Intensive Care Nurses’ Views and Practices for Eye Care: An International Comparison

2016 ◽  
Vol 26 (4) ◽  
pp. 504-524 ◽  
Author(s):  
Elem Kocaçal Güler ◽  
İsmet Eşer ◽  
Imad Hussein Deeb Fashafsheh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Normal Saline ◽  
Descriptive Study ◽  
Sterile Water ◽  
Eye Care ◽  
Icu Patients ◽  
Intensive Care Nurses ◽  
Critical Patients

Eye care is an important area of critical care. However, lack of eye care studies is a common issue across the globe. The aim of this study is to determine the views and practices of intensive care unit (ICU) nurses on eye care in Turkey and Palestine. This descriptive study was conducted using a self-administrated questionnaire. The data were collected from 111 nurses in nine kinds of ICUs in two education hospital. Normal saline (75.9%) was the most commonly reported solution for eye hygiene among the Palestinian nurses, and gauze soaked in normal saline or sterile water (64.3%) were the most frequently used supplies by the Turkish nurses. Although both Palestinian and Turkish ICU nurses took some precautions to prevent eye complications in critical patients, there were some gaps and insufficiencies in the eye care of ICU patients. There is a need for continuing training in this area.

scholarly journals Quality improvement of delirium status communication and documentation for intensive care unit patients during daily multidisciplinary rounds

2018 ◽  
Vol 7 (2) ◽  
pp. e000239 ◽  
Author(s):  
Krishna Aparanji ◽  
Shreedhar Kulkarni ◽  
Megan Metzke ◽  
Yvonne Schmudde ◽  
Peter White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Patients ◽  
Quality Metric ◽  
Risk Of Mortality ◽  
Simulation Based ◽  
Multidisciplinary Rounds

Delirium is a key quality metric identified by The Society of Critical Care Medicine for intensive care unit (ICU) patients. If not recognised early, delirium can lead to increased length of stay, hospital and societal costs, ventilator days and risk of mortality. Clinical practice guidelines recommend ICU patients be assessed for delirium at least once per shift. An initial audit at our urban tertiary care hospital in Illinois, USA determined that delirium assessments were only being performed 31% of the time. Nurses completed simulation based education and were trained using delirium screening videos. After the educational sessions, delirium documentation increased from 40% (12/30) to 69% (41/59) (two-proportion test, p<0.01) for dayshift nurses and from 27% (8/30) to 61% (36/59) (two-proportion test, p<0.01) during the nightshift. To further increase the frequency of delirium assessments, the delirium screening tool was standardised and a critical care progress note was implemented that included a section on delirium status, management strategy and discussion on rounds. After the documentation changes were implemented, delirium screening during dayshift increased to 93% (75/81) (two-proportion test, p<0.01). Prior to this project, physicians were not required to document delirium screening. After the standardised critical care note was implemented, documentation by physicians was 95% (106/111). Standardising delirium documentation, communication of delirium status on rounds, in addition to education, improved delirium screening compliance for ICU patients.

The effect of two concentrations of heparin on arterial catheter patency

1990 ◽  
Vol 10 (5) ◽  
pp. 47-57 ◽  
Author(s):  
CS Bolgiano ◽  
PT Subramaniam ◽  
JM Montanari ◽  
L Minick
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Hemodynamic Monitoring ◽  
Arterial Catheter ◽  
Arterial Line ◽  
Routine Procedure ◽  
Icu Patients ◽  
Catheter Patency

The use of invasive lines with heparinized fluid for hemodynamic monitoring is a routine procedure in critical care areas. The main objective of this study was to compare the duration of patency of indwelling arterial catheter lines and patient coagulation values when the recommended dilution of 1.0 U heparin/mL was used versus the use of only 0.25 U heparin/mL. One hundred four intensive care unit (ICU) patients were studied. There were no significant differences between the two groups in patency or coagulation values. The results of the study demonstrated that 0.25 U heparin/mL was sufficient to maintain arterial line patency for patients with lines in place for up to 3 days.

scholarly journals Training of intensive care nurses to handle continuous hemodialysis: a latent condition for safety

2019 ◽  
Vol 72 (suppl 1) ◽  
pp. 105-113 ◽  
Author(s):  
Bianca Ribeiro Porto de Andrade ◽  
Fabiana de Mello Barros ◽  
Honorina Fátima Ângela de Lúcio ◽  
Juliana Faria Campos ◽  
Rafael Celestino da Silva
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Private Hospital ◽  
Structured Interview ◽  
Thematic Content Analysis ◽  
Intensive Care Nurses ◽  
Analysis Technique ◽  
Critical Patients ◽  
Continuous Hemodialysis ◽  
Latent Failure

ABSTRACT Objective: To analyze the repercussions of the training of nurses working in the Intensive Care Unit for the management of continuous hemodialysis regarding the safety of critical patients with acute renal failure. Method: Qualitative research developed considering James Reason's reference in the Intensive Care Unit of a private hospital. The data was collected with 23 nurses who worked for more than three months in the management of continuous hemodialysis through a semi-structured interview, and analyzed with the thematic content analysis technique. Results: There are weaknesses in the training of intensive care nurses for the management of continuous hemodialysis that become a latent failure. Such a failure results in difficulties in handling hemodialysis, with risks for these professionals to commit active failures. Final considerations: The training program in service for the management of continuous hemodialysis must be perfected, to develop skills and competencies in nurses and improve their performance.

scholarly journals Telemedicine coverage for post-operative ICU patients

2016 ◽  
Vol 23 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Tara Ann Collins ◽  
Matthew P Robertson ◽  
Corinna P Sicoutris ◽  
Michael A Pisa ◽  
Daniel N Holena ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surge Capacity ◽  
Icu Patients ◽  
Critical Care Service ◽  
Surgical Critical Care

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

scholarly journals PENGALAMAN PERAWAT TENTANG CARING BERBASIS TEKNOLOGI PADA PASIEN KRITIS DI INTENSIVE CARE UNIT

2018 ◽  
Vol 2 (2) ◽  
pp. 70
Author(s):  
Lina Anggraeni ◽  
Suhartini Ismail
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Sampling Technique ◽  
Phenomenological Approach ◽  
Caring Behaviors ◽  
Central Java ◽  
Technological Competence ◽  
Critical Patients ◽  
High Competence

AbstrakICU merupakan suatu unit dengan pasien yang menerima perawatan intensif dan monitoring yang ketat. Untuk itu, diperlukan perawat yang terlatih secara khusus dengan menggunakan teknik yang canggih dan dapat memenuhi kebutuhan dasar dari pasien. Dengan membangun keseimbangan antara aspek perawatan pasien dan teknologi, perawat akan dapat memberikan perawatan yang lebih efisien dengan kualitas yang lebih tinggi. Penelitian ini bertujuan untuk mendeskripsikan pengalaman perawat tentang caring berbasis teknologi pada pasien kritis di intensive care unit. Penelitian ini merupakan penelitian kualitatif dengan pendekatan deskriptif fenomenologi. Penelitian dilakukan di Himpunan Perawat Critical Care Jawa Tengah. Partisipan penelitian sebanyak 10 perawat yang ditentukan dengan metode purpose sampling. Pengumpulan data dilakukan melalui wawancara mendalam kepada partisipan selama 40-60 menit sesuai dengan pedoman wawancara yang telah disusun sebelum penelitian. Data yang terkumpul dianalisa menggunakan metode Colaizzi. Hasil penelitian menghasilkan tiga tema yaitu kompetensi penggunaan teknologi menjadi bagian dari caring yang harus dimiliki perawat, keseimbangan perilaku caring dan kompetensi teknologi perawat di ruang pelayanan kritis, serta maleficient dan beneficient. Perawat ICU harus berperilaku caring yang ditunjukkan dengan memiliki kompetensi yang tinggi pada penggunaan teknologi agar terciptanya perawatan yang lebih baik untuk pasien kritis. Kata kunci: Caring berbasis teknologi, perawat ICU, pasien kritis, intensive care unit AbstractThe nurses’ experiences of technology-based caring in critical patients in the intensive care unit. Intensive Care Unit (ICU) is a unit in which patients receive intensive care and strict monitoring. For this reason, nurses who are specifically trained to use sophisticated techniques and able to meet the basic needs of patients are needed. By developing a balance between the aspects of patient care and technology, nurses will be able to provide more efficient care with higher quality. This study aimed to describe the nurses’ experiences of technology-based caring in critical patients in the intensive care unit. This study was qualitative research with a descriptive phenomenological approach conducted at the Critical Care Nurse Association of Central Java. The participants were ten nurses selected by using purposive sampling technique. The data were collected through in-depth interviews with the participants for 40-60 minutes based on the prepared interview guidelines. The collected data were analyzed using the Colaizzi method.  The results showed three themes that technological competence to be part of the caring that nurses must have, the balance between nurses’ caring behaviors and technological competence in the critical area, then, maleficient and beneficient. Nurses should behave caring which is shown by having high competence using of technology to provide better care for critical patients. Keywords: Caring based on technology, critical nurse, critical patient, intensive care unit

scholarly journals Validation of the Critical-Care Pain Observation Tool-Neuro in brain-injured adults in the intensive care unit: a prospective cohort study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Céline Gélinas ◽  
Mélanie Bérubé ◽  
Kathleen A. Puntillo ◽  
Madalina Boitor ◽  
Melissa Richard-Lalonde ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cohort Study ◽  
Intensive Care ◽  
Pain Intensity ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Data Set ◽  
Icu Patients ◽  
Brain Injured

Abstract Background Pain assessment in brain-injured patients in the intensive care unit (ICU) is challenging and existing scales may not be representative of behavioral reactions expressed by this specific group. This study aimed to validate the French-Canadian and English revised versions of the Critical-Care Pain Observation Tool (CPOT-Neuro) for brain-injured ICU patients. Methods A prospective cohort study was conducted in three Canadian and one American sites. Patients with a traumatic or a non-traumatic brain injury were assessed with the CPOT-Neuro by trained raters (i.e., research staff and ICU nurses) before, during, and after nociceptive procedures (i.e., turning and other) and non-nociceptive procedures (i.e., non-invasive blood pressure, soft touch). Patients who were conscious and delirium-free were asked to provide their self-report of pain intensity (0–10). A first data set was completed for all participants (n = 226), and a second data set (n = 87) was obtained when a change in the level of consciousness (LOC) was observed after study enrollment. Three LOC groups were included: (a) unconscious (Glasgow Coma Scale or GCS 4–8); (b) altered LOC (GCS 9–12); and (c) conscious (GCS 13–15). Results Higher CPOT-Neuro scores were found during nociceptive procedures compared to rest and non-nociceptive procedures in both data sets (p < 0.001). CPOT-Neuro scores were not different across LOC groups. Moderate correlations between CPOT-Neuro and self-reported pain intensity scores were found at rest and during nociceptive procedures (Spearman rho > 0.40 and > 0.60, respectively). CPOT-Neuro cut-off scores ≥ 2 and ≥ 3 were found to adequately classify mild to severe self-reported pain ≥ 1 and moderate to severe self-reported pain ≥ 5, respectively. Interrater reliability of raters’ CPOT-Neuro scores was supported with intraclass correlation coefficients > 0.69. Conclusions The CPOT-Neuro was found to be valid in this multi-site sample of brain-injured ICU patients at various LOC. Implementation studies are necessary to evaluate the tool’s performance in clinical practice.

scholarly journals Comparing the Effect of Neostigmine and Metoclopramide on Gastric Residual Volume of Mechanically Ventilated Patients in Intensive Care Unit: A Double-Blind Randomized Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Alireza Rahat-Dahmardeh ◽  
Sara Saneie-Moghadam ◽  
Masoum Khosh-Fetrat
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Randomized Clinical Trial ◽  
Normal Saline ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Double Blind ◽  
Icu Patients ◽  
Mechanically Ventilated

Introduction. The gastric residual volume (GRV) monitoring in patients with mechanical ventilation (MV) is a common and important challenge. The purpose of this study was to compare the effect of neostigmine and metoclopramide on GRV among MV patients in the intensive care unit (ICU). Methods. In a double-blind randomized clinical trial, a total of 200 mechanically ventilated ICU patients with GRV > 120   ml (6 hours after the last gavage) were randomly assigned into two groups (A and B) with 100 patients in each group. Patients in groups A and B received intravenous infusion of neostigmine at a dose of 2.5 mg/100 ml normal saline and metoclopramide at a dose of 10 mg/100 ml normal saline, within 30 minutes, respectively. GRV was evaluated 5 times for each patient, once before the intervention and 4 times (at 3, 6, 9, and 12 hours) after the intervention. In addition, demographic characteristics including age and gender, as well as severity illness based on the sequential organ failure assessment score (SOFA), were initially recorded for all patients. Results. After adjusting of demographic and clinical characteristics (age, gender, and SOFA score), the generalized estimating equation (GEE) model revealed that neostigmine treatment increased odds of GRV improvement compared to the metoclopramide group ( OR = 2.45 , 95% CI: 1.60-3.76, P < 0.001 ). However, there is a statistically significant time trend (within-subject differences or time effect) regardless of treatment groups ( P < 0.001 ). Conclusion. According to the results, although neostigmine treatment significantly improved GRV in more patients in less time, within 12 hours of treatment, all patients in both groups had complete recovery. Considering that there was no significant difference between the two groups in terms of side effects, it seems that both drugs are effective in improving the GRV of ICU patients.

scholarly journals Neurogenic vs. Myogenic Origin of Acquired Muscle Paralysis in Intensive Care Unit (ICU) Patients: Evaluation of Different Diagnostic Methods

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 966
Author(s):  
Humberto D.J. Gonzalez Marrero ◽  
Erik V. Stålberg ◽  
Gerald Cooray ◽  
Rebeca Corpeno Kalamgi ◽  
Yvette Hedström ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Diagnostic Methods ◽  
Muscle Stimulation ◽  
Muscle Paralysis ◽  
Icu Patients ◽  
Muscle Biopsies ◽  
Electrophysiological Methods

Introduction. The acquired muscle paralysis associated with modern critical care can be of neurogenic or myogenic origin, yet the distinction between these origins is hampered by the precision of current diagnostic methods. This has resulted in the pooling of all acquired muscle paralyses, independent of their origin, into the term Intensive Care Unit Acquired Muscle Weakness (ICUAW). This is unfortunate since the acquired neuropathy (critical illness polyneuropathy, CIP) has a slower recovery than the myopathy (critical illness myopathy, CIM); therapies need to target underlying mechanisms and every patient deserves as accurate a diagnosis as possible. This study aims at evaluating different diagnostic methods in the diagnosis of CIP and CIM in critically ill, immobilized and mechanically ventilated intensive care unit (ICU) patients. Methods. ICU patients with acquired quadriplegia in response to critical care were included in the study. A total of 142 patients were examined with routine electrophysiological methods, together with biochemical analyses of myosin:actin (M:A) ratios of muscle biopsies. In addition, comparisons of evoked electromyographic (EMG) responses in direct vs. indirect muscle stimulation and histopathological analyses of muscle biopsies were performed in a subset of the patients. Results. ICU patients with quadriplegia were stratified into five groups based on the hallmark of CIM, i.e., preferential myosin loss (myosin:actin ratio, M:A) and classified as severe (M:A < 0.5; n = 12), moderate (0.5 ≤ M:A < 1; n = 40), mildly moderate (1 ≤ M:A < 1.5; n = 49), mild (1.5 ≤ M:A < 1.7; n = 24) and normal (1.7 ≤ M:A; n = 19). Identical M:A ratios were obtained in the small (4–15 mg) muscle samples, using a disposable semiautomatic microbiopsy needle instrument, and the larger (>80 mg) samples, obtained with a conchotome instrument. Compound muscle action potential (CMAP) duration was increased and amplitude decreased in patients with preferential myosin loss, but deviations from this relationship were observed in numerous patients, resulting in only weak correlations between CMAP properties and M:A. Advanced electrophysiological methods measuring refractoriness and comparing CMAP amplitude after indirect nerve vs. direct muscle stimulation are time consuming and did not increase precision compared with conventional electrophysiological measurements in the diagnosis of CIM. Low CMAP amplitude upon indirect vs. direct stimulation strongly suggest a neurogenic lesion, i.e., CIP, but this was rarely observed among the patients in this study. Histopathological diagnosis of CIM/CIP based on enzyme histochemical mATPase stainings were hampered by poor quantitative precision of myosin loss and the impact of pathological findings unrelated to acute quadriplegia. Conclusion. Conventional electrophysiological methods are valuable in identifying the peripheral origin of quadriplegia in ICU patients, but do not reliably separate between neurogenic vs. myogenic origins of paralysis. The hallmark of CIM, preferential myosin loss, can be reliably evaluated in the small samples obtained with the microbiopsy instrument. The major advantage of this method is that it is less invasive than conventional muscle biopsies, reducing the risk of bleeding in ICU patients, who are frequently receiving anticoagulant treatment, and it can be repeated multiple times during follow up for monitoring purposes.

scholarly journals Deep Impact of Ultrasound in the Intensive Care Unit

2012 ◽  
Vol 117 (4) ◽  
pp. 801-809 ◽  
Author(s):  
Emilpaolo Manno ◽  
Mauro Navarra ◽  
Luciana Faccio ◽  
Mohsen Motevallian ◽  
Luca Bertolaccini ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Ultrasound Examination ◽  
Treatment Plan ◽  
Invasive Procedures ◽  
Deep Impact ◽  
High Prevalence ◽  
Critical Patients ◽  
Critical Care Ultrasonography

Background Ultrasound can influence the diagnosis and impact the treatment plan in critical patients. The aim of this study was to determine whether, without encountering major environment- or patient-related limitations, ultrasound examination under a critical care ultrasonography protocol can be performed to detect occult anomalies, to prompt urgent changes in therapy or induce further testing or interventions, and to confirm or modify diagnosis. Methods One hundred and twenty-five consecutive patients admitted to a general intensive care unit were assessed under a critical care ultrasonography protocol, and the data were analyzed prospectively. Systematic ultrasound examination of the optic nerve, thorax, heart, abdomen, and venous system was performed at the bedside. Results Environmental conditions hampered the examination slightly in 101/125 patients (80.8%), moderately in 20/125 patients (16%), and strongly in 4/125 patients (3.2%). Ultrasonographic findings modified the admitting diagnosis in 32/125 patients (25.6%), confirmed it in 73/125 patients (58.4%), were not effective in confirming or modifying it in 17/125 patients (13.6%), and missed it in 3/125 patients (2.4%). Ultrasonographic findings prompted further testing in 23/125 patients (18.4%), led to changes in medical therapy in 22/125 patients (17.6%), and to invasive procedures in 27/125 patients (21.6%). Conclusions In this series of patients consecutively admitted to an intensive care unit, ultrasound examination revealed a high prevalence of unsuspected clinical abnormalities, with the highest number of new ultrasound abnormalities detected in patients with septic shock. As part of rapid global assessment of the patient on admission, our ultrasound protocol holds potential for improving healthcare quality.

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