Correspondence

Pain scores for venipuncture among ED patients

Pain increases the patient's anxiety levels and prolongs examination and other medical processes. This study was conducted as a single-blind, randomized controlled study to determine the effects of acupressure applied on adult patients and whether it changed their vital signs, acute pain, stress and satisfaction during venipuncture.

Patients who had a BMI of 18.5–30 kg/m², presence of an internal disease, were attending a routine clinic check-up, had requested to have a blood sample, were examined by a physician, had no sign of pain, hematoma, necrosis, scar, incision or infection on the skin around the venipuncture site and had taken no analgesic drug for the last six hours were included in the trial. Patients were randomly allocated to either an acupressure group (n=100) or a no-intervention control group (n=100). Acupressure (LI 4, LI 11 and HT 7 points) was applied once by a certified researcher for 10 min prior to venipuncture. Pain, satisfaction, stress, heart rate and oxygen saturation levels of the patients in the acupressure and control groups were assessed 15 min before and immediately after the venipuncture procedure. The Visual Analog Scale for the Measurement of Pain Severity, the Visual Analog Patient Satisfaction Scale and the State-Trait Anxiety Inventory were used to collect the data.

The acupressure group had a significantly lower mean pain score than the control group (respectively, 1.23±1.09 and 1.95±1.95, p<0.05). The acupressure group had a significantly higher mean satisfaction score than the control group (respectively, 9.13±1.31 and 8.51±1.86, p<0.05). The acupressure group had a significantly lower mean stress score than the control group (respectively, 34.66±7.99 and 41.91±9.21, p<0.05).

Acupressure reduced acute pain and stress and increased satisfaction levels in adult patients undergoing venipuncture.

Analizar el dolor asociado a la inserción de catéteres venosos y extracción de sangre arterial en pacientes adultos que acuden a urgencias, y explorar posibles factores relacionados con su intensidad.

Estudio observacional multicéntrico. Se incluyeron consecutivamente pacientes que requerían un catéter venoso periférico y/o una extracción de sangre arterial para gasometría. Se preguntó por el dolor experimentado después de cada técnica, empleando la escala NRS-11.

Se evaluaron 780 canalizaciones venosas y 101 gasometrías. Las venopunciones obtuvieron una puntuación media de 2,8 (IC 95%: 2,6-3) y las gasometrías de 3,6 (IC 95%: 3,1-4). El nivel de dolor iatrogénico se asoció a la dificultad técnica media o alta del procedimiento (p < 0,001), a la elección de la arteria humeral en lugar de la radial (p = 0,02) en las gasometrías y se correlacionó con el dolor basal en las venopunciones (p < 0,001). El nivel de dolor en función de otras variables como el sexo, la procedencia o el calibre de la aguja no presentó diferencias estadísticamente significativas.

El dolor derivado de la cateterización venosa y la punción arterial para gasometría es leve-moderado y moderado, respectivamente, y su intensidad se asocia a variables como la dificultad del procedimiento, el lugar de punción o el dolor basal.

Un mayor conocimiento de los efectos dolorosos derivados de cada procedimiento de enfermería durante la asistencia en urgencias y de los factores que se asocian a la autopercepción del mismo podría ayudar a determinar cuándo y cómo debería intervenirse para mitigar este efecto indeseado.

To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors.

An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11.

780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P < .001); with the choice of the humeral rather than the radial artery (P = .02) in the gas test and correlated to baseline pain in venipunctures (P < .001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences.

Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain.

A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect.