title: Sedation shared decision-making in ambulatory venous access device placement: Effects on patient choice, satisfaction and recovery time.
abstract: This study was undertaken to determine the impact of shared decision-making when selecting a sedation option, from no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine) or moderate sedation (benzodiazepine and opiate), for venous access device placement (port-a-cath and tunneled catheters) on patient choice, satisfaction and recovery time. This is an IRB-approved, HIPPA-compliant, retrospective study of 198 patients (18-85 years old, 60% female) presenting to an ambulatory vascular interventional radiology department for venous access device placement between 22 October 2014 and 7 October 2015. Patients were educated about sedation options and given the choice of undergoing the procedure with no sedation (local anesthetic only), or minimal or moderate sedation. Satisfaction was assessed through three survey questions. No sedation was selected by 53/198 (27%), minimal sedation by 71/198 (36%) and moderate sedation by 74/198 (37%). All subjects would recommend the option to another patient and valued the opportunity to select a sedation option. Post-procedure recovery time differences were statistically significant (p<0.0001) with median recovery times of 0 minutes for no sedation, 38 minutes for minimal sedation and 64 minutes for moderate sedation. In conclusion, patient sedation preference for venous access device placement is variable, signifying there is a role for shared decision-making as it empowers the patient to select the option most aligned with his or her goals. The procedure is well-tolerated, associated with high satisfaction, and the impact on departmental flow is notable because patients choosing no or minimal sedation results in a decreased post-procedure recovery time burden.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA mchittle@partners.org.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Chittle
authors.affiliation: Mayo Clinic Arizona, Scottsdale, AZ, USA.
authors.forename: Rahmi
authors.initials: R
authors.lastname: Oklu
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Pino
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: He
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sheridan
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Martino
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D001569:Benzodiazepines / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002755:Choice Behavior; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: ambulatory vascular procedures; patient centered care; sedation; shared decision-making; venous access device