Critical care nurse
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Critical care nurse · Feb 2019
ReviewPeripheral Intravenous Access: Applying Infusion Therapy Standards of Practice to Improve Patient Safety.
The most common invasive procedure performed in the hospital setting worldwide is the insertion of a peripheral intravenous catheter. Although use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team. ⋯ Management of peripheral intravenous access in the complex setting of critical care is examined in this article. A case study approach is used to illustrate application of infusion therapy standards of practice in peripheral intravenous catheter insertion, indications for catheter placement, and assessment parameters to enhance early recognition of peripheral intravenous access-related complications.
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Critical care nurse · Feb 2019
ReviewCardiac Arrest After Cardiac Surgery: An Evidence-Based Resuscitation Protocol.
More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. ⋯ A 2017 Society of Thoracic Surgeons protocol derived from European Resuscitation Council guidelines is now standard of care in the United States. Evidence-based practices can improve survival and reduce resternotomy rates. This article describes the clinical implementation of the Society of Thoracic Surgeons guidelines.
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Critical care nurse · Feb 2019
ReviewAssociation Between Adverse Clinical Outcomes After Coronary Artery Bypass Grafting and Perioperative Blood Transfusions.
Bleeding is a serious complication of coronary artery bypass grafting that often leads to blood transfusion. Approximately 50% of patients who have the surgery receive blood products, and blood transfusions play a role in adverse outcomes after the surgery. ⋯ An association exists between red blood cell transfusions and adverse clinical outcomes for patients undergoing coronary artery bypass grafting. Transfusion of red blood cells is sometimes unnecessary, may be injurious, and should be used cautiously. Even a single-unit increase in perioperative red blood cell transfusions can have a significant adverse impact on outcomes. Individual benefits and risks should be weighed before transfusion to avoid adverse outcomes. Transfusion guidelines should be reviewed to include the latest evidence to guarantee the most appropriate use of blood products.
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Critical care nurse · Feb 2019
Phlebitis in Intravenous Amiodarone Administration: Incidence and Contributing Factors.
Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect. ⋯ Understanding factors that increase the risk of amiodarone-induced phlebitis can guide better practice. In-line filters and nursing guidelines should always be implemented when administering intravenous amiodarone. Increased surveillance is required when higher dosages and concentrations are used.
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Critical care nurse · Feb 2019
Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative.
The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.