Urokinase meta-analysis

The authors completed a meta-analysis of prospective randomized trials that examine the use of Urokinase Read more

Venepuncture practice

Irene Lavery and Emma Smith from the Western General Hospital, Edinburgh contrast and compare the skill of venepuncture against the 2008 Nursing and Midwifery Council Code.

Lavery, I. and Smith, E. (2008) Venepuncture practice and the 2008 nursing and Midwifery Council Code. British Journal of Nursing. 17(13), p.824-828.

Abstract:

This article explores the new Nursing and Midwifery Council Code (2008) in relation to venepuncture and, through analysing each clause, will present key considerations for good practice. The skill of venepuncture is discussed and, using a scenario, will review the technique and the impact of the Code on the practitioner. Any clinical skill requires safe and competent practice; it is hoped that this article will aid practitioners involved in undertaking venepuncture to reflect on their skills and knowledge, and to review best practice.

Safe transfusion

The authors examine issues that impact upon the successful implementation of national guidance such as the NHS better blood transfusion programme and the NPSA safer practice notice 14, right patient, right blood.

Gray, A., Hart, M., Dalrymple, K. and Davies, T. (2008) Promoting safe transfusion practice: right blood, right patient, right time. British Journal of Nursing. 17(13), p.812-817.

Abstract:

Despite an array of initiatives designed to support the delivery of safe and appropriate transfusion practice, incidences of patients receiving the wrong blood continue to be reported. Nurses play a key role in delivering safe and appropriate transfusion care and have a responsibility to support national initiatives, such as the NHS Better Blood Transfusion programme of action and the National Patient Safety Agency Safer Practice Notice 14, Right Patient, Right Blood. This article examines factors, which impact on the successful implementation of a programme aimed at promoting best transfusion practice, such as organizational support, leadership, education and competency assessment, and the role of audit and feedback. By championing the  systematic assessment of transfusion procedures, the implementation of education and guidelines and the use of innovative approaches, such as care bundles, we can ensure that nurses have the appropriate knowledge, skills and understanding to provide the highest standards of transfusion care to our patients.

 

Systematic review anti-infective CVC

These two recently published systematic reviews consider the impact of anti-infective-treated central Read more

Intraosseous access in children

This article reviews the safety of powered intraosseous devices in pediatric patients. The authors state that ”the rare and minor complications suggest that the powered IO device is a safe and effective means of achieving vascular access in the resuscitation and stabilization of pediatric patients” (Horton and Beamer 2008).

Horton, M.A. and Beamer, C. (2008) Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatric Emergency Care. 24(6), p.347-350.

Abstract:

OBJECTIVE: For decades, intraosseous (IO) access has been a standard of care for pediatric emergencies in the absence of conventional intravenous access. After the recent introduction of a battery-powered IO insertion device (EZ-IO; Vidacare Corporation, San Antonio, TX), it was recognized that a clinical study was needed to demonstrate device safety and effectiveness for pediatric patients.

METHODS: We measured the insertion success rate, patient pain levels during insertion and infusion, insertion time, types of fluid and drugs administered, device ease of use on a scale of 1 (easy) to 5 (difficult), and complications.

RESULTS: There were 95 eligible patients in the study; 56% were males. Mean patient age was 5.5 +/- 6.1 years. Successful insertion and infusion was achieved in 94% of the patients. Insertion time was 10 seconds or less in 77% of the one-attempt successful cases reporting time to insertion. There were 4 minor complications (4%), but none significant. For patients with a Glasgow Coma Scale (GCS) score >8, mean insertion pain score was 2.3 +/- 2.8, and mean infusion pain score was 3.2 +/- 3.5. The device was rated easy to use 71% of the time (n = 49) and the mean score was 1.4.

CONCLUSIONS: The results of this study support the use of the powered IO insertion device for fluid and drug delivery to children in emergency situations. The rare and minor complications suggest that the powered IO device is a safe and effective means of achieving vascular access in the resuscitation and stabilization of pediatric patients.

Fist clenching during phlebotomy

The authors describe the potential impact of fist clenching during blood sampling upon the incidence of pseudohyperkalaemia.

Bailey, I.R. and  and Thurlow, V.R. (2008) Is suboptimal phlebotomy technique impacting on potassium results for primary care? Annals of Clinical Biochemistry. 45(3), p.266-269.

Abstract:

Background: Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local phlebotomy clinics optimized their technique.

Methods: The effect of improving phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive.

Results: Primary care population serum potassium was inversely related to ambient temperature. Following the change in phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%.

Conclusions: Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during phlebotomy to pseudohyperkalaemia has been underestimated.

Pediatric CVAD blood sampling

Kathleen Adlard examines the issues of central venous access device blood sampling from pediatric cancer patients.

Adlard, K. (2008) Examining the Push—Pull Method of Blood Sampling From Central Venous Access Devices. Journal of Pediatric Oncology Nursing. 25(4), p.200-207.

Abstract:

“The placement of a central venous access device (CVAD) has revolutionized supportive care for pediatric cancer patients. The CVAD is used to administer chemotherapy/biotherapy, blood products, total parenteral nutrition, antibiotics, and many other supportive medications. CVADs also provide the ability to obtain blood samples without the trauma associated with venipuncture. Frequent blood sampling is often needed to monitor the side effects and response of the cancer treatment. Unfortunately, the most common method requires discarding blood (0.5-10 mL, depending on the institution’s protocol) with each lab draws, for various reasons. For pediatric oncology patients, this can result in a large volume of blood being discarded and subsequently increase the need for blood transfusions. Repeated exposure to allogeneic (donor) blood products can put this patient population at additional risk for alloimmunization and febrile reactions. The purpose of this study is to test the limits of agreement between laboratory values (chemistry panel 18 and complete blood count) obtained using the push—pull and standard methods of blood sampling from CVADs in pediatric oncology patients” (Adlard 2008).

Fatal injection of ranitidine

This case study describes the case of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac(R) 50mg prescribed as a routine post-surgical prophylaxis for stress ulcer.

Oliva, A. et al (2008) Fatal injection of ranitidine: a case report. Journal of Medical Case Reports. 2, p.232.

Abstract:

Introduction: Ranitidine hydrochloride (Zantac®), a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature.

Case presentation: We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac® 50mg prescribed as a routine post-surgical prophylaxis for stress ulcer. 

Conclusions: Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients. 

Click here to view the article.

Neonatal IV dressing

Neonatal IV dressing technique is under represented in the literature. This article attempts to redress the balance.

Sharpe, E.L. (2008) Tiny Patients, Tiny Dressings: A Guide to the Neonatal PICC Dressing Change. Advances in neonatal care. 8(3), p.150-62.

Abstract:

Advances in neonatology now support the survival of the tiniest of infants. The peripherally inserted central catheter (PICC) has now become an integral part of routine practice in neonatal intensive care units around the world. Keen attention to safe maintenance of these devices is essential. A properly applied and maintained PICC dressing is the first line of defense to minimize the risk of complications such as dislodgement, migration, and infection. This article describes a neonatal PICC dressing change and discusses the frequently encountered quandaries surrounding this important procedure, including dressing materials, frequency, site preparation, barrier precautions, and other relevant concerns.

 

External jugular Groshong catheter

This article attempts to demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access.

Ishizuka, M., Nagata, H., Takagi, K., Horie, T., Furihata, M.., Nakagawa, A. and Kubota, K. (2008) External jugular Groshong catheter is associated with fewer complications than a subclavian Argyle catheter. European surgical research. 40(2), p. 197-202.

Abstract:

BACKGROUND: To demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access. METHODS: Central venous access was done by either insertion of a Groshong catheter via the EJV or an Argyle catheter via the subclavian vein with single puncture. RESULTS: Eighty patients (group 1) were treated with 146 subclavian venous catheters for 2,770 catheter-days, and 98 patients (group 2) were treated with 147 external jugular venous catheters for 2,381 catheter-days. Fever appeared in 36.3% (53/146) and 16.3% (24/147) of the patients in groups 1 and 2, respectively (p < 0.01). The malposition and pneumothorax rates were 17.1% (25/146) and 2.0% (3/147; p < 0.01), and 2.7% (4/146) and 0% (0/147; p < 0.05) in the two groups, respectively. CONCLUSIONS: Insertion of a Groshong catheter via the EJV is more acceptable for central venous access than insertion of a conventional subclavian venous catheter.

 

PICC’s for children with cancer

This article describes PICC’s as a convenient, reliable vascular access device for children with cancer.

Abedin, S. and Kapoor, G. (2008) Peripherally inserted central venous catheters are a good option for prolonged venous access in children with cancer. Pediatric Blood & Cancer. 51(2), p. 251-5.

Abstract:

BACKGROUND: A long term venous access device is essential in children with malignancies for the safe administration of medication and to avoid repeated painful venipunctures. The advantage of peripherally inserted central venous catheters (PICC) over conventional central venous catheter (CVC) is easy bedside insertion without need for general anesthesia and theatre time. The purpose of this study was to evaluate our experience with PICCs particularly with regard to catheter life, reason for removal and complications in children suffering from various malignancies. PROCEDURE: A retrospective analysis of all PICCs inserted in children with cancer was done with regard to the demographic data, catheter life, reason for removal, and complications. The latter two were evaluated in association with patient age, catheter days, and year of insertion. RESULTS: Of 127 catheters inserted in 127 children, median catheter life was 161 days with a total of 18,955 catheter days (for 124 patients, 3 lost to follow-up). Elective removal occurred in 63/101 (62.4%) PICCs and removal due to complications resulted in a complication rate of 2.41 per 1,000 catheter days. The common reasons for catheter removal were suspected infection, breakage/leakage, dislodgement, phlebitis, and occlusion with rates of 1.27, 0.57, 0.31, 0.06, and 0.06 per 1,000 catheter days, respectively. CONCLUSION: We found PICC to be a convenient, cheap, safe, and reliable device for long term intravenous access in children with malignancies. This was possible with the help of dedicated catheter care nurses.

 

Vascular access infection control

This article highlights the importance of education in infection prevention. The authors illustrate that procedures may be common place, however they discover that the delivery of education related to vascular access and infection prevention is limited.

Higgins, M. and Evans, D.S. (2008) Nurses’ knowledge and practice of vascular access infection control in haemodialysis patients in the republic of ireland. Journal of Renal Care. 34920, p.48-53.

Abstract:

“Vascular access hygiene is an integral component of haemodialysis care. Ensuring nurses possess sufficient knowledge and utilise recommended guidelines on infection control is essential for safe practice and patient safety. The study aimed to investigate nurses’ knowledge and practice of vascular access infection control among adult haemodialysis patients in the Republic of Ireland. A confidential self-completion questionnaire was sent to all 190 qualified nurses employed in nine haemodialysis units in the Republic of Ireland, which assessed knowledge and behaviour in infection control. Although 92% of respondents reported that policies had been developed by their units and 47% had received infection control education in the previous year, knowledge and adherence to best practice demonstrated significant scope for improvement. The study recommended the development of standard guidelines and regular reviews and updates of policies. Systems should also be developed to ensure a high level of compliance” (Higgins and Evans 2008).

Neonatal procedure pain

A paper in JAMA examines painful and stressful procedures in neonates cared for in Parisian intensive care units, and comes to the conclusion that on average, each baby undergoes about 10 painful procedures a day, the majority with no analgesia at all. Many of these are repeated failures of common procedures such as insertions of intravenous cannulas or central catheters. The authors acknowledge the difficulties of effective analgesia in neonates, but suggest that the evidence that early pain can have lasting consequences means ICU staff need to think carefully about the risks and benefits of ‘routine’ practices

Carbajal et al (2008) Epidemiology and Treatment of Painful Procedures in Neonates in Intensive Care Units. JAMA. 300, p.60-70. 

Refeeding syndrome

This recently published article in the BMJ reminds us of the critical issues associated with refeeding syndrome.

Mehanna, H.M., Moledina, J. and Travis, J. (2008) Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 336, p.1495-1498.

Abstract:

“Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs. This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion. Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome. These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association” (Mehanna et al 2008).

Central venous access devices

Lynn Hadaway  has recently published an article that examines the essential care issues of central venous access devices.

Hadaway, L. (2008) Targeting therapy with Central Venous Access Devices. Nursing. 38(6), p.34-40.

Abstract: 

Zero in on your role in managing these common I.V. catheters so you can protect your patient from complications.

 

 

Topics in this article include:

• CVAD location
• Preventing infection
• CVAD management guidelines
• Stabilization advice
• Dressing changes
• Facts about flushing
• Flush solution
• Blood reflux after flushing
• Needlefree devices
• Removing the catheter

 

Jugular v Femoral catheterization

Parienti et al (2008) compare the risk of nosocomial complications associated with jugular and femoral central catheterization.

Parienti J.J., Thirion M., Megarbane B., Souweine B., Ouchikhe A., Polito A., Forel J.M., Marque S., Misset B., Airapetian N., Daurel C., Mira J.P., Ramakers M., du Cheyron D., Le Coutour X., Daubin C., Charbonneau P. and Members of the Cathedia Study Group (2008) Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA, 299(20), p.1538-3598.

Abstract:

“Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access. To determine whether jugular catheterization decreases the risk of nosocomial complications compared with femoral catheterization. A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia Study) of 750 patients from a network of 9 tertiary care university medical centers and 3 general hospitals in France conducted between May 2004 and May 2007. The severely ill, bed-bound adults had a body mass index (BMI) of less than 45 and required a first catheter insertion for renal replacement therapy. Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites. Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection. Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). The risk of catheter colonization at removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs 35.7 per 1000 catheter-days; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term 28.4). The rate of catheter-related bloodstream infection was similar in both groups (2.3 vs 1.5 per 1000 catheter-days, respectively; P = .42). Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma” (Parienti et al 2008).

Community IV care

Linda Kelly has recently published an article that examines the care of vascular access devices in community care.

Kelly, L. (2008) The care of vascular access devices in community care. British Journal of Community Nursing. 13(5), p.1462-4753.

“Infusion therapy is now an integral part of the majority of nurses’ professional practice (RCN, 2006). Infusion therapy is no longer confined to secondary care, and home intravenous therapy is becoming more commonplace (Keyley, 2002). As nurses, we are responsible for maintaining our skills and knowledge in relation to all aspects of patient care (RCN, 2006). This article provides an overview of the types of vascular access devices used in primary care, and provides guidance and recommendations to ensure best practice. Although there are many complications associated with vascular access devices (Docherty, 2006) this article will focus on the prevention of infection and maintainace of catheter patency in vascular access devices. Infection is one of the most serious complications that can result from the presence and use of a central venous catheter (Humar et al. 2000), however careful management of these devices can minimize the complications associated with infusion therapy” (Kelly 2008). 

 

Preparing IV’s

Bruce Flickinger writes about the legislation associated with compounding sterile preparation.

“Things have changed in the past 20 years. Although avoiding contamination may be possible in such uncontrolled conditions, nobody now would admit to mixing intravenous and other sterile preparations on an open countertop. Doing so could cost a pharmacist his license and his livelihood, not to mention potentially compromise the safety of his patients and employees”.

Bruce further writes… “Standards for sterility and safety now have been codified in USP Chapter <797>, a federally enforceable standard introduced in 2004 and published in revised and updated form just this month”.

Click here for the full online article.

 

Medicine administration errors

This excellent recently published article brings together both history and recent guidance associated with drug errors. It is particularly relevant due to the recent NPSA interest in heparin errors.

Click here for the article on redorbit.com

Venkatraman R. and Durai R. (2008) Errors in medicine administration: how can they be minimised? Journal of perioperative practice. 18(6), p.249-253.

Abstract:

“Errors in medicine administration often go unnoticed and unreported. This article describes three medicine-related errors and provides recommendations to reduce risk. All medicinerelated errors should be reported locally and to the National Patient Safety Agency (NPSA) so that they can be collated and trends identified. Electronic prescribing and patient/medicine identification by bar codes, double checking and using colour coded syringes for intravenous and enteral administration, employing more clinical pharmacists and regular education may reduce medicine-related errors” (Venkatraman and Durai 2008).

Vancomycin administration

In this collaborative work between Brazil and the UK the authors describe mistakes made by staff during the administration of intravenous Vancomycin.

Hoefel H., Schmitt C., Soares T. and Jordan S. (2008) Vancomycin administration: mistakes made by nursing staff. Nursing Standard. 22(39), p. 35-42.

Abstract:

“Aim: To identify the number and types of errors made by assistant and technical nurses when administering intravenous (IV) vancomycin.

Method: Preparation and IV administration of 143 doses of vancomycin by 55 assistant and technical nurses were observed in four acute wards (three adult and one paediatric) in a public university hospital in Brazil. Non-participant observers completed a structured checklist for each dose.

Results: A total of 27 (19%) doses were administered correctly and 116 (81%) incorrectly. There were 268 errors of four types: (i) incorrect dose; (ii) improper preparation of a dose; (iii) inadequate administration technique; and (iv) infusion at an incorrect rate. For 13 of 143 (9%) doses, errors occurred in all four aspects of administration. Errors were observed on all four wards.

Conclusion: The high incidence of suboptimal administration of vancomycin observed is a cause for concern. Focused education and safety measures have been introduced and their impact is being evaluated” (Hoefel et al 2008).

 

Central venous catheter tip sampling

In a recent edition of the Nursing Times, John Guest has written a brief procedural type overview of central venous catheter tip collection.

Guest J. (2008) Specimen collection: Central venous catheter tip collection. Nursing Times. 104(22), p.20-21.

Abstract:

“The removal of CVC’s should be carried out by those familiar with the procedure and those who are aware of the potential risks” (Guest 2008).

Needlefree lidocaine study

This study by Zempsky et al (2008) compares needle-free powder lidocaine with a placebo. Readers may also be interested in reading about Zingo in our product section.

Zempsky W.T., Bean-Lijewski J., Kauffman R.E., Koh J.L., Malviya S.V., Rose J.B., Richards P.T. and Gennevois D.J. (2008) Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: randomized, double-blind comparison of venipuncture and venous cannulation pain after fast-onset needle-free powder lidocaine or placebo treatment trial. Pediatrics. 121(5), p.979-987.

Abstract:

“The Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial was a randomized, single-dose, double-blind, phase 3 study investigating whether a needle-free powder lidocaine delivery system (a sterile, prefilled, disposable system that delivers lidocaine powder into the epidermis) produces effective local analgesia within 1 to 3 minutes of venipuncture and peripheral venous cannulation procedures in children. Pediatric patients (3-18 years of age) were randomly assigned to treatment with the needle-free powder lidocaine delivery system (0.5 mg of lidocaine and 21 +/- 1 bar of pressure; n = 292) or a sham placebo system (n = 287) at the antecubital fossa or the back of the hand 1 to 3 minutes before venipuncture or cannulation. All patients rated the administration comfort of the needle-free systems and the pain of the subsequent venous access procedures with the Wong-Baker Faces Pain Rating Scale (from 0 to 5). Patients 8 to 18 years of age also provided self-reports with a visual analog scale, and parents provided observational visual analog scale scores for their child’s venous access pain. Safety also was assessed. Immediately after administration, mean Wong-Baker Faces scale scores were 0.54 and 0.24 in the active system and sham placebo system groups, respectively. After venipuncture or cannulation, mean Wong-Baker Faces scale scores were 1.77 +/- 0.09 and 2.10 +/- 0.09 and mean visual analog scale scores were 22.62 +/- 1.80 mm and 31.97 +/- 1.82 mm in the active system and sham placebo system groups, respectively. Parents’ assessments of their child’s procedural pain were also lower in the active system group (21.35 +/- 1.43 vs 28.67 +/- 1.66). Treatment-related adverse events were generally mild and resolved without sequelae. Erythema and petechiae were more frequent in the active system group. The needle-free powder lidocaine delivery system was well tolerated and produced significant analgesia within 1 to 3 minutes” (Zempsky et al 2008).

Smart infusion

Linda Murdoch and Victoria Cameron from St George’s hospital, London, UK have recently published a smart infusion technology article in the British Journal of Nursing.

Murdoch L.J. and Cameron V.L. (2008) Smart infusion technology: a minimum safety standard for intensive care? British Journal of Nursing. 17(10), p.630-636.

Abstract:

“There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George’s Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the author’s’ ICU, which demonstrates their experiences with smart pumps. It is the authors’ firm belief that smart infusion technology sets a new minimum safety standard for intensive care” (Murdoch and Cameron 2008).

 

Drug calculations for nurses

Kerri Wright a Senior Lecturer at the University of Greenwich, London, UK has written a series of two articles describing the issue of drug calculations.

Wright K. (2008) Drug calculations part 1: a critique of the formula used by nurses. Nursing Standard. 22(36), p.40-42.

Abstract:

“The role of mathematics is integral to nursing practice, and careful and accurate calculations are important to help prevent medication errors. This two-part article examines different methods for solving drug calculation problems. The first part critiques the commonly taught nursing drug calculation formula. Part 2, to be published next week, explores a range of other methods that are used in practice to calculate drug dosages” (Wright 2008).

 

Wright K. (2008) Drug calculations part 2: alternative strategies to the formula. Nursing Standard. 22(37), p.42-44.

 

Abstract:

“Drug calculations are an essential skill for nurses. The clinical skill of performing a drug calculation has come under recent scrutiny, resulting in the development of essential skills clusters in which pre-registration nurses must be competent before qualifying (nursing and Midwifery Council 2007). The focus on drug calculation skills places renewed emphasis on how these skills are taught in higher education institutions and how they are learned by students theoretically and in clinical practice. Part 1 of this article (Wright 2008) examined the frequently cited drug formula as a method of calculating drug dosages, demonstrating the complex mathematical knowledge and skills required to use this method and the potential problems that reliance on this method could pose. Part 2 outlines other methods and straegies that can be used to calculate drug dosages, while keeping the calculation close to the clinical context” (Wright 2008).

 

Home IV therapy

Alison Cousins et al (2008) describe international experiences with home IV treatment for Fabry disease.

Cousins A., Lee P., Rorman D., Raas-Rothschild A., Banikazemi M., Waldek S. and Thompson L. (2008) Home-based infusion therapy for patients with Fabry disease. British Journal of Nursing. 17(10), p.53-57.

Abstract:

“Fabry disease is an inherited, progressive, life-threatening disease; therefore, lifelong therapy is needed. By replacing the deficient enzyme, disease progression may be delayed or halted, thereby avoiding serious complications. Hospital-based agalsidase therapy is generally perceived as inconvenient and home-based infusion therapy is greatly appreciated by patients, their families and healthcare professionals. Patients can get familiar with infusion therapy in a hospital setting and, if specific requirements are fulfilled, routine nurse-assisted infusion, or self-care at the patients home can be organized. A stable patient who tolerates the infusion and a suitable home environment are prerequisites for home therapy. The authors’ clinical experiences underscore the safety and practicality of home therapy. In addition to a major positive impact on the patient’s quality of life, home infusion therapy may reduces the constraints of hospital resources. This article reviews the collective experiences with agalsidase beta home infusion therapy and outlines how safe, patient-centred homecare can be organized. Home infusion therapy with Fabrazyme® should not be withheld from patients considered eligible according to the proposed criteria. Similar approaches to other enzyme therapies are also possible” (Cousins et al 2008).

Refeeding syndrome

Mary Ann Yantis and Robyn Velander have recently published an article that examines the issues of refeeding syndrome.

Yantis M.A. and Velander R. (2008) How to recognize and respond to refeeding syndrome. Nursing2008. 38(5), p.34-39.

 

Abstract:

“Severely malnourished patients can experience significant fluid shifts and electrolyte imbalances after aggressive nutritional is initiated. This potentially lethal disorder, known as refeeding syndrome (RFS), is usually associated with PN, but it can occur with enteral nutrition (EN), oral intake or dextrose-containing I.V. fluids.

Although information about RFS is available in nutrition journals, it isn’t widely discussed in general nursing literature. We’ll fill that gap with this article by discussing how to identify this dangerous complication and what to do about it” (Yantis and Velander 2008).

 

Topical local anaesthesia review

Various topical local anaesthetics are commercially available. This randomized double-blind trial reviews two alternative products.

Arendts G., Stevens M. and Fry M. (2008) Topical anaesthesia and intravenous cannulation success in paediatric patients: a randomized double-blind trial. British Journal of Anaesthesia. 100(4), p.521-4.

Abstract:

“It is not known whether the choice of topical anaesthetic influences the likelihood of successful i.v. cannulation in the paediatric population. The null hypothesis of this study was that no difference exists in the initial success rate of cannulation between two commonly used topical anaesthetics. A randomized double-blind trial conducted on patients between the age of 12 months and 12 yr presenting to a tertiary hospital emergency department. Patients requiring cannulation were randomized to either 4% amethocaine gel (AnGEL) or 5% lidocaine and prilocaine in a 1:1 emulsion (EMLA). The primary endpoint was success of initial attempt at i.v. cannulation. One hundred and seventy-seven patients were analysed of 203 enrolled. The success rate of AnGEL (73/97, 75%) and EMLA (59/80, 74%) did not significantly differ (chi2(1) 0.05, P=0.82). No difference exists in the cannulation success rates between the two anaesthetics. The choice of topical anaesthetic in paediatric cannulation should be based on other factors such as cost, time to anaesthesia, efficacy of the agent, and adverse effect profile” (Arendts et al 2008).

Distraction ‘v’ pain during cannulation

This small inventive study illustrates the potentional of a novel approach to distraction during cannulation.

Agarwal A., Yadav G., Gupta D., Tandon M., Singh P.K. and Singh U. (2008) The role of a flash of light for attenuation of venous cannulation pain: a prospective, randomized, placebo-controlled study. Anesthesia & Analgesia. 106(3), p.814-6.

Abstract:

“Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain. Ninety adults (15-60 yr), ASA physical status I and II, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group I (control); Group II (distraction): photographed without a flash of light; and Group III (flash): photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula. Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i.e., 50% (14 of 28) when compared to 100% (28 of 28) observed in the other two study groups” (Agarwal et al 2008).

Reducing hemolyzed samples in ED

Hemolyzed samples from the emergency department are common place. This article demonstrates the sampling from IV catheters may increase the incidence of hemolysis.

Lowe G., Stike R., Pollack M., Bosley J., O’Brien P., Hake A., Landis G., Billings N., Gordon P., Manzella S. and Stover T. (2008) Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques. JEN: Journal of Emergency Nursing. 34(1), p.26-32.

Abstract:

“Re-collection of hemolyzed blood specimens delays patient care in overcrowded emergency departments. Our emergency department was unable to meet a benchmark of a 2% hemolysis rate for the collection of blood samples. Our hypothesis was that hemolysis rates of blood specimens differ dependent on the blood collection technique by venipuncture or intravenous catheter draw. A prospective, cross-over study of blood collection techniques in a 64,000 annual visit, community teaching hospital emergency department was conducted. Eleven experienced registered nurses with more than 2 years’ ED experience completed a standardized phlebotomy retraining session. Registered nurses were randomly assigned to collect samples via intravenous catheters or venipuncture. After nurses collected 70 samples, they then collected samples via the other method. A standardized data collection form was completed. Blood samples were processed and assessed for hemolysis using standard procedures by laboratory technicians who were blinded to the collection method. A total of 853 valid samples were collected; 355 samples (41.6%) were drawn via venipuncture and 498 samples (58.4%) were drawn through an intravenous catheter. Of these, 28 intravenous catheter samples (5.6%) were found to be hemolyzed, whereas only 1 venipuncture sample (0.3%) was hemolyzed. This finding was significant (x2 < 0.001). Experienced ED nurses can reduce the number of hemolyzed specimens by collecting via venipuncture instead of through intravenous catheters. This practice should be considered as standard of care in the ED setting” (Lowe et al 2008).

 

Medication safety and job satisfaction

Medication safety, nursing, job satisfaction and management go hand-in-hand.

Bowcutt M., Rosenkoetter M.M., Chernecky C.C., Wall J., Wynn D. and Serrano C (2008) Implementation of an intravenous medication infusion pump system: implications for nursing. Journal of Nursing Management. 16(20, p.188-97.

Abstract:

“To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses” (Bowcutt et al 2008).

 

Neonatal vascular access

Articles that report on neonatal vascular access are not commonplace. Therefore, we are pleased to draw your attention to this recent article.

Ramasethu J. (2008) Complications of vascular catheters in the neonatal intensive care unit. Clinics in Perinatology. 35(1), p.199-222.

Abstract:

“Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU. With every passing decade, technological innovations in catheter materials and sizes have allowed vascular access in infants who are smaller and sicker for purposes of blood pressure monitoring, blood sampling, and infusion of intravenous fluids and medications. There is, however, growing recognition of potential risks to life and limb associated with the use of intravascular catheters. This article reviews complications of venous and arterial catheters in the neonatal ICU and discusses treatment approaches and methods to prevent such complications, based on current evidence” (Ramasethu 2008).

Impressive fall in needlestick injuries

These authors have demonstrated  an impressive fall in needlestick injuries with minimal cost outlay.

Whitby M., McLaws M.L. and Slater K (2008) Needlestick injuries in a major teaching hospital: the worthwhile effect of hospital-wide replacement of conventional hollow-bore needles. American Journal of Infection Control. 36(3), p.180-6.

Abstract:

“Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital. NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004). Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US $90,000 per annum. Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay” (Whitby et al 2008).

Postoperative pain in children

NEW YORK (Reuters Health) write - Postoperative pain in children with cancer can be safely managed with simultaneous epidural and intravenous opioids, according to researchers at St. Jude Children’s Research Hospital in Memphis, Tennessee.

Anghelescu D.L., Ross C.E., Oakes L.L. and Burgoyne L.L. (2008) The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients. Journal of pain and symptom management. 35(4), p.412-419.

Abstract

“Supplementation of epidural opioid analgesia with intravenous opioids is usually avoided because of concern about respiratory depression. However, the choice of adjunct analgesic agents for pediatric oncology patients is limited. Antipyretic drugs may mask fever in neutropenic patients, and nonsteroidal anti-inflammatory agents may exert antiplatelet effects and interact with chemotherapeutic agents. We examined the safety of concurrent use of epidural and intravenous opioids in a consecutive series of 117 epidural infusions in pediatric patients and compared our findings to those reported by other investigators. We observed a 0.85% rate of clinically significant respiratory complications. The single adverse event was associated with an error in dosage. In our experience, the supplementation of epidural opioid analgesia with intravenous opioids has been a safe method of postoperative pain control for pediatric patients with cancer” (Anghelescu et al 2008).

 

Journal of Infusion Nursing

The May 2008 edition of the The Journal of Infusion Nursing has been published. The content of this edition includes:

Hall G. and Esser E. (2008) Challenges of care for the patient with acute kidney injury. Journal of Infusion Nursing. 31(3), p.150-156.

Abstract

“Acute kidney injury (AKI) can be a devastating problem for hospitalized patients. Whether it is acute or chronic renal failure, or a result of prerenal, postrenal, or intrarenal causes, AKI greatly increases mortality as well as inpatient cost. This article provides an overview of AKI, along with specific information to arm the infusion nurse to optimise patient care for the long term” (Hall and Esser 2008).

 

Hertzog D.R. and Waybill P.N. (2008) Complications and controversies associated with PICCs. Journal of Infusion Nursing. 31(3), p.159-163.

Abstract

“The placement of peripherally inserted central catheters has grown into one of the most common forms of intravenous access. Although complications associated with peripherally inserted central catheters are low, most healthcare providors will encounter them on a frequent basis. Awareness of these complications will help the clinician manage these issues appropriately” (Hertzog and Waybill 2008).

 

Nichols I. and Humphrey J.P. (2008) Effiency of upper arm placement of PICCs using bedside ultrasound and microintroducer technique. Journal of Infusion Nursing. 31(3), p.165-176.

Abstract

“In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, speciality nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. this research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital’s rehabilitation facility. Of the 422 catheters removed, none exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection” (Nichols and Humphrey 2008).

 

Tripathi S., Kaushik V. and Singh V. (2008) Peripheral IVs: Factors affecting complications and patency – a randomized controlled trial. Journal of Infusion Nursing. 31(3), p.182-188.

Abstract

“Peripheral intravenous access is a common but stressful pediatric procedure. Though in use for some decades now, there is no consensus on factors affecting the duration of patency and complications. The present study is a randomized controlled trial covering all aspects associated with vascular access. This prospective interventional study was conducted over a period of 6 months in a general pediatric ward of Lady Hardinge Medical College and Associated Kalawati Saran Children’s Hospital. This sample was composed of 88 patients, from neonates to 12-year-olds who were admitted to the pediatric ward, on whom a total 377 catheters were started. Intravenous cannulations were randomized for heparin flushes (1:100 dilution) and splints. Prospective data were collected regarding duration of patency and complications. Both univariate and multivariate analysis were done. There was a statistically significant increase in the duration of patency with the use of heparin flushes. Shorter patency duration and increased complications were associated with younger age, wrist and scalp insertions, and 24-gauge catheters.

 

Improving patient safety

Simon Keady and Meera Thacker offer an insight into the rationale and steps being taken in response to recent NPSA alerts.

Reference

Keady S. and Thacker M. (2008) National Patient Safety Agency: Improving patient safety across all critical care areas. Intensive and Critical Care Nursing. 24, p.137-140.

“The National Patient Safety Agency (NPSA) reviews patient safety incidents throughout the National Health Service (NHS) in the United Kingdom and aims to initiate preventative measures. Recent alerts include injectable medication, oral syringes for enteral administration, preventing hyponatraemia in children and anticoagulation. This article gives an insight into the rationale and steps currently being undertaken to respond to these recommendations” (Keady and Thacker 2008).

Arterial blood gas analysis

Jacqueline Coggon a clinical educator at King’s Mill Hospital, UK has published an article on understanding ABG reports.

Reference

Coggon J.M. (2008) Arterial blood gas analysis 1: Understanding ABG reports. Nursing Times. 104(18), p.28-29.

“This is the first of a two-part unit on arterial blood gas (ABG) analysis, and focusses on background information and basic interpretation of ABGs where no evident compensation is taking place. It discusses the various components on a ABG report, the normal ranges and the significance of abnormal readings. A detailed step-by-step guide to ABG interpretation is available in the Portfolio Pages for this unit at nursingtimes.net, as well as practice examples” (Coggon 2008).

JVAD spring 2008

The spring edition of the The Journal of the Association of Vascular Access has been published. The content of this edition includes:

Dawson R.B. (2008) Nursing Beyond the “Process”: Collegiality and Consultation Improves Outcomes by Protecting the ftissue Integrity of PICC Insertions Sites. The Journal of the Association of Vascular Access. 13(1), p.8.

Abstract

“On a daily basis vascular access nurses are presented with complex patient care issues involving intravenous therapy. The nursing process as an instrument to organize nursing care is valuable; however, is it enough to positively affect patient outcomes? Nursing beyond the fundamental process requires the intent to advocate and protect the patient from unnecessary risk or harm. A patient with impaired tissue integrity from epidermolysis bullosa required a nurse specialist whose practice included advocacy, collegiality and consultation in order to protect a PICC insertion site and prevent complications. The intervention included the use of a soft silicone contact layer (Mepitel) and a transparent semi-permiable membrane dressing (Tegaderm). A new clinical process was born from the collaboration of two nursing professionals and it positively impacted patient outcomes. This is a professional approach to nursing care that is under utilized” (Dawson 2008).

 

Olson C. and Heilman J.M. (2008) Clincal Performance of a New Transparent Chlorhexidine Gluconate Central Venous Catheter Dressing. The Journal of the Association of Vascular Access. 13(1), p.13.

Absract

“As the sciences of vascular access and infection prevention rapidly advance healthcare professionals are often faced with new technologies designed to help, but which are often so complicated to use that they cause unforeseen problems. As a vascular access team at a major mid-western hospital, we evaluated the ease-of-use and the performance characteristics of a new transparent catheter dressing, 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) containing the antimicrobial chlorhexidine gluconate (CHG), with a variety of central venous catheters insertion sites in comparison to a standard non-antimicrobial dressing Tegaderm (3M Health Care, St. Paul, MN). Following IRB approval, sixty-three consenting patients were enrolled and randomized; 33 in the CHG antimicrobial dressing group and 30 in the standard dressing group. Thirty six patients had peripherally inserted central catheters (PICCs), 20 had intrajugular insertions (IJ), and 7 had subclavian insertions. The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was evaluated for its ability to permit visualization of the insertion site, ease of use, ease of using correctly, ability to secure the catheter and absorb exudates and remain transparent.

The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was found to be as easy to use in central venous catheter care clinical practice as the standard of care non-antimicrobial transparent adhesive dressing. No additional training or education was needed to properly use it. This dressing was applied and removed like standard transparent adhesive dressings, but offered many advantages over standard dressings. Advantages include that it is antimicrobial, handles moderate bleeding, remains transparent and appears to offer greater catheter securement than the Tegaderm (3M Health Care, St. Paul, MN) standard dressing. The CHG gel pad also conformed well to the catheter” (Olsen and Heilman 2008).

 

Daniels L.S. and Gouvas M.O. (2008) Effects of INR Levels on Bleeding Occurrances During the First 24-hours of Ultrasound Guided PICC Line Insertions. The Journal of the Association of Vascular Access. 13(1), p.22.

Abstract

“A sample of 127 patients with an International Normalized Ratio (INR) of 1.5 or greater, undergoing a Peripherally Inserted Central Catheter (PICC) insertion, were observed for bleeding at the time of insertion and for 24 hours post insertion. Over 60% of patients experienced no or mild bleeding at insertion. For an INR less than 3.0, fewer than 10% of the sample experienced moderate bleeding within the first 24 hours. No PICCs were discontinued due to bleeding. Results suggest that INR levels below 3.0 did not appear to have an impact on amount of bleeding during PICC insertion. After 24 hours, INR levels of 3.0 and above did appear to have an impact on the amount of bleeding” (Daniels and Gouvas 2008).

 

A. Scocca A., Gioia A. and Poli P. (2008) Initial Experience of a Nurse-Implemented Peripherally Inserted Central Catheter Program in Italy. Journal of the Association of Vascular Access. 13(1), p.27.

Abstract

“In Italy prior to 2006 central venous catheters were inserted only by anaesthesiologists. Nurses were excluded based on professional profile. In 2005 the nursing staff of the Pain Therapy and Palliative Care Unit (PTPCU) at Santa Chiara Hospital in Pisa, proposed that nurses be permitted to insert Peripherally Inserted Central Catheters (PICCs). The recommendation was submitted to the Italian National Board of Nurses with a request to implement a training program. The Board approved the proposal in January 2006. Initially the PTPCU nursing staff had PICC training programs through the St. Chiara Hospital Vocational Training Office. The program was initially implemented by a nurse volunteer who had critical care training, intravenous therapy experience and who demonstrated competence with PICC placement based on training by PTPCU interventional anaesthesiologists. To date, nearly 250 successful PICC placements have been performed using the Modified Seldinger TEchnique (MST) in conjunction with ultrasound guidance. Physicians and nurses identified potential candidates and the patients were assessed by the PICC nurse. The combination of PICC/MST was found to facilitate placement in patients with impalpable vessels and above the antecubital fossa as well as improve freedom of movement and reduce the likelihood of patients accidently dislodging the device. The primary reasons for PICC placement included antibiotic or antiviral therapy (26%), total parenteral nutrition administration (35%) and chemotherapy (39%). There were 211 catheters exclusively for inpatients and 39 catheters exclusively for outpatients. The PICC program resulted in an excellent safety profile, a high success rate, and few post-procedural complications. It was a less costly option compared to centrally inserted, tunnelled, or implanted central vascular access devices; it improved the quality of the nursing care and decreased patients’ waiting time for vascular access placement” (Scocca et al 2008).

 

Verhey P.T., Gosselin M.V., Primack S.L., Blackburn P.L. and Kraemer A.C. (2008) The Right Mediastinal Border and Central Venous Anatomy of Frontal Chest Radiograph - Direct CT Correlation. Journal of the Association of Vascular Access. 13(1), p.32.

Abstract

“We describe a direct and accurate method for defining chest radiographic anatomy and use this method to delineate the anatomic composition of the right mediastinal border in an adult population. Intravenous contrast-enhanced computed tomographic scans of the chest and accompanying scout tomograms from 99 adults without previously known or detected cardiopulmonary disease that could potentially distort mediastinal, cardiac, or pulmonary anatomy were retrospectively evaluated. Transverse CT images through the mediastinum were directly referenced to the respective acquisition location on the scout tomogram via the acquisition reference line. The anatomic composition of the right mediastinal border on the scout tomogram was determined by drawing a vertical line tangential to the most lateral right mediastinal structure in each transverse CT image. The lengths and relationships of these structures were tabulated. These results will help to create a consensus among radiologists and other clinicians regarding radiographic anatomy, allowing improved localization of mediastinal pathology and enabling more optimal positioning of vascular and cardiac support services” (Verhey et al 2008).

Superbug iceberg

Edwina Rawson, an associate at Charles Russell Solicitors, writes in the AvMA Medical & Legal Journal about the tip of the superbug iceberg.

“Thousands of patients die or are made seriously ill by healthcare infections, popularly known as ’superbugs’. This is a fact. It is also a fact that a proportion of these could have been avoided if hospitals and staff were, simply, cleaner.

The press is littered with heartbreaking stories of superbugs: 33 die and 334 are infected due to an outbreak of Clostridium difficile at Stoke Mandeville Hospital; 90 die following a similar outbreak at Maidstone Hospital; a two-day old baby dies from MRSA at Ipswich Hospital; a mother dies of MRSA shortly after giving birth at Stoke-on-Trent Hospital; a young nurse dies, a male patient nearly dies and 17 others are infected after a pseudomonas outbreak at Guy’s Hospital. There are many others. It is a major national problem. Despite this, we are told only of the tip of the iceberg. In addition, one would hope that the law provided appropriate redress to superbug victims, but this is often not the case” (Rawson 2008).

Reference

Rawson E. (2008) The tip of the superbug iceberg. AvMA Medical & Legal Journal. 14(2), p.72-76.

 

Drug calculations

Paul Lee, a medical devices training manager at Singleton Hospital, Swansea, UK has published an article that describes a risk-score system for mathematical calculations in intravenous therapy.

“This article outlines a training needs analysis to identify the mathematical confidence levels of qualified staff working in a large, acute NHS trust. A risk scoring tool was developed to gauge the confidence levels of nursing staff using drug calculations in their clinical areas. This now forms part of the organisation’s risk assessment strategy and a learning tool has been developed for intravenous therapy study days” (Lee P. 2008).

Reference

Lee P. (2008) Risk-score system for mathematical calculations in intravenous therapy. Nursing Standard. 22(33), p. 35-42.

Hydration at end of life

Pamela van der Riet, Philip Good, Isabel Higgins and Ludmilla Sneesby have published an article examining palliative care professionals’ perceptions of nutrition and hydration at the end of life.

“The provision of medically administered nutrition and hydration (MNH) for the terminally ill patient is a controversial issue and there has been much debate in the literature concerning this sensitive subject. This article reports on a qualitative research study that explores palliative care nurses’ and doctors’ perceptions and attitudes to patient nutrition and hydration at the end of life. Participants were from an urban and rural palliative care service. Three main discourses were identified: carers’ distress at the non-provision of MNH; palliative care doctors’ and nurses’ position that terminal dehydration lessened the burden of suffering for dying patients; an polarisation between the acute care setting and the palliative care setting. Overlaying these three main discourses are contesting discourses involving cure vs comfort, and acute care vs palliative care. Importantly, the findings of this study reveal that palliative care doctors and nurses believe that medically assisted nutrition and hydration at the end stage of life rarely benefits patients, and as long as adequate mouth care is given, patients do not suffer. However, family members do experience emotional distress in dealing with this situation. In caring for dying people, the nurse’s and doctor’s role is one of education and communication, involving a team approach to manage this difficult issue” (van der Riet et al 2008).

Reference

van der Riet et al (2008) Palliative care professionals’ perceptions of nutrition and hydration at the end of life. International Journal of Palliative Nursing. 14(3), p.145-151.

Syringe drivers in palliative care

John Costello, Brian Nyatanga, Carole Mula and Jenny Hull have written about the benefits and drawbacks of syringe drivers in palliative care.

“This article will outline the use of continuous subcutaneous infusion pumps, known as syringe drivers, including their benefits and drawbacks in a palliative care context. There have been over 5000 articles published globally describing syringe drivers in the medical and nursing literature in the last decade. Many provide guidance on their use, although much of the data are repetitious, disease or age-group specific, and focussed on pragmatic issues to do with clinical application. Several trusts and hospices across the UK are carrying out trials of the recently launched McKinley T34 syringe driver. Therefore, it seems timely to consider their wider use internationally. Globally, practitioners in palliative care are very familiar with their use, although the literature lacks specific guidance and, at times, the information is ambiguous. Having briefly reviewed their benefits, the article considers the limitations  of using syringe drivers and comments on some of the lesser known/reported practical and patient-focussed drawbacks associated with their use. We conclude by considering why, when so much education and training exists to help practitioners use these devices effectively, so many human errors occur” (Costello et al 2008).

Reference

Costello J. et al (2008) The benefits and drawbacks of syringe drivers in palliative care. International Journal of Palliative Nursing. 14(3), p.139-144.

Community IV article

Sue O’Hanlon, Ruth Glenn and Belinda Hazler write in the Nursing Standard (2008) about delivering intravenous therapy in the community setting… “This article provides an overview of how an intravenous (IV) therapy service was developed in one primary care trust in England, the challenges that were faced and how they were overcome. The article includes some recommendations for others considering setting up a community IV therapy team” (O’Hanlon et al 2008).

Reference

O’Hanlon S. et al (2008) Delivering intravenous therapy in the community setting. Nursing Standard. 22(31), p.44-48.

Apheresis article

Sandra Leighton writes about apheresis in the April (2008) edition of Nursing… “During apheresis, a blood component (red cells, white cells, platelets, or plasma) is removed from blood using a cell separator; the remaining blood components are then returned to the donor or patient. Many types of apheresis are available to treat various conditions, from initiating the process of reproducing bone marrow in cancer patients after chemotherapy to treating graft-versus-host disease…” (Leighton 2008).

Reference

Leighton S.C. (2008) The spin on apheresis. Nursing. 38(4), p.29-31.

Journal of Infusion Nursing

Body image

I have always been interested in the impact of IV therapy on body image. Yes I know, I should be concerned about infection etc (well I am)… however, the impact of body image on patients may help to address any number of problems… including those catheter related blood stream infections (CRBSI).

 

CRBSI systematic review

Ramritu et al (2008) publish a systematic review and meta-analysis of catheter related blood stream infections in intensive care units. The full reference is… Ramritu P., Halton K., Cook D., Whitby M. & Graves N. (2008) Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis. Journal of Advanced Nursing 62 (1) , 3–21.

A practical guide to venepuncture and blood sampling

Katie Scales has written this article that provides an overview of the knowledge, skills and equipment required for peripheral venepuncture. In her article Katie also provides a procedure  Read more

IV safety articles