CVC, CRBSI, Infections, procedures, evidence based
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: CVC play an important role in the treatment of critically ill patients. Unfortunately complications such as intravascular catheter related bloodstream infections (CRBSI) often occur. Infections are a major problem in hospitals all over the world, and CRBSI is a serious complication with high mortality rate. There was a need in our hospital to create a new and standardized procedure based on the evidence based knowledge related to prevention of CRBSI in patients with CVC`s.
Aim: Develop a procedure for care and maintenance of CVC in patients at Oslo University Hospital to reduce the number of infections. The procedure aims to include hygienically aspects, care and maintenance.
Methods: A systematic study of literature, were all available evidence based knowledge relevant to our aim is critically summarized. AGREE has been used to evaluate both the available and relevant research and the procedure. An interdisciplinary group representing different specialities collaborated in the process.
Results: Use a non-touch technique or aseptic non-touch technique when handling the CVC. Never touch key parts. The CVC must be secured with sutures and transparent sterile dressing. CVC placement in centimeters should daily be documented in the patient record. The transparent sterile CVC dressing should not be changed more often than every 7th day, unless it is contaminated or loose. Control insertion site daily for signs of infections. Connectors and infusion lines should be changed every 3rd day, but daily be bathed in Chlorhexidine 5 mg/ml. When flushing the CVC, use press-pause technique. Lock the catheter with a positive pressure technique. Use heparin lock if the CVC is not daily in use.
Conclusion:This procedure aims to reduce the number of infections related to CVC. Based on available research, we developed a procedure which summaries the best care and management of CVC`s. To avoid CRBSI in CVC`s, updated evidence based guidelines must be implemented.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Burn Injuries continue to be a major source of mortality and morbidity in low- and middle- income countries of the world of which Nigeria is a part.
We conducted a multi- center survey to evaluate the existence of specific guidelines used in the management of burn injuries in selected tertiary health institutions using a structured questionaire. The outcome of which indicated that while most centers have trained staff (68.4%) with adequate knowledge of burn care, 63.2% do not have standard guideline for burn management, which reflected in the low survival rate (63.2%) in the centers surveyed.
Infection was found to be the leading cause of death (31.6%), which equally supports the absence of burn protocols.
We concluded that despite the advancement in the management of burns in the developed societoes, low and moderate income countries are still backward in this critical issue of burns.
Clinical Clerkship, Intensive Care, Education, Nursing, Associate, Qualitative Research
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Introduction
Students of nursing assistants in intensive care unit (ICU) may feel anxiety and fear for their practice. Are required to be on alert and respond quickly to changes in the patient.
Aim
To describe the experience of the students ( nursing assistants) during their practice at ICU of Fuenlabrada University Hospital.
Methods
-Cualitative study with a phenomenological approach
-Sampling by purpose
-Inclusion criteria: students who have made their practices in the ICU
-Data collection: unstructured interviews. Use of an open question: How have you lived your rotation practice?
-Data analysis: Implementation of the Giorgi´s proposal. Individual meaning units were sorted and resorted as categories, and the patterns, began to emerge
-We developed “Conceptual maps” to identify the topics.
Results
The study was conducted from September 2010 until December 2010. 12 interviews were done, 19 hours of tape recording. The mean age was 21.3 years
The themes identified were:
-Learning process. With 3 subtopics: Figure of tutor, previous experience with illness and professional.
-The ICU as a learning context.
-The role of students. With 1 subtopic: Initiative
-Relationship with the patient, family and other professionals. With 1 subtopic: teamwork.
Conclusions
Students focus their learning in technical and material aspects ,ignoring the patient. They assume a professional rol rather than the students rol. They require a tutor figure, as well as their integration into the professional team. They point the ICU as a different context to learn from all units
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background: Frequent antibiotic use in the ICU patients usually suffers from antibiotic-associated diarrhea (AAD) and consequently having severe complications such as sepsis and leading to unnecessary increase of health care costs. Therefore, the aim of the present study is to evaluate the effects of probiotics to prevent AAD by improving intestinal function.
Methods: A patient / problem intervention comparison of intervention clinical outcome (PICO) problem was formed by the five Evidence-Based Nursing (EBN) steps in this study. AAD and probiotics were regarded as two main key words to search the relevant articles by using a range of medical search sites, including Cochrane library, BMJ Clinical Evidence , PubMed, etc. With the exclusion of literature of non- Clostridium difficile-associated diarrhea, there were three articles selected regarding Lactobacillus and Bifidobacterium. The first article on the Meta-Analysis showed that the ADD risk of patients with receiving probiotic treatment was 0.35 times lower than others, especially in the adult group (RR: 0.44, 95% CI 0.18 ~ 1.08). The other two articles of randomised controlled trials showed the beneficial effects of using probiotics in preventing AAD. The Absolute Risk Reduction (ARR) of the patients with or without probiotics were 22% and 3.3%, and the Number needed to treat (NNT) 5 and 30 respectively.
According to the evidence in the above literature, researchers at Mackay Memorial Hospital developed a selection criteria, educational programs of medical staff and patient instructions, and so forth.With patients’ informed consents, within 48 hours after antibiotics were used, Infloran of 250mg twice daily was prescribed for the enrolled patients for 14 days.During the 2-week period, assessments and records of defecation characteristics were performed.
The Study Results: From March to May 2011, five patients were selected in the project.Three of them were diarrhea-free with defecation frequency of 1~2 times per day, while the other two had suffered from diarrhea since the date that antibiotics were prescribed.The initial results showed that defecation frequency of the latter two patients was reduced to 1~3 times after using probiotics with the stool shape from watery to formed.The use of probiotics may be helpful in patients with AAD regarding defecation frequency and related characteristics.
Conclusion: The project will be carried out in the other intensive care units if there will be more beneficial evidence noted by using probiotics in this regard.
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
INTRODUCTION：Stridor and laryngeal edema are two main problems for removal of endotracheal tube of intensive care unit patients. Re-intubation causes further complications such as prolong days of hospitalization, increase infections rates etc. According to some research papers, removal of endotracheal tube of those patients who had been intubated for more than 24 hours will easily cause laryngeal edema. Medical physicians would give steroid either 30 minutes prior removal of endotracheal tube or one day of steroid then remove next day in attempt to prevent laryngeal edema. But it is still controversial to use prophylactic steroid therapy to reduce the occurrence of postextubation laryngeal edema cause by removal of endotracheal tube. The purpose of this study was to ascertain whether administration of single doses of dexamethasone to critically ill, intubated patients reduces or prevents the occurrence of postextubation airway obstruction.
METHODS: We use the five steps of EBN to Appraisal the literature. Find the single dose of Hydrocortisone before extubation cannot improve postextubation laryngeal edema and prevent the occurrence of stridor, cuff-leak test should alert the clinician of a high risk of upper airway obstruction. Cohorts of 108 translaryngeal intubated patients in the medical intensive care unit (ICU) were enrolled. A cuff leak test was conducted before extubation. If positive cuff-leak test were intravenously given 100mgs of Hydrocortisone every 6 hours for one day. The clinical response and cuff-leak volume before and after steroid treatment were gathered for analysis.
RESULTS: The incidence of postextubation stridor was 7.41% (8/108). No one with stridor needed reintubation. Overall, 100% of patients (8/8) with postextubation stridor improved with steroid treatment.
CONCLUSIONS: A cuff-leak test should alert a high risk of upper airway obstruction and Prophylactic administration of multiple-dose dexamethasone is effective in reducing the incidence of postextubation stridor for postextubation laryngeal edema.
Surgical intensive care unit, Delirium, high risk factor
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
Background
Delirium is one of the most serious problems in the intensive care unit (ICU), which might complicated with serious problem like prolong hospital stay, increased medical expense and mortality.
Purpose
We plan to analysis the incidence and risk factors related to delirium in ICU
Method
This is a descriptive, related and prospective study. For the convenient sampling, 30 patients were collected the surgical intensive care unit in one medical center from 1st October, 2011 to 6th November, 2011.The CAM-ICU and RASS score was used to assessed and diagnose Delirium. The data was analyzed by Chi-square and t-test.
Result
According to our study, the incidence of acute delirium in SICU is 46.7%. There is no significant statistic difference in disease type, gender and age. Solitary and alcoholism (P=.05), physical restriction (P< .01), fever (P< .02) and indwelling catheters (P< .003), high TISS score (P< .002) and low GCS score (P< .03) is statistic difference significantly.
Discussion
For ICU patients, nursing staff should be cautious to prevent the delirium risk factors, including the necessity for indwelling catheters and physical restriction on patients, and the treatment of fever episode. Pay attention to high TISS score and low GCS score patients, in order to reduce the incidence of delirium.
