Discomfort Reported by Patients After Cardiac Catheterization Using the Femoral or Radial Approaches

Effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography

BACKGROUND

Reflexology is a popular non-invasive complementary medicine technique to enhance anxiety, pain, and fatigue among patients undergoing coronary angiography.

OBJECTIVE

This study aimed to investigate the effect of hand reflexology in ameliorating anxiety, pain, and fatigue among patients undergoing coronary angiography.

METHODS

A quasi-experimental research design was used on 60 patients undergoing coronary angiography at Alexandria Main University Hospital's cardiology department (30 patients in each study and control group). Four tools were used to collect data: the socio-demographic and clinical data assessment sheet, the visual analogue scale, the Rhoten fatigue scale, and the Beck anxiety inventory.

RESULTS

Scores of moderate anxiety, intractable pain, and severe fatigue among the study group significantly decreased after 2 h and three days of applying hand reflexology.

CONCLUSION

The current study findings showed that hand reflexology is a simple, non-invasive nursing intervention that is effective and useful for managing pain, fatigue, and anxiety in patients undergoing coronary angiography as it resulted in a significant reduction in the severity of pain, fatigue, and anxiety after coronary angiography in the study group compared to the control group.

TRIAL REGISTRATION

The study was registered in the clinical trial.gov database (Clinicaltrials.gov NCT05887362 , 23/05/2023).

Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization

Objective

We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl.

Background

Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy.

Methods

A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable).

Results

Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p=0.95).

Conclusions

Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl's unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.

Age and pain as predictors of discomfort in patients undergoing transfemoral percutaneous coronary interventions

BACKGROUND

Transfemoral percutaneous coronary intervention (PCI) requires strict bed rest, causing pain and discomfort in patients. However, no studies have investigated this issue.

OBJECTIVES

To investigate the predictors of discomfort in transfemoral PCI patients.

METHODS

A cross-sectional sample of 110 patients from two coronary care units completed questionnaires on demographic and clinical characteristics, visual analogue pain scale, and discomfort.

RESULTS

Eight factors predicted overall discomfort: physiologic pain, physiological discomfort, psychological discomfort, analgesic use after sheath removal, hemostasis method, and bed rest duration. Psychological discomfort was associated with age, chronic obstructive pulmonary disease, analgesic use after sheath removal, successful hemostasis, and hematoma >5 cm. A hierarchical regression model explained 70.5% of the variance in overall discomfort.

CONCLUSIONS

Age and physiologic pain are major predictors of overall discomfort, especially in patients aged <60 years having high pain sensitivity. Critical care providers should note patients' physiological and psychological issues throughout the PCI process.

Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory

Abstract OBJECTIVE To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. METHOD Cross-sectional study with retrospective data collection. RESULTS Overall, 345 patients were included; 116 (34%) experienced post-procedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. CONCLUSION The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions.

Elaboração e validação de um manual informativo sobre cateterismo cardíaco

Resumo Objetivo Elaborar e validar um manual informativo sobre o cateterismo cardíaco. Métodos Trata-se de um estudo metodológico. O manual foi elaborado de acordo com a experiência dos pesquisadores e em dados da literatura. Foi submetido à validação por oito enfermeiros, utilizando a Técnica de Delphi e para ser considerado válido deveria alcançar 100% de concordância. Posteriormente foi avaliado por 35 pacientes e deveria alcançar uma média de pontuação igual ou superior a 4. Resultados O manual contém os tópicos: definição, local e tempo de realização, como ele é realizado e os cuidados antes, durante e após o procedimento. Foram necessárias quatro rodadas para validar o manual com os enfermeiros. Na segunda etapa observou-se que todas as questões sobre o manual tiveram médias altas (4,83 a 4,91, p<0,001), tornando o manual válido pelos pacientes. Conclusão O manual foi elaborado e considerado válido pelos enfermeiros e pacientes e, poderá ser utilizado por diversas instituições.

Nursing Interventions and Outcomes for the Diagnosis of Impaired Tissue Integrity in Patients After Cardiac Catheterization: Survey

PURPOSE

Determine the outcomes and interventions for patients undergoing cardiac catheterization with nursing diagnosis of impaired tissue integrity.

METHODS

Survey with e-questionnaires sent for expert nurses in two rounds.

FINDINGS

Only one nursing outcome was approved: tissue integrity-skin and mucosa and five related interventions, namely, pressure control, topical drug administration, care of incision site, care of injuries, and infection control.

CONCLUSIONS

The expected outcomes and the most significant interventions for the implementation of nursing care during the immediate recovery of patients with impaired tissue integrity following invasive hemodynamic procedures were defined.

IMPLICATIONS FOR NURSING PRACTICE

The study findings support selection of appropriate nursing outcomes and interventions for this patient profile.