title: Implantation of venous access devices under local anesthesia: patients' satisfaction with oral lorazepam.
abstract: OBJECTIVE
  The aim of the study reported here was to evaluate patients' satisfaction with implantation of venous access devices under local anesthesia (LA) with and without additional oral sedation.
  
  
  METHODS
  A total of 77 patients were enrolled in the prospective descriptive study over a period of 6 months. Subcutaneous implantable venous access devices through the subclavian vein were routinely implanted under LA. Patients were offered an additional oral sedative (lorazepam) before each procedure. The level of anxiety/tension, the intensity of pain, and patients' satisfaction were evaluated before and immediately after the procedure using a visual analog scale (ranging from 0 to 10) with a standardized questionnaire.
  
  
  RESULTS
  Patients' satisfaction with the procedure was high (mean: 1.3±2.0) with no significant difference between the group with premedication and the group with LA alone (P=0.54). However, seven out of 30 patients (23.3%) in the group that received premedication would not undergo the same procedure without general anesthesia. There was no significant influence of lorazepam on the intensity of pain (P=0.88). In 12 out of 30 patients (40%) in the premedication group, the level of tension was higher than 5 on the visual analog scale during the procedure. In 21 out of 77 patients (27.3%), the estimate of the level of tension differed between the interventionist and the patient by 3 or more points in 21 out of 77 patients (27.3%).
  
  
  CONCLUSIONS
  Overall patient satisfaction is high for implantation of venous access devices under LA. A combination of LA with lorazepam administered orally might not be adequate for patients with a high level of anxiety and tension. The level of tension is often underestimated by the interventionist. Pre-procedural standardized questionnaires could be used to identify patients for whom a gradual approach of individualized sedation may be more effective.
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: De-Hua
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Hiss
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Herich
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Becker
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Kamal
authors.initials: K
authors.lastname: Mammadov
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Franke
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: Department of Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Persigehl
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Maintz
authors.affiliation: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bangard
keywords: central venous port implantation; chemotherapy; pain; patient satisfaction; supportive care