Procedural Pain in the Adult Neurological Intensive Care Unit: A Retrospective Study Examining Arterial Line...

Area of Science:

• Neuroscience
• Critical Care Medicine
• Pain Management

Background:

• Arterial catheter insertion is a painful procedure common in neurological intensive care units (NICUs).
• Patients in NICUs often have impaired consciousness, complicating pain assessment.
• Procedural pain management is crucial for patient well-being and recovery.

Purpose of the Study:

• To evaluate documented pain assessment and intervention practices during arterial catheter insertion in an adult NICU.
• To determine associations between patient characteristics, procedural factors, provider licensure, and pain management.
• To identify gaps in pain assessment and intervention for this vulnerable patient population.

Main Methods:

• Retrospective chart review of 120 electronic patient medical records over one year.
• Inclusion criteria applied to 100 charts for analysis of documented pain assessments and interventions.
• Data analysis focused on pain-related practices, patient factors, and provider documentation.

Main Results:

• Overall pain assessment was documented in 100% of charts, but procedure-specific assessment for arterial lines occurred in only 4%.
• Local analgesia was administered in 76% of documented procedures; other interventions in 10%.
• Procedure-specific pain assessment and interventions were associated with fewer insertion attempts; patient ethnicity influenced pain interventions.

Conclusions:

• While general pain assessment was documented, specific assessment for arterial line insertion pain was rare.
• A significant percentage of patients did not receive preprocedural analgesia, indicating potential undertreatment of procedural pain.
• There is a clear need for enhanced clinician education and further research into optimizing pain management during arterial line insertion in NICU patients.