Heart & lung : the journal of critical care
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Heparinized arterial catheters are commonly used in critically ill patients to monitor pressures and to collect blood for laboratory analysis. To remove the heparinized fluid used to keep these lines patent large volumes of blood are often withdrawn and discarded or calculations of tube volume must be made. Repeated violation of stopcocks may lead to contamination and infection of arterial lines. ⋯ The average arterial PT was 0.12 seconds less than venous control and the average arterial aPTT was 0.49 seconds greater than control. Neither of these differences was significant. We conclude that this type of high-pressure tubing allows accurate blood samples to be obtained from arterial lines without the necessity of precise calculations or blood wastage.
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The primary purpose of this study was to determine whether a modified Norton scale at admission to the hospital would predict which patients would develop pressure ulcers when hospitalized for surgery for a period of up to 3 weeks. The sample was composed of 387 adult patients admitted for elective cardiovascular surgery or neurosurgery. By regression analysis, no difference was found in the modified Norton scale scores for those who did and those who did not have pressure ulcers during hospitalization. ⋯ The knee and lateral malleolus were the sites of the most severe pressure ulcers. Subjects who were hospitalized for longer periods had more severe ulcers. Future research is needed to more precisely determine which patients in the acute care setting are at risk for the development of pressure ulcers.
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Limited data are available on the efficacy of a common endotracheal suctioning intervention to prevent postsuctioning decreases in arterial oxygenation (PaO2). This study evaluated the effect on Pao2 of five hyperinflation (tidal volume 1.5 times normal) and hyperoxygenation breaths, administered before and after each of two consecutive endotracheal suctioning passes, with use of a manual resuscitation bag (PMR-2 model). The convenience sample consisted of 32 patients with endotracheal tubes who were observed within 24 hours of coronary artery bypass surgery. ⋯ In addition, a clinical measure of alveolar-capillary gas exchange (PaO2/PAO2 ratio) was found to be a significant predictor of PaO2 after suctioning, accounting for 38% of the variance. The data from this study support the efficacy of administering five hyperinflation and hyperoxygenation breaths, with use of a manual resuscitation bag, before and after endotracheal suctioning in stable patients after coronary artery bypass surgery. Further study is necessary to determine the efficacy of this suctioning intervention in patients with other respiratory problems.
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Patients undergoing cardiac surgery are mildly hypothermic by the completion of the surgical procedure. They need to return to a normothermic state if enzymatic functions are to proceed in their normal manner. The body can produce heat by elevating metabolic rate or by activating the shivering mechanism. ⋯ External methods, which minimize additional heat loss, include the use of warming lights, elevation of room temperature, and the use of blankets. Internal methods, which transfer heat by convection, may be used to help actively reverse hypothermia. Such techniques include warmed inhalation gases and intravenous fluids, warmed nasogastric lavage fluid, and warmed peritoneal dialysis fluid for patients with end-stage renal failure with severe electrolyte disorders after surgery.
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Clinical Trial Controlled Clinical Trial
Patient-controlled analgesia versus intermittent analgesia dosing.
Actively involving the patient in his or her own pain management by using patient-controlled analgesia (PCA) during the postoperative period is a concept recently introduced. This method allows self-administration of small, frequent doses of an analgesic agent to maintain a state of constant pain control. We studied the relative efficacy of PCA compared with intermittent analgesic dosing in 16 male patients requiring posterolateral thoracotomy. ⋯ In the patients using PCA, a significant reduction in the postoperative pulmonary complication rate, as evidenced by radiographic findings, was noted. In addition, significantly less medication was used and postoperative fever was substantially reduced in the PCA group. We believe PCA to be a safe, effective, and beneficial pain management modality that deserves attention in the postoperative period.