Pain and Satisfaction Perceptions of Ultrasound-Guided Versus Conventional Peripheral Intravenous Catheterization: A Randomized Controlled Trial.

BACKGROUND: While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA). AIMS: This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization. DESIGN: Randomized controlled clinical trial. METHODS: Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample. RESULTS: 120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction. CONCLUSION: US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure. CLINICAL IMPLICATIONS: US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.

Dolor local durante la administración de paracetamol endovenoso que tiene como excipiente ácido acético / Local pain during the administration of intravenous paracetamol with acetic acid as excipient

Objetivo: evaluar la presencia de dolor local durante la administración endovenosa de paracetamol con ácido acético respecto a la administración de paracetamol sin ácido acético en los pacientes intervenidos en el bloque quirúrgico.Métodos: se realizó un ensayo clínico controlado aleatorizado doble ciego de dos grupos. Se incluyeron los pacientes mayores de edad intervenidos en el bloque quirúrgico de la Fundació Salut Empordà (Girona, España) durante los meses de agosto a noviembre de 2020, que precisaron administración de paracetamol endovenoso. Se requerían 60 pacientes por grupo (paracetamol con acetato frente a paracetamol sin acetato). Se recogieron variables sociodemográficas, relativas al catéter venoso, tratamiento, presencia de dolor y momento, valoración del dolor según escala numérica verbal (0 sin dolor a 10 peor dolor imaginable). Análisis descriptivo y bivariado. Comparación de grupos según el protocolo asignado.Resultados: se incluyeron 60 pacientes en cada grupo. La media de edad fue de 56,6 años (DE=15,6), el 56,7% fue varón. Los grupos fueron homogéneos y comparables en el momento basal. Se identificó presencia de dolor en el 48,3% (n= 29) de los pacientes del grupo de infusión de paracetamol con ácido acético, mientras que en el grupo sin acetato no se dio ningún caso de dolor (p< 0,001).Conclusiones: se observaron diferencias estadísticamente significativas entre el grupo de pacientes intervenidos del bloque quirúrgico a los que se les administró paracetamol sin ácido acético, que no presentaron dolor, frente al grupo de paracetamol con ácido acético, con presencia de dolor casi en la mitad de los pacientes.(AU)

Objective: to evaluate the presence of local pain during the intravenous administration of paracetamol with acetic acid compared with the administration of paracetamol without acetic acid in patients undergoing a procedure in the surgical unit.Methods: a double-blind randomized controlled clinical trial was conducted on two groups. All patients of age who underwent a procedure in the surgical unit of the Fundació Salut Empordà (Girona, Spain) from August to November 2020 and who needed the administration of intravenous paracetamol were included in the study. Sixty (60) patients were required per group (paracetamol with acetate vs. paracetamol without acetate). Sociodemographic variables were collected, as well as those related to the venous catheter, treatment, presence and time of pain, pain assessment according to the verbal numerical scale (from 0=no pain to 10=the worst pain imaginable). Descriptive and bivariate analysis. Comparison between arms according to the assigned protocol.Results: sixty (60) patients were included in each arm. Their mean age was 56.6 years (SD =15.6), and 56.7% were male. Arms were homogeneous and comparable at baseline. The presence of pain was detected in 48.3% (n= 29) of patients in the group receiving infusion of paracetamol with acetic acid, while there were no cases of pain in the group without acetate (p< 0.001).Conclusions: statistically significant differences were observed between the group of patients undergoing procedures in the surgical unit who were administered paracetamol without acetic acid, who did not present pain, vs. the group receiving paracetamol with acetic acid, where pain was present in almost half of the patients.(AU)

Development, Diagnostic Sensitivity, and Prognostic Accuracy of the Adult-Difficult Venous Catheterization Scale for Emergency Departments.

INTRODUCTION: Difficulty in accessing peripheral veins in emergency departments increases patients' discomfort and impedes their diagnosis. The objective of this study was to develop and test the prognostic accuracy of an easily applied scale to measure difficult venous access to peripheral veins in emergency departments, called the Adult-Difficult Venous Catheterization scale. METHODS: This prospective observational study was conducted in adults from the hospital catchment area attending the emergency department. Using the Delphi technique, 5 experts reached a consensus regarding a 3-item scale scored from 0 to 5. Concurrent validity and predictive validity were analyzed using a numeric rating scale and the number of access attempts, respectively. Internal consistency and interobserver reliability for 3 independent observers were analyzed using Cronbach alpha and Cohen kappa, respectively. RESULTS: In 392 participants, the concurrent and predictive validity scores pointed to positive relationships with the numeric rating scale (r = 0.82; P < 0.001) and the number of access attempts (r = 0.5; P < 0.001), respectively. The odds ratio for 1 to 2 access attempts versus more than 2 access attempts in relation to the Adult-Difficult Venous Catheterization scale score was 2.76 (95% confidence interval 1.86, 4.08; P < 0.001). Sensitivity and specificity values for the Adult-Difficult Venous Catheterization scale were good, at 93.75% and 78.99%, respectively, as were internal consistency (Cronbach alpha 0.81) and interobserver reliability (Cohen kappa 0.75). DISCUSSION: The Adult-Difficult Venous Catheterization scale is a valid and reliable instrument for predicting difficult venous access in emergency departments.

Dispositional Optimism, Burnout and Their Relationship with Self-Reported Health Status among Nurses Working in Long-Term Healthcare Centers.

The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers (n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.

Evolution of Job Satisfaction and Burnout Levels of Emergency Department Professionals during a Period of Economic Recession.

Satisfaction at work has been found to be a predictive factor of permanency. On the other hand, burnout has been associated with financial loss. The purpose of this study was to analyse the levels of satisfaction and burnout of professionals in a hospital emergency department and make a comparison with results from the same service during the economic recession in 2012. An analytical, cross-sectional and descriptive study was undertaken during two time periods into the levels of satisfaction and burnout of the professionals of an emergency department. Consequently, 146 replies were received. The percentage of professionals who considered their salary to be unsatisfactory in 2012 diminished in comparison with 2018 (p = 0.034), while job stability was considered more satisfactory in 2018 (p = 0.039) and the timetable in 2018 as more unsatisfactory (p = 0.009). With regards to burnout, it was observed that in 2018 the score for depersonalisation had fallen (p = 0.029) in comparison with 2012. An improvement in the level of satisfaction is observed in 2018, and more positive scores have also been found in the depersonalisation subscale in 2018. An inverse association was observed between depersonalisation in 2018 and overall satisfaction.

Factores asociados a la satisfacción de los profesionales de un servicio de urgencias hospitalario / Factors associated with professional satisfaction in a hospital emergency department

INTRODUCCIÓN: La satisfacción en el trabajo se relaciona con el rendimiento laboral y la calidad de la asistencia sanitaria. El objetivo fue identificar los factores asociados a la satisfacción de los profesionales de un servicio de urgencias de un hospital comarcal según las características personales y laborales de los mismos. MÉTODOS: Estudio descriptivo transversal. Se estudió a los profesionales del servicio de urgencias mediante encuestas, de octubre a diciembre de 2012. Se incluyeron todos los profesionales que trabajaron en el servicio y se excluyeron los que estuvieron de baja laboral. Se utilizaron las pruebas estadísticas adecuadas a las variables estudiadas. RESULTADOS: Respondieron 81 (71,0%) profesionales, con una media de edad de 35,9 años (DE=9,4). La puntuación media del nivel de satisfacción laboral fue 6,7 (DE=1,5). Los profesionales con menor agotamiento emocional [B=-0,055; IC 95% (-0,09 a -0,02); p = 0,005] y mayor realización personal fueron los más satisfechos [B=0,053; IC 95% (0,005-0,10); p = 0,031]. Una mayor edad se relacionó con el agotamiento emocional (ρ=0,372; p = 0,007), y los profesionales con contrato laboral permanente obtuvieron puntuaciones superiores a los eventuales en agotamiento emocional (p = 0,044). Se observó que a menor optimismo percibido, mayor puntuación en agotamiento emocional (ρ=-0,266; p = 0,020), y a mayor percepción de optimismo, mayor realización personal (ρ=0,518; p < 0,001). CONCLUSIONES: Los factores asociados a una mayor percepción de satisfacción laboral fueron un menor agotamiento emocional y una mayor realización personal. La edad se asoció a mayor agotamiento emocional; de igual modo el contrato laboral permanente. El optimismo se asoció de forma positiva a la realización personal y, de forma negativa, al agotamiento emocional

INTRODUCTION: Job satisfaction is related to job performance and the quality of healthcare. The aim of this study was to identify associated factors in professional's satisfaction in an Emergency Department with sociodemographic factors and working factors. METHOD: Cross-sectional study. Professionals of the emergency service were studied through surveys during the months of October to December 2012. All professionals who worked in the service were included, and those who were off work were excluded. The statistical tests used were adapted to the variables studied. RESULTS: 81 professionals answered the questionnaire (71.0%). Average age of professionals was 35.9 years (SD=9.4). The mean punctuation of job satisfaction level was 6.7 (SD=1.5). Professionals with les emotional exhaustion [B=-0.055; IC 95% (-0.09 a -0.02); p = 0.005] and greater personal accomplishment were the most satisfied [B=0.053; IC 95% (0.005-0.10); p = 0.031]. Older age was related to emotional exhaustion (ρ=0.372; p = 0.007), and professionals with a permanent work turned out greater punctuations than eventual workers in emotional exhaustion (p = 0.044). It was observed that at lower optimism perception, greater punctuation in emotional exhaustion (ρ=-0.266; p = 0.020), and that at better optimism perception, greater personal accomplishment (ρ=0.518; p < 0.001). CONCLUSIONS: Factors related to a better perception of working satisfaction were less emotional exhaustion and greater personal accomplishment. Furthermore, age was associated to more emotional exhaustion, as it was permanent work. Optimism was positively associated to personal accomplishment and, negatively, to emotional exhaustion

Factors associated with patients' and companions' satisfaction with a hospital emergency department: A descriptive, cross-sectional study.

AIM: The aim was to study the level of satisfaction with an emergency department and to identify the factors associated with satisfaction. DESIGN: This research consisted of a descriptive, cross-sectional study. METHODS: The study population was composed of patients and companions who visited the emergency department during a three-month period. The patients were selected randomly from the register of visits to the emergency department during the period of study. Sociodemographic variables and variables related to the attention received were studied through questionnaires (response rate 33%). RESULTS: Older age was associated with greater satisfaction (p = 0.002), as was female sex (p = 0.013) and greater optimism (p < 0.001). Greater control of pain was a factor associated with satisfaction (p = 0.033), as was the perception of a shorter waiting time before the medical visit (p < 0.001).

La importancia del triaje en los servicios de urgencias / Importance of triage in hospital emergency departments

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Impacto de la presencia de los padresen el miedo de niños sometidosa técnicas de Enfermería / The impact of the parent’s presence on the fears of children subjected to nursing techniques

Objetivo: determinar el impacto de la presencia de los padres durante larealización de técnicas de Enfermería a su hijo, sobre el nivel de miedodel menor; estudiar la variabilidad de dicho miedo en diferentes edadesinfantiles y entre la presencia de los padres y el número de intentos necesariospara realizar la técnica.Material y método: estudio observacional analítico de cohorte prospectivoen el servicio de urgencias del Hospital de Figueres (Girona), sobreniños/as de un mes a 12 años a los que se practicaban técnicas de Enfermería,30 expuestos a la presencia de los padres y 27 no. El nivel demiedo manifestado durante la técnica se midió a través del resultadoNOC Nivel de miedo 1210. Otras variables de estudio: edad, sexo, tipode técnica realizada, intentos necesarios para realizar la técnica y motivode consulta. Se utilizaron pruebas no paramétricas de contraste dehipótesis (test de U de Mann-Whitney test de Wilcoxon).Resultados: los niños de 0-6 años experimentaron miedo frente a lastécnicas de Enfermería. La presencia de los padres no redujo de maneraestadísticamente significativa el miedo ante las técnicas. Tampocoexistía relación entre la presencia de los padres y el número de intentosnecesarios por parte del profesional enfermero para realizar la técnica.Conclusiones: los niños de 0-6 años experimentan miedo durante losprocedimientos enfermeros, no siendo así en los de 6-12 años. No se demuestrarelación entre la presencia de los padres y el miedo a que experimentanlos niños ante técnicas de Enfermería. Tampoco se evidenciaasocación entre el número de intentos necesarios para realizar latécnica y la presencia de los progenitores, hecho que puede ayudar a reducirel estrés del equipo de Enfermería, favoreciendo el vínculo padres-hijos y la relación de éstos con el profesional de la salud (AU)

Objective: to assess the impact of the parent’s presence on their childrenwhile they undergo nursing techniques, to determine the level of fear ofthe minor, to assess the variability of this fear at different child ages andbetween the presence of the parents and the number of attempts tocomplete the technique.Materials and methods: analytical prospective observational cohortstudy at the emergency service of the Figueres hospital (Girona), on boysand girls aged 1 month to 12 years who underwent nursing techniques. 30were exposed to the parent’s presence and 27 were not. The level of fearmanifested during the technique was measured through the 2010 NOCLevel of Fear. Other study variables included: age, gender, type of techniqueperformed on the child, attempts needed to perform the techniqueand motive for consultation (Mann-Whitney t test and Wilcoxon test).Results: children aged 0-6 years experienced fear when subjected tonursing techniques. The presence of the parents did not significantly reducefear to the techniques. No relationship was found either betweenthe presence of the parents and the amount of attempts needed to performthe technique by the nursing professional.Conclusions: children aged 0-6 years experienced fear to nursing procedures,that not being the case for children aged 6-12 years. No relationshipis found between the presence of the parents and the fear experiencedby children to nursing techniques. There is also no evidenceon the association between the number of attempts needed to completethe technique and the presence of the parents, a fact that might help reducethe stress of the nursing team thus favouring the link betweenparent-child and their relationship with the healthcare professional (AU)