How often do we perform painful and stressful procedures in the paediatric intensive care unit? A prospective observational study.
Adolescent
Analgesia
/ methods
Child
Child, Preschool
Critical Care
/ methods
Diagnostic Tests, Routine
/ adverse effects
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Pain Management
/ nursing
Pain Measurement
/ nursing
Prospective Studies
Respiration, Artificial
/ adverse effects
Analgesia
Children
Paediatric intensive care
Pain
Stress
Journal
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
09
12
2017
revised:
03
04
2018
accepted:
14
04
2018
pubmed:
22
5
2018
medline:
14
4
2020
entrez:
22
5
2018
Statut:
ppublish
Résumé
Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management. The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures. A prospective, single-centre observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10. In a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures. Mechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation.
Sections du résumé
BACKGROUND
Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management.
OBJECTIVE
The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures.
METHODS
A prospective, single-centre observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10.
RESULTS
In a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures.
CONCLUSIONS
Mechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation.
Identifiants
pubmed: 29779912
pii: S1036-7314(17)30500-3
doi: 10.1016/j.aucc.2018.04.003
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Pagination
4-10Informations de copyright
Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.