Control of central venous access device |
Indicate early on a central venous access device, based on individual characteristics and the proposed chemotherapy protocol. The Adult Venous Assessment Tool (VAT) and Deciding on Intravenous Access (DIVA) were applied for the purpose of decision making (16). |
Provide information related to the device (type, indication, function and precautions with the device). |
Clarify the short-, mid- and long-term risks and benefits of catheters. |
Check that the patient understands the purpose, care and maintenance of the semi-implanted catheter. |
Reduction of anxiety and fear |
Help the patient identify situations that precipitate anxiety and fear. |
Identify other situations that cause panic and anxiety, such as differential diagnosis (4,20) of needle phobia. |
Apply specific scales for assessing levels of anxiety (10), fear and depression, before, during and after chemotherapy. The Beck Anxiety Inventory (12-13) and Hospital Anxiety and Depression Scale (anxiety subscale) (14-15) were applied. |
Teach slow breathing exercises to promote relaxation (4). Reduction of carbon dioxide blood levels, triggered by hyperventilation, should be avoided. This results in cerebral vascular constriction, reduced availability of oxygen and syncope symptoms. In addition, blood pressure levels may also be high due to the intervention (21). |
Instruct the patient to avoid medications and substances such as alcohol, caffeine and stimulants of the central nervous system, since they can aggravate the symptoms of anxiety and/or phobia (4). |
Assess verbal and non-verbal signs of anxiety (10), fear and potential psychological complications associated with intravenous insertion. |
Refer to a mental health specialist when necessary, since certain interventions are beyond the technical, ethical and legal competencies of nurses, in order for the patient to receive psychotherapeutic and clinical treatment for phobia and mood disorders (4,20). |
Recognize panic attack risk factors in the nursing record, such as low weight, start of treatment, younger age, fear of fainting, concerns about health risks, fear of "being afraid", treatment with anxiolytics or antidepressants, smoking and use of illicit substances (22). |
Counseling |
Educate the patient about the disorder (4,20), supplying factual information as necessary and appropriate (10). Teach the patient to replace thoughts that increase fear, such as "expecting to faint" with others that promote self-confidence, such as: "whatever goes up (fear), comes down". |
Distraction |
Encourage the individual to choose distraction techniques, such as listening to music, deep breathing exercises and recalling positive events (4,10,23). |
Promotion of cerebral perfusion |
Provide instruction in the muscle tension technique, which is the application of repeated isometric tension in the muscles of the legs, buttocks, abdomen or trunk during other invasive procedures or those with needles. The intervention prevents and alleviates presyncope and syncope symptoms. This leads to an improvement in cerebral blood flow, oxygenation, cardiac output and blood pressure. This technique diverts peripheral blood from large muscles to central circulation (21). |