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At least 307 records · Page 17Linked to original sources
PubMed2006

Formal procedural skills training using a fresh frozen cadaver model: a pilot study.

Graduating medical students are expected to be proficient in a number of procedural skills. A structured curriculum is infrequently available. In addition, the use of a mannequin tends to be unrealistic and students continue to have some anxiety when performing procedures on patients. This pilot study was designed to demonstrate the utility of a fresh frozen cadaver model in practicing procedural skills as compared to mannequins. Seven third-year students carried out a number of basic procedural skills using a mannequin model and a fresh frozen cadaver. We surveyed the students after they had carried out the procedures on the different models with regards to ease of procedure, the sense of realism and their success rate. The pilot course improved the overall confidence of the students in performing basic skills. In addition, despite the fact that the mannequin was somewhat easier to perform a number of procedures on, the fresh frozen cadaver was a more realistic model and the preferred model for practicing the skills. The fresh frozen cadaver is a feasible and valid instructional tool for training procedural skills and has the advantage of being more realistic than a typical mannequin model.

Anatomy↗
PubMed1991

Core temperature measurement in the intensive care unit.

OBJECTIVE: To compare three devices that measure core body temperature at the bedside in ICU patients. DESIGN: Prospective, consecutive sample. SETTING: Voluntary community teaching hospital. PATIENTS: Fifteen patients, 78 +/- 6 (SD) yrs of age, admitted to the medical ICU over a 5-month period who had pulmonary artery catheters inserted as part of their routine care were studied. Thirteen patients were studied once, one patient twice, and one patient six times for a total of 21 sets of measurements. INTERVENTIONS: All patients had urinary bladder thermistor catheters inserted just before pulmonary artery catheterization. Simultaneous core temperatures were measured for the duration of pulmonary artery catheterization every 4 hrs by the pulmonary artery thermistor catheter, the bladder thermistor catheter, and by a tympanic membrane infrared probe set on its core temperature setting. The three devices were then compared with each other in vitro using a specialized constant water bath setup. Finally, two of the tympanic membrane infrared probes were compared with each other in 20 ambulatory emergency department patients. MEASUREMENTS AND MAIN RESULTS: Over 32 hrs of pulmonary artery catheterization, the pulmonary artery thermistor catheters and bladder thermistor catheters showed excellent agreement, with a bias of only -0.04 degrees C between the two. However, the bias comparing the tympanic membrane infrared probe with the pulmonary artery thermistor catheter was -0.38 degrees C, and the bias was -0.34 degrees C comparing the tympanic membrane infrared probe with the bladder thermistor catheter. The tympanic membrane infrared probe readings remained significantly higher than the pulmonary artery thermistor catheter or bladder thermistor catheter readings over the entire 32-hr period. The two tympanic membrane infrared probes compared with each other in emergency room patients showed excellent agreement (p less than .001). In the in vivo water bath setup, the tympanic membrane infrared probe on most of its settings again registered significantly (p less than .01) higher than both the pulmonary artery thermistor catheter and the bladder thermistor catheter. CONCLUSIONS: Pulmonary artery thermistor catheters and bladder thermistor catheters appear to give consistent, highly reliable bedside measurements of core body temperature in ICU patients. The currently available device that measures core body temperature from the tympanic membrane appears to give erroneously high readings, and should be used with caution.

Aged↗
PubMedDate not supplied

The necessity of routinely replacing peripheral intravenous catheters in hospitalized children. A review of the literature.

Insertion of a peripheral intravenous catheter can be a traumatic experience for a child. Current Centers for Disease Control and Prevention guidelines for adults recommend peripheral intravenous catheter replacement every 48 to 72 hours, but there are no pediatric recommendations. The rationale for changing catheters every 48 to 72 hours is to reduce the risk of complications such as phlebitis and infection. This article reviews literature on the use of peripheral intravenous catheters in the pediatric setting and will make a recommendation on replacement intervals.

Age Factors↗
PubMed1995

Peripheral access options.

With the dramatic downsizing of acute care facilities and shifting to alternate care settings, infusion therapy is a major aspect of outpatient and home health services. Health care reform has forced health care practitioners to make cost-driven clinical decisions, while at the same time demanding quality outcomes. Technology has advanced our capabilities to provide infusion therapies in all settings. Controversial questions are asked regarding the selection of the appropriate device, catheter tip position, tip position verification, and care and management techniques, which only well-designed research protocols can answer. In the meantime, clinical decisions must be based on current science and physiologic principles, rather than tradition, anecdotal observation, or competitive financial agendas. Peripheral access catheters, if widely used, afford a tremendous opportunity for positive outcomes and cost savings.

Bacteremia↗
PubMed1994

Systemic candidiasis in four foals.

Four foals were admitted to the neonatal intensive care unit in the first 2 days of life with problems related to birth hypoxia (neonatal maladjustment syndrome, renal failure, necrotizing enterocolitis) and sepsis. Foals were hospitalized for an extended period (35 to 70 days) and received treatment with several broad spectrum antimicrobial agents. Invasive monitoring and treatment procedures included intravenous catheterization, urinary catheterization, and parenteral nutritional and ventilatory support. In each foal, infections of undetermined cause developed, and systemic candidiasis was diagnosed after Candida albicans was isolated from specimens obtained from 1 or more internal sites. The 3 foals in which treatment was attempted responded well to IV administration of amphotericin B and/or oral administration of fluconazole, and were discharged from the hospital.

Amphotericin B↗
PubMedDate not supplied

Heparin vs. saline for peripheral i.v. locks in children.

PURPOSE: To determine the efficacy of saline versus heparin flush solution to maintain peripheral i.v. locks in a pediatric population. METHOD: A prospective, randomized, double-blind design was used. A sample of 124 peripheral i.vs. were flushed with either saline or heparin in saline. Subjects were infants over 28 days of age and children. FINDINGS: The heparin and saline groups were comparable for total hours duration of the i.v. and for incidence of complications. CONCLUSIONS: Saline is efficacious in maintaining patency of peripheral i.v. locks in children over 28 days of age.

Catheterization, Peripheral↗
PubMed1999

Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access.

STUDY OBJECTIVE: Emergency department patients who require intravenous access but lack peripheral intravenous sites frequently require central line placement. Blind percutaneous brachial vein cannulation has been proposed as an alternative in these patients but is associated with high failure and complication rates. We evaluated an ultrasound-guided approach to percutaneous deep brachial vein or basilic vein cannulation in ED patients with difficult intravenous access. METHODS: We prospectively enrolled ED patients who required intravenous access in whom there had been 2 unsuccessful attempts at establishing a peripheral intravenous line. Using a 7.5-MHz ultrasound probe, the deep brachial vein or basilic vein was identified and then cannulated with a 2-in, 18- to 20-gauge intravenous catheter. Time from probe placement to cannulation, number of attempts, and complications were recorded. RESULTS: One hundred one patients were enrolled, of whom 50 were injection drug users and 21 were obese. Cannulation was successful in 91 patients (91%) and accomplished on the first attempt in 73 (73%). The mean (+/-SD) time required for cannulation was 77 seconds (+/-129, range 4 to 600 seconds). The line infiltrated or fell out within 1 hour of cannulation in 8 (8%) patients. One patient reported severe pain. There were 2 (2%) cases of brachial artery puncture. CONCLUSION: Ultrasound-guided brachial and basilic vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access.

Adolescent↗
PubMed2005

A comparison of peripheral and centrally collected cyclosporine a blood levels in pediatric patients undergoing stem cell transplant.

PURPOSE/OBJECTIVES: To measure differences in cyclosporine A (CSA) trough concentrations from blood collected as a peripheral sample and from a CSA-uncontaminated (naive) lumen of a double-lumen central line. DESIGN: Prospective, comparative study. SETTING: Pediatric university teaching hospital in metropolitan Australia. SAMPLE: 71 paired central and peripheral CSA blood samples from a convenience sample of 14 pediatric allogeneic stem cell transplant recipients receiving IV CSA as prophylaxis or treatment for graft-versus-host disease. Ages ranged from 2 months to 14 years, 5 months. METHODS: Comparing blood samples collected from a peripheral site and a CSA-naive lumen of a double-lumen central line. Data were analyzed using a paired student t test and calculation of the 95% confidence interval of the concentration ratio from different sampling sites. MAIN RESEARCH VARIABLES: Site of blood sampling and CSA trough concentrations. FINDINGS: No significant difference existed between CSA concentration in samples collected from the different sites in children receiving intermittent infusions of CSA (p = 0.13). The 95% confidence interval of the CSA concentration ratio was 0.92 1.04. CONCLUSIONS: When CSA is administered on an intermittent dosing schedule, comparable CSA trough concentrations can be determined from blood collected via the CSA-naive lumen of a double-lumen central line or at a peripheral sampling site. IMPLICATIONS FOR NURSING: Pediatric allogeneic stem cell transplant recipients who require regular CSA trough concentrations no longer will require peripheral blood samples when receiving an intermittent dosing schedule.

Adolescent↗
PubMed2006

Bridging the gap between knowledge and action for health: Case studies.

Biomedical discoveries could improve people's health only if they are suited to the diverse political and social contexts, health systems and population groups. Knowledge generated through evidence-informed health policy and practice when applied to the local situation enhances the quality and efficiency of health care. This article describes four case studies on bridging the gap between knowledge and action for health in a tertiary care hospital in Bangkok, Thailand. Gaps between knowledge and action for health are classified into "know-do" and "do-know" gaps with knowledge implementation and knowledge generation being the key measures for bridging the gap.

Antibiotic Prophylaxis↗
PubMed1995

Comparison of vascular access devices.

OBJECTIVE: To provide an overview of venous access device designs and methods of insertion and removal. CONCLUSIONS: Venous access devices are indicated for many patients who require reliable long-term venous access. Three types of venous access devices are available including nontunneled, tunneled, and implanted ports. Since their introduction into clinical practice, the widespread use of these devices has had an enormous impact on cancer treatment by decreasing the overuse of peripheral veins while allowing for more flexibility and choice of the type of device used. Although numerous devices are available, each offers unique designs and performance expectations. Each type of device has similar features and can be used for intravenous drug and nutritional therapy, administration of blood products, and withdrawal of blood. IMPLICATIONS FOR NURSING PRACTICE: Even if only a single device is used in a given setting, the nurse must have a basic understanding of all types of venous access devices. It is imperative that the nurse be fully cognizant of the anatomic position and structure of the major vessels associated with the central venous system, especially for the insertion of peripheral central catheters. Understanding the venous system and venous access design can assist in preventing or assessing potential complications.

Catheterization, Central Venous↗
PubMed2003

Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants < 1000 g.

OBJECTIVE: To evaluate in infants of < 1000 g (extremely low birth weight; ELBW) the success rate of insertion of percutaneous central venous catheters (PCVC) and their duration; and the short- and long-term complications, i.e. mechanical and infectious, when compared to a control group of infants of the same age treated only with peripheral venous access. STUDY DESIGN: A cohort of 44 ELBW infants managed with PCVC (study group) was compared to a cohort of 44 infants managed only with peripheral venous access (control group). The two groups were matched for birth weight, gestational age and gender, and were comparable for severity of illness (CRIB scores). RESULTS: The success rate of PCVC insertion was 74% with the right axillary vein being the most frequently used site. The mean duration of PCVC treatment was 28 +/- 13 days. The reasons for removal of the catheter were: cessation of the total parenteral nutrition administration in 75% of the cases and occlusion in 25%. There were three infectious episodes for a total of 1138 catheter days in the PCVC group vs. 12 episodes for a total of 1114 days (p = 0.03) in the control group. Three infants died in the study group and 11 infants died in the control group (p = 0.05) of infants of ELBW. CONCLUSION: Insertion of PCVC is successful in the vast majority of cases and carries a lower risk of infection than multiple insertions of peripheral lines in infants of ELBW. It prevents repeat and painful introductions of intravenous needles.

Bacteremia↗
PubMed1993

Difficulty in removing a percutaneous central venous catheter inserted from a peripheral vein.

Two girls with acute lymphocytic leukemia (ALL) are reported. There were difficulties in removing their central venous catheters inserted from a peripheral vein. One girl required surgery under general anesthesia for the removal. The other patient received continuous infusion of low dose urokinase from a distal peripheral vein. The residual catheter was then removed successfully.

Adolescent↗
PubMedDate not supplied

A trial with a new peripheral implanted vascular access device.

In a prospective study, a new implanted vascular access device designed for peripheral placement in the arm was evaluated. Thirty-two patients requiring long-term venous access received the Port-A-Cath P.A.S. Port over a 13-month period. The access devices were used for multiple therapies including chemotherapy, antibiotics, antivirals, antifungals, and blood products. After 4,896 patient days (range 12-388), 19 complications occurred in 14 patients or 3.88/1,000 catheter days. The infection rate was 3% or 0.2/1,000 catheter days. Port pocket cellulitis was reported in 3% of patients or 0.2/1,000 catheter days. Vein phlebitis occurred at 12.5% or 0.8/1,000 catheter days. Two instances of vessel thrombosis occurred (6.2% or 0.4/1,000 catheter days). Ten incidents in six patients of inability to aspirate blood samples were noted (18.75% or 2/1,000 catheter days). No infiltrations or extravasations were reported. Nurses involved in this early trial found performance similar to the standard venous chest ports. Peripheral port placement was accepted well by patients.

Adult↗
PubMed2004

PET imaging in pediatric oncology.

High-quality PET imaging of pediatric patients is challenging and requires attention to issues commonly encountered in the practice of pediatric nuclear medicine, but uncommon to the imaging of adult patients. These include intravenous access, fasting, sedation, consent, and clearance of activity from the urinary tract. This paper discusses some technical differences involved in pediatric PET to enhance the quality of scans and assure the safety and comfort of pediatric patients.

Adolescent↗