Critical care nurse
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Critical care nurse · Dec 2019
Randomized Controlled Trial Comparative StudyEffect of 2 Enteral Feeding Schedules on Intra-abdominal Pressure in Patients Receiving Mechanical Ventilation: A Randomized Controlled Trial.
Elevated intra-abdominal pressure is associated with morbidity in critically ill patients. Enteral feeding is important for these patients but may cause complications. ⋯ Intra-abdominal pressure was not significantly affected by feeding interval. However, reducing the time interval between intermittent enteral feedings may minimize the risk for constipation and abdominal distension.
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Critical care nurse · Dec 2019
Review Case ReportsPeripheral Intravenous Administration of High-Risk Infusions in Critical Care: A Risk-Benefit Analysis.
In critical care, the short peripheral intravenous catheter is an essential venous access route, often used in emergency situations to administer high-risk medications and fluid resuscitation. This route of administration is generally viewed as routine and benign. ⋯ Recommendations for peripheral intravenous catheter replacement are based on clinical indications rather than routine replacement, so standards of practice for catheter insertion and management must be consistently applied. This article reviews recent studies that challenge the need for central catheter placement for vasopressor therapy, current knowledge of peripheral intravenous catheter-related adverse events, and evidence-based standards of care for short peripheral intravenous catheter insertion and maintenance.
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Critical care nurse · Dec 2019
Implementation of a Bowel Protocol to Improve Enteral Nutrition and Reduce Clostridium difficile Testing.
Underfeeding is common among adult patients receiving enteral nutrition. Constipation and diarrhea have been associated with low enteral nutrition volume in critically ill patients. In patients with diarrhea, Clostridium difficile is often suspected and tested for, although medications, illness, or enteral formulas are usually the cause. The use of bowel protocols to proactively address constipation, diarrhea, and inappropriate testing for hospital-onset C difficile infection, thereby improving enteral nutrition, remains unclear. ⋯ The implementation of bowel protocols improved delivery of total enteral volumes and reduced inappropriate testing for hospital-onset infections with C difficile, and they may improve patient safety and facilitate positive patient outcomes.
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Critical care nurse · Dec 2019
Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review.
Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E-mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. ⋯ Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.
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Critical care nurse · Dec 2019
Exemplars Illustrating De-implementation of Tradition-Based Practices.
Clinical practice must be based on evidence. When evidence suggests that a certain practice may be ineffective or even harmful, that practice should be discontinued. The Choosing Wisely campaign, an initiative of the ABIM (American Board of Internal Medicine) Foundation, is intended to bring attention to tradition-based practices, or "sacred cows," which lack evidence to support their ongoing use. ⋯ This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.