Heart & lung : the journal of critical care
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Randomized Controlled Trial Clinical Trial
Retention of cardiopulmonary resuscitation skills among nursing personnel: what makes the difference?
The American Association of Critical-Care Nurses' Position Statement on cardiopulmonary resuscitation (CPR) certification states that "nurses who care for the critically ill must have annual BCLS or CLS certification...." Review of literature, however, did not reveal any studies among nurses that examined the question of whether Basic Cardiac Life Support (BCLS) was superior to other forms of CPR education, such as Basic Life Support-A (BLS-A) (Heartsaver). The purpose of this 2 by 3 factorial design study was to examine the relationship between the method of instruction and the quality of retention of one-person CPR skills at 4 and 8 months after the initial class. The two methods of instruction under consideration were a BLS-course A (hospital-wide Heartsaver course) and a BLS-course C (Basic Cardiac Life Support course). ⋯ Other variables that were described in the literature were education, practice of skills, current position, years in profession, previous CPR training, motivation, and felt level of competence. These variables also were included in the study to find out the total variable impact on CPR retention. At least 30 registered nurses were selected from each of the high, medium, and low use areas and randomly assigned to one of the instruction groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Relationship between arterial and venous activated partial thromboplastin time values in patients after percutaneous transluminal coronary angioplasty.
This quasi-experimental study was conducted to determine whether reliable activated partial thromboplastin time (APTT) values could be obtained from samples taken from indwelling arterial catheter lines. The 30 subjects, who were receiving heparin infusions after a percutaneous transluminal coronary angioplasty (PTCA), had femoral intraarterial lines. With use of a counterbalanced design, APTT values determined in two serial samples of venous and arterial blood were compared for the 30 subjects. ⋯ The histogram indicated that three of the 30 subjects had arterial-venous APTT differences that exceeded 19 seconds when four times the discard volume was used. In the samples where six times the discard volume were used, only one person had an APTT reading greater than 8 seconds. Paired t tests revealed statistically significant differences between the arterial and venous APTT values (t = 2.95, df = 29, p less than 0.01) for discards of four times the catheter dead space volume, whereas no statistically significant difference was found between the arterial and venous APTT values (t = 2.62, df = 28, p greater than 0.01) for discards of six times the dead space volume.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pulse oximetry represents a major advance in noninvasive oxygenation monitoring in critically ill adults. Its technology has given practitioners a safe, accurate, and continuous method for assessing arterial oxygen saturation. ⋯ The clinical utility of pulse oximetry monitoring in critically ill adults is discussed, with consideration given to patient selection and specific procedures that incur hypoxemic risk. Issues of quality assurance and risk management that surround the use of pulse oximetry are addressed.
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Randomized Controlled Trial Clinical Trial
Effects of lung hyperinflation on mean arterial pressure and postsuctioning hypoxemia.
Our purpose was to determine the effect of five different lung hyperinflation volumes (tidal volume, 12 cc/kg, 14 cc/kg, 16 cc/kg, and 18 cc/kg lean body weight) on mean arterial pressure and postsuctioning hypoxemia (arterial blood gases). Subjects received three consecutive lung hyperinflations at one of the five randomly ordered volumes in 15 seconds via a ventilator "sigh" control at a fraction of inspired oxygen of 1.0. The three lung hyperinflations were followed by 10 seconds of continuous suction (flow rate 16 L/min). ⋯ The sample consisted of eight men and women 4 hours after coronary artery bypass graft surgery. Data indicated a statistically significant (by analysis of variance, p = 0.000) mean increase of 15 mm Hg in mean arterial pressure over the three lung hyperinflation sequences that was not volume dependent. There was a significant increase (p = 0.0001) in arterial oxygen pressure at 0 seconds after suctioning that increased with each increasing lung hyperinflation volume.
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An examination of the functions of intensive care units, their historical development, and their benefits, risks, and costs indicates the need for investigation of their effectiveness. Further study is proposed of collaboration between nurses and physicians, potentially a crucial element in improving patient outcomes in intensive care units.