Comprehensive Nursing Pharmacology Q 285
A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply?
A. “You will have general anesthesia so you won’t feel anything.”
B. “It will be inserted rapidly, and any discomfort is fleeting.”
C. “The insertion site will be anesthetized. Threading the catheter through the vein is not painful.”
D. “You will receive sedation prior to the procedure.”
Correct Answer: C. “The insertion site will be anesthetized. Threading the catheter through the vein is not painful.”
Pain-related to PICC insertion occurs with the puncture of the skin. When inserting PICC lines, the insertion site is anesthetized so no pain is felt. Unnecessary pain should be prevented. Peripherally inserted central catheters (PICCs) are a subset of central venous catheters. They are 50 cm to 60 cm long single, double or triple lumen catheters that are placed in a peripheral arm vein and terminate in the thorax. They can be used for medium-term venous access, which is defined as anywhere between several weeks to 6 months.
Option A: The patient will not receive general anesthesia or sedation. After placement and functionality have been confirmed, appropriate maintenance, which includes the use of stabilization devices, frequent flushing of line with saline and heparin-containing solutions, and sterile dressings replaced at regular intervals, should be employed to minimize complications.
Option B: If not treated, pain can compromise the resolution of processes underlying disease, delay surgical recovery, and increase the costs of healthcare. In addition, multiple painful and stressful events experienced by clients induce acute physiological changes, as well as permanent structural and functional changes in the central nervous system. This can have long-term consequences, including chronic pain and altered neurobehavioral responses to pain. Appropriate use of environmental, behavioral, and pharmacological interventions may prevent, reduce, or eliminate the pain associated with procedures in clients.
Option D: An exploratory descriptive study, that evaluated 43 neonates in the neonatal unit of a hospital in the city of São Paulo, indicated that 86.1% of PICC insertions were not accompanied by analgesia, and in 13.9% of cases, sedatives were used. Nonpharmacologic methods of pain relief and stress were not used. Therefore, a high frequency of sedatives was noted during PICC insertion in neonates. Midazolam is a benzodiazepine with a short and limited analgesic effect, commonly used in the NICU to produce sedation and muscle relaxation. Chloral hydrate is used for sedation, particularly when numbness is necessary without analgesia. An increased incidence of apnea and oxygen desaturation in term neonates less than one month of age and preterm infants less than 60 weeks of postnatal age, who received this barbiturate to perform magnetic resonance imaging, was identified.