SP608ANXIETY AND PAIN WITH TUNNELED DIALYSIS CATHETER INSERTION IN PATIENTS WITH END STAGE RENAL DISEASE
Bibliographic record
Abstract
INTRODUCTION AND AIMS: About 50% of hemodialysis patients require tunneled catheters for hemoaccess because a fistula is not feasible. Tunneled catheters are typically inserted with local anesthesia alone. However, conscious sedation is sometimes used, though 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 requesting or requiring conscious sedation 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 conscious sedation in this setting, clinical practice varies widely. Importantly, patient preferences regarding this choice are unknown. Objectives: 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 conscious sedation. METHODS: Ten-item mail out questionnaire to all patients >18y who had tunneled catheter procedures between April 2016 and October 2017. 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 future RESULTS: A total of 109 of 590 questionnaires were returned (18.5%). 57 patients had local freezing only, 32 had conscious sedation, and 15 didn’t remember. Pain (median = 2) and anxiety (median = 3) were low in both groups. Patients undergoing sedation experienced a higher level of pain post-procedure (median of 3 vs. 1; p = 0.014). The majority of respondents preferred one procedure with freezing only to two procedures (non-tunneled insertion, then sedation for tunneled catheter) (69% vs. 31%), or to waiting for a sedated procedure at a later date (76% vs. 24%). CONCLUSIONS: Patients experienced low levels of pain and anxiety 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 local anesthesia alone can be used without significant additional distress in most patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".