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Pain is often inflicted in patients attending the Accident and Emergency Department (A&E) as they require undergoing common medical procedures including venipuncture and intravenous cannulation. These procedures greatly affect patients due to pain and discomfort they induce. Thus, adequate pain management for procedural pain is an important clinical goal which is often neglected in the busy A&E environment.
To define pain, it is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Phlebotomy, also known as venipuncture refers to the puncture of a peripheral vein for blood taking and often involves the insertion of peripheral intravenous access to provide patients with intravenous therapy or medication.
When patients attend the A&E, pain is often their primary complaint which results in over 40% of the 100 million or more emergency visits each year. Once in the emergency department, patients often need to undergo invasive procedures such as venipuncture for obtaining blood and establishing an intravenous access for treatment. This has demonstrated to cause significant pain as perceived by adult patients and is among the top three of the most common painful procedures in adults in the emergency setting. However, no anesthesia was used for blood taking while only 1.6% for intravenous procedure received anesthesia. Yet, it is recommended to provide analgesia care not only for the adults’ complaints presenting to the emergency department but also for the workup and procedures performed in the A&E.
Since the pain level is so significant in adults while performing these necessary procedures, it is necessary to deal with the inadequately treated pain. Currently, there are no measures taken to alleviate the pain caused by phlebotomy apart from verbal reassurance. This is why it is important to introduce effective pain control measures for procedural pain in the emergency setting. Vapocoolant spray is one such intervention which should be promoted since it is cost-effective, easy to use and is efficient to apply on patients attending the A&E requiring phlebotomy. As phlebotomy refers to a vascular access procedure, emphasis will be placed on both venipuncture and intravenous cannulation in this dissertation.
The lack of pain management for procedural pain negatively affects adult patients physiologically and psychologically. Physiologically, patients may develop light-headedness, dizziness, sweating and even nausea. This may develop into vasovagal attack evidenced by low blood pressure and decreased heart rate, resulting in fainting. Psychologically, phlebotomy can cause adults to develop fear and anxiety, even before the procedure starts. Usually, the source of this anxiety is from the anticipated pain caused by venipuncture or establishing an intravenous access.
There have been several episodes of adults undergoing phlebotomy, who either feel pain from the procedure or have fear of needles, and consequently develop vasovagal syncope. Not only is this unpleasant for patients, but may also result in anxiety about medical treatments and have an adverse effect on them, solely due to the lack of effective pain management causing a gap from achieving optimal patient care.
Moreover, there are many adults who cannot tolerate the pain and tend to move the limbs as the nurses start to perform venipuncture or intravenous access. This ends up in numerous attempts which prolong the procedural time and the length of stay in A&E, possibly causing a delay in treatment as well. If the patients are not cooperative, usually more manpower will assist in immobilizing the patients’ limbs to ensure minimal movement during the procedure and increase the chance of successful attempt. However, it is undeniable that when patients feel pain, they get agitated and move vigorously, which results in the healthcare professionals at a higher chance of having needle stick injury.
Despite pain management being an optimal standard of healthcare, there is lack of integration into usual practice especially for procedural pain in the local emergency setting. The Joint Commission is one of many organizations which has emphasized the need to establish policies or procedures for pain assessment and management in hospitals, as it can improve quality of patient care. By incorporating this into the target setting related to procedural pain, not only will it improve patient outcomes but also result in increased patient satisfaction. In addition, decision-making regarding the procedural pain care process enables advocacy to take place, leading to a sense of empowerment for both patients and nurses.
For all the above mentioned reasons, it is essential to develop strategies to enhance pain management for adult patients in the emergency setting. The use of topical analgesics is gaining popularity to provide pain relief for patients requiring phlebotomy. It acts by desensitizing the skin and mucous membrane after direct application, resulting in superficial loss of pain sensation.
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