Understanding the patient experience of pain and discomfort during cardiac catheterization

Mall, Anna; Girton, Thomas A; Yardley, Kevin; Rossman, Paige; Ohman, E. Magnus; Jones, W. Schuyler; Granger, Bradi B.

doi:10.1002/ccd.28403

Cited by 6 publications

(12 citation statements)

References 14 publications

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“…Sedation is desirable during catheter-based cardiac procedures to produce analgesia and to improve overall patient comfort [ 26 ]. Despite the prevalence of coronary angiography, there is a paucity of data regarding optimal sedation techniques for this procedure.…”

Section: Discussionmentioning

confidence: 99%

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

Black

Baljepally

Shali

et al. 2021

Journal of Interventional Cardiology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Black

Baljepally

Shali

et al. 2021

Journal of Interventional Cardiology

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“…Both time intervals were within standard medication administration times as previously described. 1 Subsequent doses of procedural sedation were administered as needed at the discretion of the proceduralist.…”

Section: Methodsmentioning

confidence: 99%

“…During CC, this discomfort has yet to be adequately characterized, has relied on provider observation rather than self-report, and is likely underreported. 1 The use of procedural sedation is commonly used in the United States during CC to ensure procedural success, enhance patient comfort, and to alleviate anxiety during the procedure. [2][3][4][5] For angiography, average doses range from 0.5 to 6 mg midazolam, 0 to 125 mcg of fentanyl, 5 to 10 mg diazepam, and verying doses and comibination of diphenhydramine and morphine.…”

Section: Introductionmentioning

confidence: 99%

“…Rather, these markers are consistently decreased. 1 Conversely, -observed assessments of pain, such as grimacing and behavioral pain responses, are taken to suggest that procedural sedation was not optimally achieved. Conventional measures of sedation are therefore poorly calibrated with patientreported outcomes in the procedural area as they do not adequately account for decreased consciousness after procedural sedation.…”

Section: Introductionmentioning

confidence: 99%

“…A strategy of "sedate then wait" to obtain vascular access may allow for intraprocedural sedation to take effect, decreasing anxiety and pain before subcutaneous lidocaine administration. 1 The aim of this study was therefore to determine the extent to which experimental manipulation of the time interval between sedation administration and local anesthetic influences patient pain, discomfort, and satisfaction. The primary hypothesis was that a longer time interval between procedural sedation administration and local anesthetic would be associated with less total procedural sedation and fewer doses of sedation, with no difference in patient reported pain and satisfaction and nurse observed pain.…”

Section: Introductionmentioning

confidence: 99%

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Timing of sedation and patient‐reported pain outcomes during cardiac catheterization: Results from the UNTAP‐intervention study

Mall

Girton

Yardley

et al. 2023

Cathet Cardio Intervent

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Background Invasive cardiac catheterization (CC) temporarily increases pain, discomfort, and anxiety. Procedural sedation is deployed to mitigate these symptoms, though practice varies. Research evaluating peri‐procedural patient‐reported outcomes is lacking. Methods and Results We randomized 175 patients undergoing CC to short interval ([SI] group, <6 min) or long interval ([LI] group, ≥6 min) time intervals between initial intravenous sedation and local anesthetic administration. Outcomes included: (1) total pain medication use, (2) patient‐reported and behaviorally assessed pain and (3) patient satisfaction during outpatient CC. Generalized linear mixed effect models were used to evaluate the impact of treatment time interval on total medication utilization, pain, and satisfaction. Among enrollees the mean age was 62 (standard deviation [SD] = 13.4), a majority were male (66%), white (74%), and overweight (mean body mass index = 28.5 [SD = 5.6]). Total pain medication use did not vary between treatment groups (p = 0.257), with no difference in total fentanyl (p = 0.288) or midazolam (p = 0.292). Post‐treatment pain levels and nurse‐observed pain were not statistically significant between groups (p = 0.324 & p = 0.656, respectively. No significant differences with satisfaction with sedation were found between the groups (p = 0.95) Patient‐reported pain, satisfaction and nurse‐observed measures of pain did not differ, after adjustment for demographic and procedural factors. Analyses of treatment effect modification revealed that postprocedure self‐reported pain levels varied systematically between individuals undergoing percutaneous coronary intervention (PCI) (SI = 2.2 [0.8, 3.6] vs. LI = 0.7 [−0.6, 2.0]) compared with participants not undergoing PCI (SI = 0.4 [−0.8, 1.7] vs. LI = 0.7 [−0.3, 1.6]) (p = 0.043 for interaction). Conclusion No consistent treatment differences were found for total medication dose, pain, or satisfaction regardless of timing between sedation and local anesthetic. Treatment moderations were seen for patients undergoing PCI. Further investigation of how procedural and individual factors impact the patient experience during CC is needed.

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Preparation for cardiac procedures: a cross-sectional study identifying gaps between outpatients’ views and experiences of patient-centred care

Fakes

Williams

Collins

et al. 2023

European Heart Journal - Quality of Care and Clinical Outcomes

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Background To examine and identify gaps in care perceived as essential by patients; this study examined outpatients’: 1) views on what characterises essential care and 2) experiences of care received, in relation to cardiac catheterisation and subsequent cardiovascular procedures. Methods Cross-sectional descriptive study. Surveys were posted to outpatients who had undergone elective cardiac catheterisation in the prior six months at an Australian hospital. Participants completed a 65-item survey to determine: a) aspects of care they perceive as essential to patients receiving care for a cardiac condition (Important Care Survey); or b) their actual care received (Actual Care Survey). Numbers and percentages were used to calculate the most frequently identified essential care items; and the experiences of care received. Items rated as either ‘Essential’/‘Very important’ by at least 80% of participants were determined. A gap in patient-centred care was identified as being any item that was endorsed as essential/very important by 80% or more of participants but reported as received by less than 80% of participants. Results Of 582 eligible patients, 264 (45%) returned a completed survey. 43/65 items were endorsed by > 80% of participants as essential. Of those, for 22 items, <80% reported the care as received. Gaps were identified in relation to GP consultation (1 item), preparation (1 item) subsequent decision making for treatment (1 item), prognosis (6 items) and post-treatment follow-up (1 item). Conclusions Areas were identified where actual care fell short of patients’ perceptions of essential care.

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Understanding the patient experience of pain and discomfort during cardiac catheterization

Cited by 6 publications

References 14 publications

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

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

Timing of sedation and patient‐reported pain outcomes during cardiac catheterization: Results from the UNTAP‐intervention study

Preparation for cardiac procedures: a cross-sectional study identifying gaps between outpatients’ views and experiences of patient-centred care

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