicose; posicionando, contendo e organizando o recém-nascido de forma confortável; promovendo acalento, aconchego e manuseando de forma cuidadosa o recém-nascido; preocupando-se com a punção venosa e com o recém-nascido. Para tornar esse procedimento o menos doloroso possível para o recém-nascido, os enfermeiros apontam cuidados que consideram essenciais para alívio da dor diante da punção venosa, porém não diferenciam as etapas desse processo.

This study aimed to identify how nurses perform care to minimize pain before, during and after venous puncture in premature newborns. This qualitative study involved 12 nurses in a neonatal intensive care unit at a university hospital in Rio de Janeiro City. Data were collected by semi-structured interview in March-April 2011 and were analyzed by Bardin content analysis, which identified four categories: performing suction and using glucose; positioning, containing and organizing the premature newborn comfortably; giving warmth, comfort and handling the newborn carefully; and feeling concern over the venous puncture and the newborn. In order to make this procedure as painless as possible for the newborn, the nurses indicated care they consider essential for pain relief in venous puncture, but they do not differentiate the stages in this process.

Este estúdio objetivó describir de que forma el enfermero realiza los cuidados para minimizar el dolor antes, durante y después de la punción venosa em recién nacidos prematuros. Los sujetos fueron 12 enfermeros de una unidad de terapia intesiva neonatal de un hospital universitário situado en el município de Rio de Janeiro-RJ-Brasil. La recolección de datos acaeció por entrevista semiestructurada, en el período de marzo/abril de 2011. El método aplicado fue el analisis de contenido de Bardin. En este sentido, emergieron cuatro categorías: realizando la succión y el uso de la glucosa; posicionando, conteniendo y organizando el recién nacido de forma confortable; promoviendo cariño, confort y manoseando de forma cuidadosa el recién nacido; preocupándose con la punción venosa y con el recién nacido. Para que ese procedimiento sea lo menos doloroso posible para el recién nacido, los enfermeros muestran cuidados que consideran esenciales para el alivio del dolor en la punción venosa, pero sin diferenciar las etapas de ese proceso.

PINCHAR HACE DAÑO Representaciones del dolor en el niño, en edad escolar,sometido a punción venosa / No disponible

Introducción: El dolor forma parte de la condición humana y es inalienable de su existencia. Es entendido como una experiencia universal con inicio precoz en cada individuo y gana heterogeneidad de configuraciones sociales y variabilidad de grados de intensidad. Como experiencia intransmisible, marcará, de diversas formas, la construcción psicológica y social de la persona. En el niño es una experiencia común y perturbadora, muchas veces subestimada y subintervencionada en contextos de salud. Metodología: Con este estudio exploratorio de naturaleza mixta, basado en la teoría de las representaciones sociales, pretendemos dar voz a los niños sometidos a punción venosa. Los objetivos de este trabajo son identificar las representaciones asociadas a la experiencia de punción venosa y evaluar el grado de dolor asociado a esta experiencia, en niños en edad escolar. Se aplicó la asociación libre de palabras con dos cuestiones estímulo: «El dolor me hece pensar en…», «El pinchazo de la aguja me hace sentir…» y la escala numérica de evaluación del dolor, a 43 niños con edades comprendidas entre 6 y 12 años ingresados en un hospital de la Sub-región de Salud de Lisboa. Los datos se analizaron con recurso del software SPAD-T (análisis factorial de correspondencias simples) y SPSS (estadística descrpitiva). Resultados: Los datos obtenidos permiten decir que los niños que participaron en este estudio consideraron que el dolor funciona como factor desencadenante de sufrimiento y está asociado a manifestaciones físicas como el llanto y a sentimentos expresados ante el dolor, como el miedo y la ansiedad. El grado de dolor está asociado a la punción venosa y presenta variabilidad con factores como la edad y las experiencias anteriores. Conclusión: La punción venosa es un procedimiento doloroso y, según los niños que participaron en el estudio, provoca miedo y ansiedad. Sin embargo, muchos evitaron tener comportamientos sugestivos de dolor por vergüenza de ser considerados más flojos o por entender que es un dolor necesario. De ahí el hecho de que algunos niños, asociaran al dolor la valentía que se necesita tener para soportarla (AU)

Introduction: Pain is a part ofhuman nature and is an unalienable part of our existence. It is understood as a universal experience, with an early beginning, in each person, and it gans heterogeneity from social configurations and varying intensity. As an untransferrableexperience, it marks the construction of the psychological and social person in various ways. For children, pain is a common and disturbing experience that is sometimes underestimated in health contexts. Methodology: This exploratory study is of a mixed nature, which was based on the theory of social representations, aims to dentify the representation associated to pain, in school age children submitted to venous puncture and to the degree ofpain associated to venous puncture. Therefore, the free association of words technique was applied using two stimulus questions: «Pain makes me think about…», the needle prick makes me feel…», and the numerical scale of pain evaluation, to forty three children with ages between six and twelve years old, who were hospitalized in Lisbon’s Health Sub-region. The data have been analyzed using SPAD-T (factorial analysis of simple correspondence) and SPSS (descriptive statistics) software. The Results show that for those children pain is a factor which arouses suffering and is associated, by children, to physical manifestations, such as crying and to feelings expressed in the presence of pain, like fear. This procedure provokes fear and anxiety in hospitalized children. The degree of pain associated to venous puncture changes with factors like age and mainly with previous experience. In Conclusion, venipuncture is a painful procedure and according to the children who participated in the study, it causes fear and anxiety. However, many avoided suggestive feelings of pain, because they were ashamed to be considered weaker or deem it a necessary pain; hence the fact that some children associate pain and the need to have the necessary courage to support it (AU)

¿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)

La punción del acceso vascular en hemodiálisis es una necesidad, el método Buttonhole una opción / Vascular access puncture in haemodialysis is a necessity. The buttonhole method is an option

Introducción. La técnica de punción del acceso, además de influir en la supervivencia de éste, es motivo de ansiedad y disconfort para el paciente. Existen tres técnicas de punción: escalera, área de punción y Buttonhole. Estudios realizados sobre esta última la asocian con disminución de dolor y de las complicaciones asociadas a la punción. Objetivo Introducción del método de punción Buttonhole en nuestra Unidad. Metodología Estudio descriptivo observacional, realizado en nuestra unidad de hemodiálisis. Se han incluido en este estudio todos los pacientes de hemodiálisis portadores de fístula arterio-venosa sana y no protésica. La muestra será de 35 pacientes randomizados aleatoriamente con un periodo de seguimiento de 6 meses. Previamente al inicio del estudio enfermería se formó en la técnica y se creó un protocolo de punción específico. Cada hemodiálisis se recogen todas las variables a analizar en una hoja de registro. Se aplica estadística descriptiva para las variables. t de Student para la diferencia entre medias y x2 y prueba exacta de Fisher para la de proporciones, considerando significativo p<0.05. Análisis de la supervivencia Kaplan-Meier. Paquete estadístico SPSS 14.0. Resultados La sensación de dolor durante la punción y el tiempo de hemostasia han disminuido significativamente en todos los pacientes. Durante el periodo del estudio no se ha producido ninguna complicación. Conclusiones La técnica Buttonhole disminuye el dolor percibido por el paciente comportando una mayor satisfacción. El Buttonhole es una buena alternativa para accesos poco desarrollados o con problemas de punción favoreciendo las opciones de auto-punción y hemodiálisis domiciliaria (AU)

Introduction. The access puncture technique, as well as affecting survival, is a cause for anxiety and discomfort for the patient. There are three puncture techniques: rope-ladder, area and buttonhole. Studies carried out on this last method associate it to a reduction in pain and the complications associated to puncture. Aim To introduce the buttonhole puncture method in our Unit. Methodology Observational descriptive study, carried out at our haemodialysis unit. All the patients on haemodialysis with a healthy and non-prosthetic arteriovenous fistula were included in this study. The sample will be 35 randomized patients with a monitoring period of 6 months. Prior to commencing the study, nursing staff were trained in the technique and a specific puncture protocol was created. All the variables to be analysed are recorded at each haemodialysis session. Descriptive statistics is applied for the Student t variable for the difference between means and x2 and Fisher’s exact test for the proportions, where p<0.05 is considered significant. Kaplan- Meier survival analysis. SPSS 14.0. statistical package. Results The sensation of pain during puncture and bleeding time were reduced significantly in all patients. No complications occurred during the study period. Conclusions The buttonhole puncture technique reduces the pain perceived by the patient, giving greater satisfaction. The buttonhole puncture technique is a good alternative for accesses that are not well developed or have puncture problems, favouring self-puncture and home haemodialysis options (AU)

[Nurse's role in the processes of hospital humanization and procedural pain relief in children]. / L'umanizzazione dell'ospedale: il ruolo dell'infermiere nella riduzione della paura e dello stress nel bambino, con particolare riferimento alla procedura del prelievo venoso periferico.

In childhood, hospital admission is frequently seen as something unexplanable and close to a "punishment". Involving parents/caretakers in the process of care is critical for the child to cope with the distress arising from hospital contacts and medical procedures. However, some grey zone remains for common procedures as venipuncture in hospital and ambulatory settings. We have conducted a literature review, searching for articles focused on procedural distress reduction/control in children. Several studies show that communication play a critical role and that children as young as 5 are able to "read" the way nurses and doctors interact with them and their approach is very important in reducing procedural distress. However, children attitude toward communication of health information may not be so linear, because they tend to continuously shift from a position of "passive bystander" to a "active participant" one, and viceversa. Nurse's role is crucial for the reduction of procedural distress because of her/his frequent contact with the young patients, but often she/he does not have the skills to help children to cope with procedural distress. Several approaches to this issue are discussed.

Respostas multidimensionais de dor em recém-nascidos prematuros submetidos a punções venosas periféricas na unidade de tratamento intensivo neonatal: contribuições para a prática da enfermagem / Multidimensional pain responses in premature infants undergoing to venipunctures in neonatal intensive care unit: contributions to nursing practice

A punção venosa periférica é sabidamente um procedimento doloroso e uma prática comum realizada pela enfermagem na Unidade de Tratamento Intensivo Neonatal. Os objetivos deste estudo foram descrever as características das mães e prematuros segundo dados sóciodemográficos e clínicos, mensurar a dor do recém-nascido prematuro (RNPT) submetido a punções venosas periféricas com cateter sobre agulha para terapia intravenosa através das escalas perfil de dor do prematuro (PIPP) e escala de dor do neonato (NIPS) e comparar as respostas multidimensionais à dor que os recém-nascidos prematuros apresentam em três momentos diferentes ao longo dos primeiros 15 dias de internação. Métodos: Trata-se de um estudo de coorte prospectivo em uma unidade de tratamento intensivo neonatal (UTIN) do município do Rio de Janeiro. Foi uma amostra de conveniência de todos os RNPTs que preencheram os critérios de inclusão, obtendo de seus responsáveis autorização para participação na pesquisa...

Reducing neonatal pain during routine heel lance procedures.

PURPOSE: To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group. DESIGN AND METHODS: A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Infants in the experimental group (n = 22) were swaddled and held in an upright position during routine heel lance procedures while neonates in the control group (n = 20) remained in a standard care position. Pain was measured with the Neonatal Inventory Pain Scale (NIPS) at two points in time for each group (just before the heel lance procedure and at the completion of the heel lance). Total collection time was measured using a stopwatch accurate to 1/100th of a second. Specimen quality was measured based on the number of rejected specimens for each group. Descriptive statistics and t tests were used to analyze the data. RESULTS: The mean NIPS score for neonates who were swaddled and held during the procedure (experimental group) was significantly lower (M = 1.3, SD = .9) than the score for infants in the standard position (control group) (M = 2.7, SD = 1.3), t (40) = -4.48, p < .001. Although the total collection time was lower for infants who were swaddled (2 minutes and 17 seconds, SD = 59) versus (2 minutes and 47 seconds, SD = 85) for controls, this was not a statistically significant difference (p = .45). CLINICAL IMPLICATIONS: Swaddling combined with positioning neonates upright during routine heel lance procedures offers nurses a nonpharmacologic method of neonatal pain reduction for heel sticks. This technique can be easily implemented on any unit independent of facility protocols. Furthermore, the technique is not associated with any cost or policy development, making it more likely that nurses can use it in practice.

Ventricular reservoir punctures performed by nurses: an improvement in quality of care.

Management strategies in the treatment of infants with posthemorrhagic ventricular dilation include the placement of a ventricular reservoir. Traditionally, ventricular punctures of these reservoirs have been performed only by physicians. In the pilot project described in this article, we taught nursing staff to perform punctures of a cerebral ventricular reservoir in neonates with hydrocephalus to give nurses more control in their daily care of these infants.All consecutive punctures performed between August 2006 and March 2007 (n = 302) were studied. The chart was reviewed for the infant's state during the puncture, the caregiver who performed the puncture, and the timeliness of the puncture with respect to schedule and to infant state. During the day shift, there was no significant difference in timeliness, whether the puncture was performed by a physician, a nurse, a physician assistant (PA), or a nurse under the supervision of a physician. On the night shift, punctures were performed on schedule significantly more often when they were carried out by nurses (p>.001). This pilot project demonstrated that nurses can learn to perform cerebrospinal fluid removal from a ventricular reservoir. Because it increased the timeliness with which punctures were performed and gave nurses more control in planning rest periods for these infants, this policy change was judged a success.

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

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.