Critical care nurse
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Critical care nurse · Dec 2021
Using Simulation to Improve Adherence to Get With the Guidelines Time to First Shock.
Evidence demonstrates that shocking patients in ventricular fibrillation or pulseless ventricular tachycardia in 2 minutes or less leads to improved outcomes. At our facility in Orlando, Florida, 4 of 7 time to first shock fallouts occurred in the intensive care unit. No standardization for conducting code situations existed in the intensive care unit. ⋯ Online education and code simulation positively affected time to first shock in code situations and empowered nurses to confidently function in these situations.
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Critical care nurse · Dec 2021
Favorable Outcomes After Implementing a Nurse-Driven Sedation Protocol.
In patients receiving mechanical ventilation, prolonged exposure to sedative and analgesic medications contributes to negative clinical outcomes. ⋯ These preliminary data suggest that implementation of a nurse-driven sedation protocol resulted in favorable outcomes by decreasing duration of mechanical ventilation, intensive care unit length of stay, and duration of continuous sedation and increasing the number of spontaneous awakening trials performed.
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Critical care nurse · Dec 2021
Case ReportsNursing Management of a Patient With COVID-19 Receiving ECMO: A Case Report.
Venovenous extracorporeal membrane oxygenation has been recommended as an effective rescue therapy for select critically ill patients with COVID-19. This case report describes a first experience caring for a patient with COVID-19 who received venovenous extracorporeal membrane oxygenation and expands the literature by discussing relevant nursing management and operational considerations. ⋯ Caring for a patient with COVID-19 receiving venovenous extracorporeal membrane oxygenation posed unprecedented challenges that required deviations from standards of care to optimize infection control measures and staff safety while providing quality care. This case report may inform, prepare, and guide other critical care nurses who will be caring for similar patients during this pandemic.
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Critical care nurse · Dec 2021
Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?
The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter-associated bloodstream infection risk. ⋯ Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.
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Critical care nurse · Dec 2021
Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk.
Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. ⋯ Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.