
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

39312362
MD-D-24-00678
00063
10.1097/MD.0000000000039575
3
4500
Research Article
Observational Study
An observational study on the modulation of anxiety, depression, and adverse event incidence in painless colonoscopy patients through venous access nursing
https://orcid.org/0009-0000-9562-6804
Zhu Linzhen MB a*
Zhu Linlin MB 952017505@qq.com
b
Jin Chengfeng MM 8013015@zju.edu.cn
c
a Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
b Central Health of Shangxi Town, Yiwu, Zhejiang, China
c Department of Digestive Medicine, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China.
* Correspondence: Linzhen Zhu, Department of Nursing, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, No. N1, Shangcheng Avenue, Yiwu, Zhejiang 322000, China (e-mail: linzhenzhu187@163.com).
20 9 2024
20 9 2024
103 38 e3957517 1 2024
14 8 2024
15 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

To investigate the clinical significance of venous access nursing in modulating anxiety, depression, and adverse event incidence among patients undergoing painless colonoscopy. Sixty patients who underwent painless colonoscopy in our hospital from September 2021 to September 2022 were selected as the control group (CG, receiving routine perioperative nursing). Sixty patients who underwent painless colonoscopy in our hospital from October 2022 to August 2023 were taken as the study group (SG, receiving venous access nursing modulation). After nursing, patients in the SG exhibited lower scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale than those in the CG (P < .05). The SG showed significantly lower mean Ottawa Bowel Preparation Score, but exhibited higher adequacy of bowel preparation compared with the CG (P < .05). The colonoscopy insertion time was (7.18 ± 1.02) minutes in the SG and (8.69 ± 1.00) minutes in the CG, and the colonoscopy withdrawal time was (4.66 ± 1.66) minutes in the SG and (5.64 ± 1.06) minutes in the CG, which showed statistically significant differences between the 2 groups (P < .05). The total incidence of adverse events did not have statistical significance between the 2 groups (P > .05). Application of venous access nursing in patients undergoing painless colonoscopy may help alleviate adverse emotions and shorten colonoscopy insertion time and colonoscopy withdrawal time, thus warranting recognition for its safety and efficacy.

adequacy of bowel preparation
adverse events
anxiety
depression
painless colonoscopy
OPEN-ACCESSTRUE
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pmc1. Introduction

Colorectal cancer is one of the most common gastrointestinal malignant tumors occurring in the colon and rectum.[1] Global cancer data indicate that the incidence and mortality rates of colorectal cancer respectively rank third and second among all cancers, and approximately 1.8 million new cases of colorectal cancer are diagnosed globally each year, ranking it third in incidence, following breast and lung cancer; about 880,000 individuals succumb to colorectal cancer annually, positioning it as the second leading cause of death, surpassed only by lung cancer.[2,3] Over the past few years, with the rapid growth of the economy in China, the dietary patterns, exercise mode, and work pressure of the residents have changed considerably, leading to a continuous upward trend in the incidence of colorectal cancer.[4] Epidemiological surveys show that the incidence rates of colon cancer and rectal cancer are 12.2/100,000 and 22.4/100,000, respectively in China, which is 84.1% higher than that in 1990; the mortality rates of colon cancer and rectal cancer are 7.6/100,000 and 18.7/10,000, respectively, which is 8.2% higher than that in 1990, with the incidence and mortality rates surpassing the global average.[5,6]

The prognosis of colorectal cancer patients is closely related to the staging. The 5-year survival rate for patients with early-stage colorectal cancer is over 90%, while for late-stage cases, it falls short of 10%. Hence, early screening for colorectal cancer is of great significance to improve the prognosis of patients.[7] Colorectoscopy is currently the most commonly used, intuitive and accurate detection means for colorectal cancer screening, which is now widely used in clinical practice and plays an important role in saving the lives of patients with early-stage colorectal cancer.[8] Although painless colonoscopy has improved the examination experience of patients to a certain extent compared to traditional colonoscopy, it is still an invasive procedure that requires patients to undergo anesthesia through venous access, leading to obvious anxiety and depressive emotions in most patients.[9] Meanwhile, influenced by the examiner’s experience, patients’ underlying diseases, and the aftereffects of anesthesia drugs, the traditional measures for painless colonoscopy nursing have certain deficiencies, such as the lack of care and concern for the patient and the insufficient emphasis on venous nursing, which may affect the patient’s colonoscopy experience. This study revealed that the application of venous access nursing in painless colonoscopy patients contributed to ameliorating their adverse emotions and enhancing their bowl preparation, and it investigated the value of venous access nursing in painless colonoscopy patients primarily from emotional, procedural, and safety perspectives, which provides innovative insights and serves as a reference for subsequent examinations of painless colonoscopy patients.

2. Materials and methods

2.1. General data

Sixty patients who underwent painless colonoscopy in our hospital from September 2021 to September 2022 were selected as the control group (CG, receiving routine perioperative nursing). Sixty patients who underwent painless colonoscopy in our hospital from October 2022 to August 2023 were taken as the study group (SG, undergoing venous access nursing modulation). The study complied with the Declaration of Helsinki and was conducted with the approval of the Ethics Committee of The Fourth Affiliated Hospital, Zhejiang University School of Medicine. Due to the retrospective nature of this study, the informed consent was waived.

Inclusion criteria: (1) patients who underwent painless colonoscopy in our hospital; (2) patients with complete clinical data; (3) patients who aged 40 to 70 years; (4) patients with the American Society of Anesthesiologists grades I–II.

Exclusion criteria: (1) patients with concurrent severe cardiac diseases, asthma, or a history of previous craniocerebral injury; (2) patients with comorbid mental disorders; (3) patients who were allergic to anesthetics used in painless colonoscopy; (4) patients with alcohol or drug dependencies; (5) patients with acute liver failure; (6) pregnant or lactating women; (7) patients with concurrent sleep apnea syndrome.

2.2. Intervention methods

Patients in the CG did not undergo specialized interventions. Prior to the procedure, patients received relevant examinations, including laboratory tests and radiological assessments. They were instructed to abstain from food and drink for 6 hours before the procedure and ensure proper bowel preparation. Prior to the procedure, nursing staff gave health education to the patients, imparting pertinent medical insights, preparing a range of emergency equipment, and vigilantly monitoring vital signs, including blood pressure, pulse, respiration, and heart rate. Anesthesiologists administered propofol and fentanyl in patients to induce and maintain anesthesia. Throughout the anesthesia process, they vigilantly monitored the vital signs of patients. Once the painless colonoscopy was completed, patients were transferred to the anesthesia recovery room.

Patients in the SG group were additionally given venous access nursing. The specific measures were as follows: (1) throughout the entire nursing process, in conjunction with the timing of patient appointment for painless colonoscopy, an assessment of venous access was conducted. The patient’s venous vascular condition was assessed in advance to prepare for anesthesia during subsequent examinations. Upon the patient’s arrival for the examination, a reassessment of the vascular system was performed, with meticulous determination of the puncture site (to prevent the loosening at the site of tee connection and needle dislodgement, it was typically recommended as the right upper limb, proximal to the heart, free of venous valves, displaying excellent elasticity, and featuring a thick and straight vein), fixation method (it was recommended to use tape for initial fixation after successful puncture, followed by reinforced fixation with indwelling needle application), and the specific gauge of the indwelling needle used (in view of the fact that anesthesia drugs such as propofol could inhibit the patient’s circulatory status and possess a certain degree of irritation, it was recommended that the indwelling needle be selected as a slightly smaller gauge). Following successful puncture and anesthesia, normal saline was utilized to maintain venous access, ensuring prompt responsiveness in emergencies. The indwelling needle was removed once the patient regained consciousness. (2) Ensuring optimal patient positioning, it was advisable for the patient to take a left lateral decubitus position. The patient’s punctured limb should be placed properly under the premise of ensuring intraoperative procedures and safety. Given the potential need for patients to undergo position changes during the procedure, nursing staff should maintain continuous monitoring of the venous access throughout the procedure. During patient repositioning, venous access should be promptly secured to ensure smooth access and prevent adverse events. (3) During the procedure, anesthesia drug management was strictly administered. Prior to administering anesthesia drugs, it was essential to assess the patency of the patient’s access with normal saline solution. Simultaneously, most patients might have a certain level of apprehension towards anesthesia drugs. Therefore, nursing staff ought to inform patients of potential risks prior to the procedure, and, through active guidance, rectified any misconceptions to prevent patients from experiencing fear and anxiety due to the unknown. (4) Prior to the procedure, proactive health guidance should be provided. This may involve the utilization of videos and past successful cases to inspire patients, enhancing their treatment compliance, ensuring that patients could correctly comprehend and cooperate with the undertaking of painless colonoscopy.

2.3. Observation indicators and evaluation standards

The anxiety and depression of the 2 groups were compared before examination and 1 hour after awakening. Anxiety assessment was conducted using the Self-Rating Anxiety Scale (SAS),[10] which consists of 20 items, including 15 forward grading questions and 5 reverse grading questions. Each of the items is answered on a four-point Likert scale ranging from 1 to 4, with a total scale score of 80. Higher scores on this scale correlate with greater severity of anxiety in the subjects. Depression assessment was conducted using the Self-Rating Depression Scale (SDS),[11] which consists of 20 items rated on a four-point Likert scale ranging from 1 to 4, with a total scale score of 80. Higher scores indicate the greater severity of depression in the subjects. The bowl preparation of patients was assessed utilizing the Ottawa Bowel Preparation Scale (OBPS),[12] which is a scale with a total score ranging from 0 to 14, with higher scores representing inadequate bowl preparation, and a score of ≥5 indicates inadequate bowel preparation. The colonoscopy insertion time and colonoscopy withdrawal time were recorded and compared between the 2 groups. The differences in the incidence of adverse events such as nausea, vomiting, and abdominal distension were recorded in both groups.

2.4. Statistical methods

The collected data were analyzed utilizing SPSS 28.0. Counting data were presented as percentages (%) and analyzed using the χ² test. The normality of measurement data was assessed utilizing the Kolmogorov–Smirnov test. In the case of data subjecting to a normal distribution, analysis of variance or the t test was implemented, with the measurement data expressed in the form of mean ± standard deviation (SD) (the data in this study conformed to a normal distribution). Statistical significance was determined at P < .05.

3. Results

3.1. Comparison of general clinical data between the 2 groups

General clinical data including gender, mean age, mean body mass index, residence status, bowel habits, and reasons for medical visits were included in the 2 groups, and the intergroup comparison revealed no statistically significant differences between the 2 groups of patients in terms of the aforementioned data (P > .05), suggesting favorable comparability, as shown in Table 1 and Figure 1.

Table 1 Comparison of general clinical data between the 2 groups (χ¯±s)/[n (%)].

General clinical data	Study group (n = 60)	Control group (n = 60)	t/χ²	P	
Gender	Male	39	40	0.037	.847	
Female	21	20	
Mean age (years)	68.32 ± 5.13	68.16 ± 4.98	0.173	.863	
Mean BMI (kg/m2)	22.06 ± 1.96	21.98 ± 2.21	0.210	.834	
Residence status	Living alone	13	10	0.622	.733	
Living with spouse	29	29	
Living with children	18	21	
Bowel habits	Normal	12	10	0.262	.877	
Diarrhea	24	24	
Constipation	24	26	
Reason for medical visits	Abdominal discomfort	10	9	0.223	.716	
Frequent bowel movements	16	15	
Fecal occult blood or hematochezia	18	16	
Physical examination	16	20	
BMI = body mass index.

Figure 1. Comparison of general clinical data between the 2 groups. There was no significant difference between the 2 groups in terms of gender, reasons for medical visits and residence status (P > .05). CG = control group, SG = study group.

3.2. Comparison of anxiety and depression scores before and after nursing between the 2 groups

The SAS and SDS were used to assess the anxiety and depression states of the 2 groups of patients before and after nursing. The differences in the SAS and SDS scores were not statistically significant between the 2 groups of patients before nursing (P > .05). After nursing, the SAS and SDS scores of the 2 groups of patients were significantly reduced compared with those before nursing, and the SAS and SDS scores of the SG were lower than those of the CG, exhibiting statistically significant differences between the groups (P < .05), as depicted in Figures 2 and 3.

Figure 2. Comparison of anxiety scores before and after nursing between the 2 groups. There was no statistically significant difference in the SAS scores between the SG and CG before nursing (P > .05), and the SAS scores of the patients in the SG were lower than those in the CG after nursing (P < .05). * represents a statistically significant difference between the 2 groups. CG = control group, SAS = Self-Rating Anxiety Scale, SG = study group.

Figure 3. Comparison of depression scores before and after nursing between the 2 groups. There was no statistically significant difference in the SDS scores between the SG and CG before nursing (P > .05), and the SDS scores of the patients in the SG were lower than those in the CG after nursing (P < .05). * represents a statistically significant difference between the 2 groups. CG = control group, SDS = Self-Rating Depression Scale, SG = study group.

3.3. Comparison of OBPS scores and the adequacy of bowel preparation between the 2 groups

The mean OBPS score was (4.62 ± 1.06) points in the SG and (5.92 ± 0.91) points in the CG, and the adequacy of bowel preparation was 71.67% (43/60) in the SG and 53.33% (32/60) in the CG. The mean OBPS score of the SG was significantly lower than that of the CG, but the adequacy of bowel preparation of the SG was higher than those of the CG (P < .05), as depicted in Figure 4.

Figure 4. Comparison of OBPS scores and the adequacy of bowel preparation between the 2 groups. The SG exhibited lower OBPS scores and higher adequacy of bowel preparation compared with the CG (P < .05). * represents a statistically significant difference between the 2 groups. CG = control group, OBPS = Ottawa Bowel Preparation Score, SG = study group.

3.4. Comparison of colonoscopy insertion time and colonoscopy withdrawal time between the 2 groups

In the SG, the colonoscopy insertion time was (7.18 ± 1.02) minutes, and the colonoscopy withdrawal time was (4.66 ± 1.66) minutes; in the CG, the colonoscopy insertion time was (8.69 ± 1.00) minutes, and the colonoscopy withdrawal time was (5.64 ± 1.06) minutes. The differences in the above indicators were statistically significant between the 2 groups (P < .05), as depicted in Figure 5.

Figure 5. Comparison of colonoscopy insertion time and colonoscopy withdrawal time between the 2 groups. The SG exhibited shorter colonoscopy insertion time and colonoscopy withdrawal time compared with the CG (P < .05). * represents a statistically significant difference between the 2 groups. CG = control group, SG = study group.

3.5. Comparison of incidence of adverse events between the 2 groups

The SG reported nausea in 10 cases, vomiting in 7 cases, abdominal distension in 2 cases, and abdominal pain in 2 cases, with a total adverse event incidence of 35.00% (21/60). The CG reported nausea in 11 cases, vomiting in 6 cases, abdominal distension in 4 cases, and abdominal pain in 4 cases, with a total adverse event incidence of 41.67% (25/60). The total incidence of adverse events showed no statistically significant difference between the 2 groups (P > .05), as displayed in Figure 6.

Figure 6. Comparison of incidence of adverse events between the 2 groups. There was no significant difference in the total incidence of adverse events between the SG and CG (P > .05). CG = control group, SG = study group.

4. Discussion

Colorectal cancer ranks third in the incidence of malignant tumors among males and second among females.[13] A previous study pointed out that developed countries exhibited a higher incidence of colorectal cancer than developing countries; however, in recent years, the refinement of the dietary habits of Chinese residents and the increase in work pressure have led to a significant change in the incidence of colorectal cancer.[14] According to national statistics, the number of colorectal cancer patients in China has continued to increase in recent years and shows a trend toward a younger demographic, and the current incidence of colorectal cancer is second only to lung and gastric cancers, posing a serious threat to the health of residents.[15,16]

Painless colonoscopy is presently a widely applied and highly precise diagnostic technique in clinical practice. Compared to conventional colonoscopy, painless colonoscopy can utilize anesthetic agents to enable patients to undergo gastrointestinal examinations without discomfort, thereby garnering favor of the majority of patients.[17,18] With the widespread application of painless colonoscopy, some medical professionals have also noted certain shortcomings in painless colonoscopy examinations. For instance, the anesthetic drugs used during the procedure, such as propofol, have been associated with adverse effects such as respiratory depression and hypotension, leading to postoperative occurrence of anxiety, depression, nausea, and vomiting in patients. Moreover, the use of venous access also increases the incidence of adverse events in postoperative patients,[19,20] thus establishing prerequisites for enhancing measures in painless colonoscopy nursing.

In this study, a controlled grouping method was used to explore the clinical value of applying venous access nursing in the context of painless colonoscopy patients. The results revealed that, in comparison to the CG of patients receiving routine nursing, patients in the SG, who received additional venous access nursing, exhibited significantly lower scores in anxiety and depression assessments, suggesting that the implementation of proactive venous access nursing could alleviate the anxiety and depression emotions in painless colonoscopy patients. The authors of this study analyze that, although patients do not experience explicit anguish during the painless colonoscopy process, this examination still belongs to an invasive procedure, inducing significant discomfort in patients. Furthermore, given that most patients lack experience with painless colonoscopy, it is inevitable that they may have apprehensive sentiments towards the examination, consequently giving rise to anxiety and depressive emotions.[21,22] Mild anxiety and depression contribute to enhancing patient adherence to medical examinations, but excessive anxiety and depression may diminish patient adherence to medical treatment and even increase the incidence of adverse events during examinations.[23] Therefore, it is imperative to give adequate attention to patients’ anxiety and depression. In this research, the patients in the SG underwent venous access nursing measures, including comprehensive and all-encompassing nursing. The comprehensive nursing approach, through proactive assessment of the venous access, precise vascular selection, and effective fixation measures, significantly mitigated adverse stimuli on the patients during procedures, which maximized patient intraoperative comfort, contributing to ameliorating their adverse emotional states. Li et al[24] found that adverse emotions including anxiety and depression had impacts on the required dosage of propofol for patient sedation, with patients in anxious states requiring higher dosages of propofol to achieve an equivalent level of sedation compared to those without anxiety. The authors of this study contend that actively adjusting anxiety and depression emotions in painless colonoscopy patients contributes to a reduction in the required dosage of propofol during the procedure. This, in turn, holds substantial significance for diminishing the occurrence of various postoperative adverse events in patients, and is one of the reasons for the lower incidence of adverse events in the SG compared with the CG. The lack of statistical significance in the difference of adverse event incidence between the 2 patient groups in this study may be attributed to the relatively smaller number of cases in each group.

In this study, the differences in bowel preparation and examination time were further compared between the 2 groups, and the results showed that the SG exhibited lower OBPS scores, higher adequacy of bowel preparation, and shorter colonoscopy insertion time and colonoscopy withdrawal time compared with the CG, suggesting that the patients in the SG had a better bowel preparation and a smoother examination. Cheng et al[25] conducted a prospective observational study on 48 colonoscopy patients and found a significant correlation between anxiety and depression and the presence of bowel air bubbles in patients, and they indicated that excessive anxiety and depression increased the incidence of bowel air bubbles and decreased the efficiency of the examination. Ye et al[26] elucidated in their meta-analysis that proactive health education significantly ameliorated the pain severity and anxiety levels in painless colonoscopy patients, and affirmative health education also augmented patients’ bowel preparation. The authors of this study contend that the venous access nursing administered to patients in the SG is combined with vascular care, health education, and psychological intervention. These measures not only ameliorate anxiety and depressive emotions in painless colonoscopy patients, but also enhance their cognitive awareness and compliance with the examination, which contributes to improving their bowel preparation, laying a good foundation for the subsequent examination, and shortening the duration of the useless examination.

5. Conclusions

In conclusion, application of venous access nursing in patients undergoing painless colonoscopy may help alleviate adverse emotions such as anxiety and depression, improve adequacy of bowel preparation of patients, and shorten colonoscopy insertion time and colonoscopy withdrawal time, thus warranting recognition for its safety and efficacy.

Author contributions

Conceptualization: Linzhen Zhu, Linlin Zhu, Chengfeng Jin.

Data curation: Linlin Zhu, Chengfeng Jin.

Formal analysis: Linlin Zhu, Chengfeng Jin.

Investigation: Linlin Zhu, Chengfeng Jin.

Validation: Linlin Zhu, Chengfeng Jin.

Writing – original draft: Linzhen Zhu.

Writing – review & editing: Linzhen Zhu.

Abbreviations:

CG the control group

OBPS Ottawa Bowel Preparation Score

SAS Self-Rating Anxiety Scale

SD standard deviation

SDS Self-Rating Depression Scale

SG the study group

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Zhu L, Zhu L, Jin C. An observational study on the modulation of anxiety, depression, and adverse event incidence in painless colonoscopy patients through venous access nursing. Medicine 2024;103:38(e39575).
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