Contenuto dell'articolo principale
Abstract
Introduzione. Le procedure di emodinamica ed elettrofisiologia (coronarografie radiali/femorali, impianto di pacemaker/defibrillatore) possono provocare dolore di diverso tipo ed intensití durante l'esecuzione e nelle ore seguenti. Obiettivi. Valutare l'insorgenza di dolore e ansia in pazienti sottoposti a procedure di emodinamica ed elettrofisiologia. Descrivere la somministrazione, la frequenza, la tempistica e il dosaggio di farmaci analgesici e ansiolitici pre, intra, post procedura e l'esito ottenuto.
Metodi. E' stato condotto uno studio descrittivo multicentrico; rilevati dati su ansia, dolore con una scala VAS (0-10) prima, durante, post procedura e sulla soddisfazione del paziente per le informazioni ricevute e il controllo del dolore.
Risultati. Sono stati raccolti dati su 230 pazienti, la procedura più eseguita è stata la coronarografia radiale (68.7% dei casi), la più dolorosa (mediana 4, IQR 3-6) e ansiogena (mediana 5, IQR 2-6) l'impianto di pacemaker/defibrillatore. Durante la procedura 13 pazienti hanno ricevuto un'analgesia per un dolore da lieve ad elevato; nelle 24 ore successive 34 (5 sottoposti a coronarografia radiale e 29 ad impianto pacemaker/defibrillatore) hanno riferito un dolore elevato e tutti tranne 5 hanno richiesto un'analgesia. La soddisfazione per il controllo del dolore è stata insufficiente per i pazienti sottoposti ad impianto pacemaker/defibrillatore e 55 pazienti avrebbero desiderato più spiegazioni sul dolore.
Conclusioni. L'attenzione al controllo del dolore e la soddisfazione del paziente sono migliorabili. Eventuali stati d'ansia andrebbero indagati maggiormente e si dovrebbero fornire più informazioni sulla procedura. Parole chiave: pain management, percutaneous coronary intervention, implantable cardioverter-defibrillator, pacemaker artificial.
Introduction: gestione del dolore, intervento coronarico percutaneo, defibrillatore cardioverter impiantabile, pacemaker artificiale.
Measurement and management of pain during coronary interventions and electrophysiology procedures: a multicentric descriptive study
Aim: To assess the onset of pain and anxiety in patient undergoing coronary interventions and electrophysiology procedures; to describe the administration (frequency, timing, dosage and outcomes) of analgesics and anxiolytics before, during and after the procedure.
Methods: A descriptive multicenter study was carried out. Pain and anxiety were measured with a 10-point visual analogue scale (VAS) before, during, after the procedure and for the following 24 hours. Patient were asked to rate their satisfaction for the information received and pain control.
Results: Data on 230 patients were collected. The most performed procedure was the transradial coronary catheterization (68.7%). The pacemaker/defibrillator implantation resulted the most painful procedure (median 4, IQR 3-6) and also the most anxious (median 5, IQR 2-6). 13 Patients received an analgesic during the procedure for a low-to-severe pain; during the following 24 hours 34 patients (5 undergoing transradial coronary catheterization and 29 the implant of pacemaker/cardiac-defibrillator) suffered from severe pain and with the exception of 5, all requested pain relief. Satisfaction for pain control was inadequate for patients who underwent electrophysiology procedures and 55 patients would have needed more information on pain.
Conclusions: Pain control and patient satisfaction may be improved, pre-procedural anxiety needs more attention and better information on the procedure should be provided. Key words: pain management, percutaneous coronary intervention, implantable cardioverter-defibrillator, pacemaker artificial.
Dettagli dell'articolo
Riferimenti
- Aktí¼rk, E., KurtoÄŸlu, E., ErmiÅŸ, N., Aí§Ä±kgí¶z, N., YaÄŸmur, J., AltuntaÅŸ, M. S., ... Ozdemir, R. (2014). Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study. Anadolu Kardiyoloji Dergisi: AKD = the Anatolian Journal of Cardiology, 14(2), 140–146. https://doi.org/10.5152/akd.2014.4607
- Angelini, S., Ricceri, F., & Dimonte, V. (2011). [Assessment of pain associated to common invasive procedures and nurse's opinion]. Assistenza infermieristica e ricerca: AIR, 30(4), 189–197. https://doi.org/10.1702/1007.10957
- Beddoes, L., Botti, M., & Duke, M. M. (2008). Patients' experiences of cardiology procedures using minimal conscious sedation. Heart & Lung: The Journal of Critical Care, 37(3), 196–204. https://doi.org/10.1016/j.hrtlng.2007.05.012
- Bode, K., Breithardt, O.-A., Kreuzhuber, M., Mende, M., Sommer, P., Richter, S., ... Bollmann, A. (2015). Patient discomfort following catheter ablation and rhythm device surgery. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 17(7), 1129–1135. https://doi.org/10.1093/europace/euu325
- Bunz, M., Lenski, D., Wedegärtner, S., Ukena, C., Karbach, J., Bí¶hm, M., & Kindermann, I. (2016). Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 105(3), 216–224. https://doi.org/10.1007/s00392-015-0909-1
- Celikyurt, U., Agacdiken, A., Bozyel, S., Argan, O., Sade, I., Vural, A., & Ural, D. (2013). Assessment of shoulder pain and shoulder disability in patients with implantable cardioverter-defibrillator. Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing, 36(1), 91–94. https://doi.org/10.1007/s10840-012-9753-7
- Czarnecki, M. L., Turner, H. N., Collins, P. M., Doellman, D., Wrona, S., & Reynolds, J. (2011). Procedural pain management: a position statement with clinical practice recommendations. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, 12(2), 95–111. https://doi.org/10.1016/j.pmn.2011.02.003
- Delewi, R., Vlastra, W., Rohling, W. J., Wagenaar, T. C., Zwemstra, M., Meesterman, M. G., ... Henriques, J. P. S. (2017). Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. International Journal of Cardiology, 228, 926–930. https://doi.org/10.1016/j.ijcard.2016.11.043
- Ferrell, B. R., McGuire, D. B., & Donovan, M. I. (1993). Knowledge and beliefs regarding pain in a sample of nursing faculty. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 9(2), 79–88.
- Foji, S., Tadayonfar, M. A., Mohsenpour, M., & Rakhshani, M. H. (2015). The study of the effect of guided imagery on pain, anxiety and some other hemodynamic factors in patients undergoing coronary angiography. Complementary Therapies in Clinical Practice, 21(2), 119–123. https://doi.org/10.1016/j.ctcp.2015.02.001
- Gallagher, R., Trotter, R., & Donoghue, J. (2010). Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 9(1), 38–44. https://doi.org/10.1016/j.ejcnurse.2009.09.001
- Hess, C. N., Krucoff, M. W., Sheng, S., Anstrom, K. J., Barham, W. B., Gilchrist, I. C., ... Rao, S. V. (2015). Comparison of quality-of-life measures after radial versus femoral artery access for cardiac catheterization in women: Results of the Study of Access Site for Enhancement of Percutaneous Coronary Intervention for Women quality-of-life substudy. American Heart Journal, 170(2), 371–379. https://doi.org/10.1016/j.ahj.2015.04.024
- Looi, K.-L., Lee, A. S. Y., Cole, K., Agarwal, S., Heck, P. M., Begley, D. A., ... Fynn, S. P. (2013). Conscious sedation and analgesia use in cardiac device implantation. International Journal of Cardiology, 168(1), 561–563. https://doi.org/10.1016/j.ijcard.2013.01.167
- Miller, J. L., Thylén, I., & Moser, D. K. (2016). Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients. Pacing and Clinical Electrophysiology: PACE, 39(2), 149–159. https://doi.org/10.1111/pace.12786
- Rutka, J. K., Bryniarski, K., Tokarek, T., DÄ™bski, G., Krawczyk, A., Å»abówka, A., ... Dudek, D. (2016). Comparison of patient comfort after coronary angiography by standard arterial access approaches. Kardiologia Polska, 74(1), 68–74. https://doi.org/10.5603/KP.a2015.0118
- Trotter, R., Gallagher, R., & Donoghue, J. (2011). Anxiety in patients undergoing percutaneous coronary interventions. Heart & Lung: The Journal of Critical Care, 40(3), 185–192. https://doi.org/10.1016/j.hrtlng.2010.05.054
Riferimenti
Aktí¼rk, E., KurtoÄŸlu, E., ErmiÅŸ, N., Aí§Ä±kgí¶z, N., YaÄŸmur, J., AltuntaÅŸ, M. S., ... Ozdemir, R. (2014). Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study. Anadolu Kardiyoloji Dergisi: AKD = the Anatolian Journal of Cardiology, 14(2), 140–146. https://doi.org/10.5152/akd.2014.4607
Angelini, S., Ricceri, F., & Dimonte, V. (2011). [Assessment of pain associated to common invasive procedures and nurse's opinion]. Assistenza infermieristica e ricerca: AIR, 30(4), 189–197. https://doi.org/10.1702/1007.10957
Beddoes, L., Botti, M., & Duke, M. M. (2008). Patients' experiences of cardiology procedures using minimal conscious sedation. Heart & Lung: The Journal of Critical Care, 37(3), 196–204. https://doi.org/10.1016/j.hrtlng.2007.05.012
Bode, K., Breithardt, O.-A., Kreuzhuber, M., Mende, M., Sommer, P., Richter, S., ... Bollmann, A. (2015). Patient discomfort following catheter ablation and rhythm device surgery. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 17(7), 1129–1135. https://doi.org/10.1093/europace/euu325
Bunz, M., Lenski, D., Wedegärtner, S., Ukena, C., Karbach, J., Bí¶hm, M., & Kindermann, I. (2016). Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 105(3), 216–224. https://doi.org/10.1007/s00392-015-0909-1
Celikyurt, U., Agacdiken, A., Bozyel, S., Argan, O., Sade, I., Vural, A., & Ural, D. (2013). Assessment of shoulder pain and shoulder disability in patients with implantable cardioverter-defibrillator. Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing, 36(1), 91–94. https://doi.org/10.1007/s10840-012-9753-7
Czarnecki, M. L., Turner, H. N., Collins, P. M., Doellman, D., Wrona, S., & Reynolds, J. (2011). Procedural pain management: a position statement with clinical practice recommendations. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, 12(2), 95–111. https://doi.org/10.1016/j.pmn.2011.02.003
Delewi, R., Vlastra, W., Rohling, W. J., Wagenaar, T. C., Zwemstra, M., Meesterman, M. G., ... Henriques, J. P. S. (2017). Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. International Journal of Cardiology, 228, 926–930. https://doi.org/10.1016/j.ijcard.2016.11.043
Ferrell, B. R., McGuire, D. B., & Donovan, M. I. (1993). Knowledge and beliefs regarding pain in a sample of nursing faculty. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 9(2), 79–88.
Foji, S., Tadayonfar, M. A., Mohsenpour, M., & Rakhshani, M. H. (2015). The study of the effect of guided imagery on pain, anxiety and some other hemodynamic factors in patients undergoing coronary angiography. Complementary Therapies in Clinical Practice, 21(2), 119–123. https://doi.org/10.1016/j.ctcp.2015.02.001
Gallagher, R., Trotter, R., & Donoghue, J. (2010). Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 9(1), 38–44. https://doi.org/10.1016/j.ejcnurse.2009.09.001
Hess, C. N., Krucoff, M. W., Sheng, S., Anstrom, K. J., Barham, W. B., Gilchrist, I. C., ... Rao, S. V. (2015). Comparison of quality-of-life measures after radial versus femoral artery access for cardiac catheterization in women: Results of the Study of Access Site for Enhancement of Percutaneous Coronary Intervention for Women quality-of-life substudy. American Heart Journal, 170(2), 371–379. https://doi.org/10.1016/j.ahj.2015.04.024
Looi, K.-L., Lee, A. S. Y., Cole, K., Agarwal, S., Heck, P. M., Begley, D. A., ... Fynn, S. P. (2013). Conscious sedation and analgesia use in cardiac device implantation. International Journal of Cardiology, 168(1), 561–563. https://doi.org/10.1016/j.ijcard.2013.01.167
Miller, J. L., Thylén, I., & Moser, D. K. (2016). Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients. Pacing and Clinical Electrophysiology: PACE, 39(2), 149–159. https://doi.org/10.1111/pace.12786
Rutka, J. K., Bryniarski, K., Tokarek, T., DÄ™bski, G., Krawczyk, A., Å»abówka, A., ... Dudek, D. (2016). Comparison of patient comfort after coronary angiography by standard arterial access approaches. Kardiologia Polska, 74(1), 68–74. https://doi.org/10.5603/KP.a2015.0118
Trotter, R., Gallagher, R., & Donoghue, J. (2011). Anxiety in patients undergoing percutaneous coronary interventions. Heart & Lung: The Journal of Critical Care, 40(3), 185–192. https://doi.org/10.1016/j.hrtlng.2010.05.054