Aim: To evaluate the effectiveness of the application of topical heat, high pressure or a combination of both on antebrachial venous cannulation.
Design: A cross-over clinical trial blinded for haemolysis analysis.
Methods: This cross-over clinical trial with two periods was performed in the Clinical Trial Unit of Hospital Universitario de La Princesa (Madrid) during June-July of 2017 in 59 healthy adults who were randomly allocated to one of three interventions: (1) Using dry topical heat for 7 min produced by two hot seed bags (N = 21), (2) Applying controlled pressure from a sphygmomanometer inflated to 100 mmHg (N = 18) and (3) combining heat and pressure (N = 20) in one period out of two. All interventions were contrasted to standard clinical practice in the other period. The comparator involved a standard tourniquet around the upper arm to restrict venous blood flow. The primary outcome was effectiveness measured as vein cannulation at first attempt. Secondary outcomes were vein perception, pain, haemolysis in blood samples and adverse events.
Results: All the interventions were more effective than comparator. Vein perception was optimized in about all individuals. Moreover, pain relief was significantly higher when high pressure was applied. Haemolysis was not affected in any of the three interventions. In addition, no serious adverse events appeared.
Conclusion: High pressure is determined to be the most effective in vein catheterization, pain relief, vein perception and quality of blood sample inalterability. Moreover, it is safe considering that only one adverse event appeared.
Impact: Vein cannulation is a very common invasive technique, where repeated failures have been registered. Thus, we consider it relevant to develop interventions to achieve venous catheterization at first attempt to alleviate the pain and anxiety associated with this technique. We advocate using high pressure intervention for emergency, due to swiftest method and feasible in case of lacking resources, such as sphygmomanometers in the ambulance. Interventions can be extrapolated to healthy young adults, adults and patients who have healthy vein status perception. Pressure intervention could be an alternative to heat intervention when performing vein cannulation due to its lower risk of transient paresthesia for older people who often suffer from arterial hypertension.
目的: 评估局部热敷、高压或两者联合应用于前臂静脉置管的效果。 设计: 一项溶血分析盲法交叉临床试验。 方法: 2017年6月至7月, 在公主校立医院(马德里) 的临床试验中心, 对59名健康成人进行了两个周期的交叉临床试验, 他们被随机分配到三种干预措施之一: (1) 使用两个热种子包(N=21) 产生的7分钟局部干燥发热, (2)用血压计加压至100毫米汞柱(N=18) 以及(3) 在两个周期中的一个周期内结合热压 (N=20) 。所有干预措施均与其他时期的标准临床实践进行对比。比较仪包括在上臂周围使用标准止血带来限制静脉血液流动。主要结果是首次尝试静脉置管时的有效性。次要结果为静脉感觉、疼痛、血液样本溶血和不良事件。 结果: 与比较仪相比, 所有干预措施均有效。所有个体的静脉知觉均得到了优化。此外, 当施加高压时, 疼痛缓解明显更高。溶血在三种干预措施中未受影响。此外, 未出现严重的不良事件。 结论: 高压被认为是最有效的静脉置管, 疼痛缓解, 静脉知觉和血液样本质量不变。此外, 考虑到只出现了一种不良反应, 则认为该方法是安全的。 影响: 静脉置管是一种非常常见的侵入性技术, 屡屡失败。因此, 我们认为有必要开发干预措施, 以在第一次尝试中实现静脉置管, 减轻与该技术相关的疼痛和焦虑。我们提倡在紧急情况下使用高压干预, 原因是这是在缺乏资源情况下的最快和可行的方法, 如救护车上的血压计。 健康的年轻人、有正常静脉状态的成人和患者也可通过干预措施推定。在进行静脉置管时, 压力干预可能是热干预的替代方法, 原因是对于经常患有动脉高血压的老年人来说, 压力干预具有较低的瞬态感觉异常风险。.
Keywords: dry heat; heating; nursing; pain; patient safety; peripheral venous catheterization; tourniquet; venipuncture.
© 2020 John Wiley & Sons Ltd.