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K A Puntillo

Publications and source records attributed to K A Puntillo.

9 recordsLinked to original sources
PubMed1996

Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial.

BACKGROUND: Moderate to severe pain associated with the removal of pleural chest tubes is poorly controlled with opioids. New methods are needed to manage the pain associated with this procedure. OBJECTIVES: To compare the effects of interpleural injections of 0.25% bupivacaine without epinephrine to those of normal saline on chest tube removal pain in cardiothoracic surgery patients. METHODS: A randomized, double-blind, placebo-controlled trial was used, with a repeated measures design. Pain intensity and distress were measured before, immediately after, and 1 hour after chest tube removal. Pain sensations and affect were evaluated immediately after chest tube removal. The experimental group (n = 21) received bupivacaine and the control group (n = 20) received normal saline. RESULTS: In both groups pain intensity and distress scores were significantly higher at the time of chest tube removal than immediately before or 1 hour after. No significant differences in pain intensity, distress, sensation, or affect scores were found between the two treatment groups. The 13 patients who received intramuscular ketorolac an average of 3.5 hours before the procedure, independent of the study design, had significantly lower pain intensity scores at the time of chest tube removal than the 26 who did not. CONCLUSIONS: These data demonstrate that chest tube removal pain is of moderate to severe intensity and that pleural chest tube injections of bupivacaine were not effective in decreasing chest tube removal pain. However, the decrease in pain associated with the administration of ketorolac warrants future study.

Aged↗
PubMed1996

Analgesics prescribed and administered to intensive care cardiac surgery patients: does patient age make a difference?

This study was conducted to determine the effects of patient age on the opioid prescription and administration practices of professionals in a sample of 80 cardiac surgery patients. The age categories were patients < 65 years of age and patients > or = 65 years of age. Medical records of adult cardiac surgery patients undergoing valve replacements and coronary artery bypass surgery within a single metropolitan teaching hospital were reviewed. Data were collected for up to three days or until the patient was discharged from the intensive care unit (ICU). For each of the study days, the specific types of opioids prescribed and administered were recorded. Calculations were performed to determine the maximum amounts of opioids prescribed and administered during the study period and to analyze for differences between the two age groups. Analyses revealed that all patients received small amounts of opioid analgesics during their three ICU days: mean = 9.4 mg, day of surgery; mean = 13.3 mg, postoperative day one; mean = 12.1 mg, postoperative day 2. When the total patient sample was evaluated, a significant difference in the doses of opioids prescribed versus administered was found across all three study days. Differences in amounts of opioids administered to the two age groups progressively increased across the three days, with patients > or = 65 receiving less than patients < 65. These differences approached significance on postoperative days one and two. The findings that elderly patients received less opioids than younger patients and that these differences became greater over time is intriguing. Questions remain as to whether ICU patients in pain are under-medicated and whether postsurgical pain control is effective over time.

Adult↗
PubMed1995

Pain, pain relief and accuracy of their recall after cardiac surgery.

This study investigated how much pain and pain relief cardiac surgery patients experience in Intensive Care Units (ICUs), and the accuracy of their recall later, during hospital recovery. Thirty-nine patients completed the first interview in the ICU, and 31 of them answered recall questions later. The worst pain patients experienced in the ICU was moderately high, and patients reported 65% pain relief from analgesics administered. In general, patients' later recalled ICU pain was less severe and recalled pain relief from pain medications was greater than what they had reported when in the ICU. A substantial number of patients were unable to rate the effects of analgesics because they did not remember being mediated. One gender difference was noted: women recollected having a higher "worst pain" in ICU than men. Although recall of ICU pain is less than accurate, ICU cardiac surgical patients have episodes of substantial pain. Despite advances in pain management, patients report that pain relief is frequently incomplete and that they do not remember receiving analgesics. A more proactive approach to pain management by health care professionals, which includes informing patients when they are receiving analgesics, may help to improve pain relief in cardiac surgical patients.

Adult↗
PubMed1995

Chest tube removal practices in critical care units in the United States.

BACKGROUND: Pain assessment and management are recognized as major problems in critical care settings. However, little is known about pain management practices related to medical procedures performed in the ICU, particularly removal of chest tubes. OBJECTIVES: To describe practices related to chest tube removal in the United States, with an emphasis on pain assessment and management. METHODS: A survey instrument was developed and mailed to 995 members of the American Association of Critical-Care Nurses who cared for patients with chest tubes. They were asked about chest tube removal practices in their institutions. RESULTS: Chest tubes are removed primarily by physicians and house staff, although 11% of respondents reported that specially trained nurses removed the tubes. Only 16% indicated that a prescription for pain medication was routinely available before chest tube removal. The drug administered most frequently was intravenous morphine sulfate, but the dose varied considerably. Nurses were generally satisfied (65.6%) with practices related to chest tube removal in their unit; nurses who were not satisfied (34.4%) wished to see better pain management practices (45%), removal of tubes by the patient's assigned nurse (17.8%), a protocol for tube removal (13.9%), notification of the nurse before removal (12.2%), and other changes (10%). CONCLUSIONS: Practices associated with chest tube removal, especially pharmacologic management of procedure-related pain, vary in critical care units. Caregivers are advised to develop practice policies to guide decisions about management of acute pain in this patient population.

Adult↗
PubMed1994

Dimensions of procedural pain and its analgesic management in critically ill surgical patients.

BACKGROUND AND PURPOSE: Many critically ill patients undergo endotracheal suctioning and chest tube removal procedures, yet little documentation of associated pain exists. Therefore, a study was conducted to (1) compare the magnitude and dimensions of pain associated with endotracheal suctioning and chest tube removal in intubated and nonintubated patients and (2) correlate preprocedural analgesic administration and pain magnitude. METHODS: Multiple dimensions of pain (ie, intensity, extent, sensation, and affect) were measured after postoperative cardiovascular surgery patients underwent endotracheal suctioning (N = 45) or chest tube removal (N = 35). Preprocedural analgesics and intubation status during pain assessments were noted. RESULTS: Patients reported lower pain intensity with endotracheal suctioning (mean, 4.9 on a 0-10 numerical rating scale) than with chest tube removal (mean, 6.6). Pain extent, sensation, and affect scores were relatively low for endotracheal suctioning and chest tube removal. Similar words such as "tender," "sharp," and "heavy" were used to describe both procedures; however, more patients described their response to chest tube removal as "fearful." Intubated patients had different pain experiences than extubated patients. Patients received little analgesic premedication, and correlations were low and nonsignificant between amount of medication received and pain magnitude. CONCLUSIONS: Patients were able to communicate extensive information about procedural pain, even when intubated. Endotracheal suctioning and chest tube removal were both painful; yet, there was little preparatory analgesic management of the pain. Research is needed to investigate a variety of pharmacological and nonpharmacological interventions for pain related to endotracheal suctioning and chest tube removal.

Adult↗
PubMed1990

Pain experiences of intensive care unit patients.

The purpose of this study was to describe various dimensions of the pain experiences of intensive care unit (ICU) patients. A purposive, primarily surgical sample of 24 ICU patients from two hospitals was interviewed after transfer from ICU. All but one patient remembered their ICU stay. Although this and six other patients had no recall of pain, 63% of the sample rated their pain as being moderate to severe in intensity. In a subgroup of nine patients having cardiac surgery, mean morphine sulfate administration during the first three postoperative days was 14 mg/day. This group of patients reported a lack of total pain relief from analgesics. Patients also described various sources of their pain, difficulties they had in communicating their pain, and nonpharmacologic methods that helped relieve their pain. Results of this study clearly indicate that not only pain but its communication and treatment were significant problems for a substantial portion of this ICU sample. Further descriptive and experimental research of pain characteristics and treatment practices for ICU patients is urgently needed. Improvements in nursing practice that result from such research may make a substantial difference in the comfort and well-being of critically ill patients.

Adult↗
PubMed1988

The phenomenon of pain and critical care nursing.

Pain is a multidimensional, complex experience. Critically ill patients are particularly vulnerable to pain. Patients in a critical care environment often have difficulty communicating their pain, and their pain may be aggravated by fear and anxiety. Indeed, their response to pain may compromise recovery. Although the significance of pain has been cited in literature, there is a dearth of research regarding pain in the critically ill. Such future research, as well as practice interventions, should be based on an understanding of pain psychophysiology. This article presents an in-depth review of pain mechanisms, including a discussion of pain modulation by the endogenous opioid system. Also reviewed are various pain theories contributing to our knowledge of pain. Finally, methods of pain measurement and treatment are outlined, and their appropriateness to critical care is evaluated. Although knowledge about pain mechanisms, measurement, and therapies has expanded, many issues remain unexplained. This article poses questions regarding pain in critically ill patients and presents specific areas for future nursing research.

Critical Care↗
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