Painful and stressful procedures and analgesia in newborns from the viewpoint of professionals

Moraes, Etiene Leticia Leone de; Freire, Márcia Helena de Souza

doi:10.1590/0034-7167-2018-0326

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (suppl 3) • Dec 2019 • https://doi.org/10.1590/0034-7167-2018-0326 copy

Painful and stressful procedures and analgesia in newborns from the viewpoint of professionals

Procedimientos dolorosos, estresantes y analgesia en neonatos bajo la perspectiva de los profesionales

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the procedures considered painful and stressful by health professionals from a neonatal intensive care unit and check the measures of analgesia.

Method:

Descriptive exploratory quantitative study with 65 health professionals, from November 2016 to February 2017.

Results:

The procedures considered painful were removal of adhesives, vein, arterial and lumbar puncture, phlebotomy, and thoracic drainage. Oral suctioning, intravenous catheter removal and tracheal extubation were considered stressful. Fentanyl was the most cited pharmacological measure, and restraint and nonnutritive suction were the most used nonpharmacological measures.

Conclusion:

Professionals were able to classify the painful and stressful procedures; however, low use of measures for analgesia was evidenced.

Descriptors:
Acute Pain; Pain Management; Critical Pathways; Neonatal Intensive Care Unit; Health Team

Procedure	Nurse (n = 10)						Nursing technicians (n = 37)
	P		S		U		P		S		U
	n	%	n	%	n	%	n	%	n	%	n	%
Fundoscopy	8	80	2	20	0	0	22	59.4	14	37.8	1	2.7
Lumbar puncture	10	100	0	0	0	0	37	100	0	0	0	0
Postoperative care	10	100	0	0	0	0	36	97.3	0	0	0	0
Chest drainage	10	100	0	0	0	0	37	100	0	0	0	0
Phlebotomy	10	100	0	0	0	0	37	100	0	0	0	0
Intramuscular and subcutaneous injection	10	100	0	0	0	0	36	97.3	0	0	1	2.7
Tracheal intubation	10	100	0	0	0	0	31	83.8	5	13.5	1	2.7
Arterial Puncture	10	100	0	0	0	0	37	100	0	0	0	0
Vein puncture	10	100	0	0	0	0	37	100	0	0	0	0
Heel puncture	10	100	0	0	0	0	36	97.3	0	0	0	0
PICC	10	100	0	0	0	0	35	94.6	1	2.7	1	2.7
Tracheal suctioning	7	70	3	30	0	0	14	37.8	22	59.4	1	2.7
Oral suctioning	2	20	8	80	0	0	6	16.2	29	78.4	2	5.4
Umbilical catheter	10	100	0	0	0	0	25	67.6	7	18.9	5	13.5
Gastric probing	7	70	3	30	0	0	18	48.6	18	48.6	1	2.7
Extubation	5	50	5	50	0	0	13	35.1	20	54.1	4	10.8
Removal of intravenous catheter	7	70	3	30	0	0	18	48.6	17	45.9	2	5.4
Removal of adhesive	10	100	0	0	0	0	37	100	0	0	0	0
Bath	0	0	2	20	8	80	0	0	5	13.5	32	86.5
Anthropometric measurements	0	0	4	40	6	60	3	8.1	20	54.1	16	43.2
Change of decubitus	0	0	1	10	9	90	5	13.5	5	13.5	30	81.1

Procedure	Physical therapists (n = 10)						Physicians (n = 8)
	P		S		U		P		S		U
	n	%	n	%	n	%	n	%	n	%	n	%
Fundoscopy	6	60	4	40	0	0	4	50	3	37.5	1	12.5
Lumbar puncture	10	100	0	0	0	0	8	100	0	0	0	0
Postoperative care	10	100	0	0	0	0	8	100	0	0	0	0
Chest drainage	10	100	0	0	0	0	8	100	0	0	0	0
Phlebotomy	10	100	0	0	0	0	8	100	0	0	0	0
Intramuscular and subcutaneous injection	10	100	0	0	0	0	8	100	0	0	0	0
Tracheal intubation	9	90	1	10	0	0	7	87.5	1	12.5	0	0
Arterial Puncture	10	100	0	0	0	0	8	100	0	0	0	0
Vein puncture	10	100	0	0	0	0	8	100	0	0	0	0
Heel puncture	9	90	0	0	1	10	8	100	0	0	0	0
PICC	9	90	1	10	0	0	8	100	0	0	0	0
Tracheal suctioning	3	30	7	70	0	0	4	50	4	50	0	0
Oral suctioning	2	20	8	80	0	0	1	12.5	6	75	1	12.5
Umbilical catheter	8	80	2	20	0	0	5	62.5	3	37.5	0	0
Gastric probing	3	30	7	70	0	0	3	37.5	5	62.5	0	0
Extubation	0	0	10	100	0	0	2	25	5	62.5	1	12.5
Removal of intravenous catheter	3	30	5	50	2	20	3	37.5	5	62.5	0	0
Removal of adhesive	10	100	0	0	0	0	8	100	0	0	0	0
Bath	0	0	3	30	7	70	0	0	3	37.5	5	62.5
Anthropometric measurements	0	0	8	80	2	20	0	0	3	37.5	5	62.5
Change of decubitus	0	0	2	20	8	80	0	0	4	50	4	50

Procedure	NU. (n = 10)		PT. (n = 10)		PHYS. (n = 8)		NSG. TECHN. (n = 37)		Total (N = 65)		p value
Procedure	n	%	n	%	n	%	n	%	n	%	p value
Selective tracheal intubation	7	70	5	50	5	62.5	11	29.7	28	43.1	0.070
Endotracheal tube and airway suctioning	6	60	7	70	2	25	6	16.2	21	32.3	0.002^* * significant difference (p< 0.05).
Gastric and enteral probing	6	60	3	30	1	12.5	5	13.5	15	23.1	0.016^* * significant difference (p< 0.05).
Umbilical catheter insertion	5	50	5	50	6	75	18	48.6	34	52.3	0.595
Insertion of PICC	8	80	10	100	8	100	25	67.6	51	78.5	0.056
Phlebotomy	8	80	8	80	7	87.5	17	45.9	40	61.5	0.030^* * significant difference (p< 0.05).
Arterial Puncture	6	60	3	30	4	50	14	37.8	27	41.5	0.494
Vein puncture	7	70	6	60	3	37.5	17	45.9	33	50.8	0.435
Heel puncture	4	40	2	20	2	25	8	21.6	16	24.6	0.666
Intramuscular or subcutaneous injection	3	30	2	20	2	25	5	13.5	12	18.5	0.631
Lumbar puncture	4	40	5	50	3	37.5	3	8.1	15	23.1	0.010^* * significant difference (p< 0.05).
Chest drainage	8	80	8	80	8	100	17	45.9	41	63.1	0.008^* * significant difference (p< 0.05).
Fundoscopy	3	30	3	30	1	12.5	7	18.9	14	21.5	0.709
Postoperative care	9	90	10	100	7	87.5	21	56.7	47	72.3	0.013^* * significant difference (p< 0.05).
Others - Installation of CPAP	0	0	0	0	0	0	1	2.7	1	1.5	-

Tipo de analgesia	TECHN. (n = 10)		PT. (n = 10)		PHYS. (n = 8)		NSG. TECHN. (n = 37)		TOTAL (N = 65)		p value
Tipo de analgesia	n	%	n	%	n	%	n	%	n	%	p value
Pharmaceutical Agent
Midazolam	2	20	1	10	3	37.5	1	2.7	6	9.2	0.025
Fentanyl	7	70	1	10	5	62.5	9	24.3	22	33.8	0.005^* * significant difference (p< 0,05).
Dipyrone	1	10	3	30	3	37.5	4	10.8	11	16.9	0.176
Paracetamol	0	-	0	0	1	12.5	0	0	1	1.5	-
25% Glucose	5	50	2	20	2	25	9	24.3	18	27.7	0.389
Lidocaine	3	30	2	20	3	37.5	6	16.2	14	21.5	0.520
Anesthetic eye drop	1	10	0	0	0	0	0	0	1	1.5	-
Nonpharmacological
Restraint	6	60	3	30	2	25	6	16.2	17	26.2	0.048^* * significant difference (p< 0,05).
Winding	5	50	0	0	0	0	0	0	5	7.7	-
Nonnutritive suction	6	60	2	20	2	25	5	13.5	15	23.1	0.022^* * significant difference (p< 0,05).
Positioning	1	10	0	0	0	0	1	2.7	2	3.1	-
Red Reflex Test	1	10	0	0	0	0	0	0	1	1.5	-
Maternal lap	1	10	0	0	0	0	1	2.7	2	3.1	-
Skin-to-skin contact	1	10	0	0	0	0	0	0	1	1.5	-

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[1] Corresponding Author: Etiene Leticia Leone de Moraes. E-mail: etieneleticia@hotmail.com