Abstract: SA-PO971
Anxiety and Pain with Tunneled Dialysis Catheter Insertion in Patients with ESRD
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Nadurak, Stewart, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Rigatto, Claudio, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Komenda, Paul, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Tangri, Navdeep, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Whitlock, Reid, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Dunsmore, Sara E., Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Lloyd, Alissa, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Armstrong, Sean, Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
Background
About 50% of hemodialysis patients require tunneled catheters for hemoaccess because a fistula is not feasible. Tunneled catheters are typically inserted with local anesthetic (LA) alone. However, conscious sedation (CS) is sometimes used and may be associated with slightly increased cardiorespiratory risk, or require several hours of post-procedure observation in hospital. Given limited access to recovery beds, patients receiving CS are usually bridged with a non-tunneled catheter until conversion to a tunneled catheter can be booked. As there is no consensus on the benefit of CS in this setting, clinical practice varies widely and patient preferences regarding this choice are unknown. Our objectives are to assess: 1) pain and anxiety experienced by patients during tunneled catheter procedures; 2) patient preferences with respect to the time vs. discomfort trade-off inherent in the choice of using or not using CS.
Methods
We mailed a 10-item questionnaire to all patients >18y who had tunneled catheter procedures in Manitoba, Canada between Apr-16 and Oct -17; as well as to incident patients from Nov-17 until present. Participants rated their experience of pain and anxiety from their most recent procedure on a Likert scale from ‘0’ to ‘10’. Patients were also asked which procedure they would prefer in the future.
Results
A total of 148 of 651 questionnaires were returned (22.7%); where 80 patients had LA only and 37 had CS. Pain (median = 2) and anxiety (median = 4) during the procedure were low in both groups. Patients undergoing CS experienced a higher level of pain post-procedure (median of 2.5 vs. 1; p = 0.02) and anxiety during procedure (median of 5.5 vs 3; p=0.01). The majority of respondents preferred one procedure with LA only to two procedures (non-tunneled insertion, then CS for tunneled catheter) (68% vs. 32%), or to waiting for a CS procedure at a later date (76% vs. 24%). Limitations: retrospective survey. Response rate was low.
Conclusion
Low levels of pain and anxiety were experienced regardless of procedure type. When faced with a trade-off, patients preferred a procedure that took less time even if more discomfort was involved. We conclude that LA alone can be used without significant additional distress in most patients.