Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses
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Intensive Crit Care Nurs · Jun 2004
ReviewPractical considerations in the administration of intravenous vasoactive drugs in the critical care setting: the double pumping or piggyback technique-part one.
Part I of this review aims to identify the factors associated with safe administration of continuous intravenous vasoactive drug therapy, specifically epinephrine and norepinephrine. Intravenous vasoactive drugs are administered in the critical care setting to maintain patients' cardiovascular function by continuous intravenous infusion. To ensure uninterrupted administration, one infusion is commenced when the other is almost empty. ⋯ Furthermore, the infusion pump should feature minimal start up delay, a sensitive occlusion alarm system and the absence of a bolus in the event of infusion occlusion. This may reduce patients experiencing adverse haemodynamic responses due to alterations to the infusion. Indeed, a review of the 'double pumping' or 'piggybacking' technique in the clinical setting is required to establish current practice and develop evidence based guidelines.
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Intensive Crit Care Nurs · Jun 2004
Bridging the gap between the intensive care unit and general wards-the ICU Liaison Nurse.
The acute care system in our public hospitals has seen an increase in acuity for multiday patients with associated pressure on access to the intensive care unit (ICU) beds for both elective and emergency patients. When an ICU bed has not been available at this hospital, it has resulted in elective surgery being cancelled and/or emergency patients requiring an ICU admission being transferred to other hospitals. Apart from the problems either of these situations can cause to patients and their families, both government and hospital managements expect that access to an ICU (or other) bed will be available for patients in our community who require this level of care. ⋯ This paper relates our experience of developing and introducing an advanced practice nursing position (the ICU Liaison Nurse) in 1998, to oversee the transition of patients discharged from ICU to the general wards. Between 1997 and 2002 with the development of the ICU Liaison Nurse (ICU LN) post, medical readmissions to ICU were reduced from 2.3 to 0.5%. It is now 5 years since the position was introduced and the role has evolved over this time so that today the ICU LN not only bridges the gap between ICU and ward-based care, but when necessary can be involved in the care of patients on the ward whose condition has deteriorated to the point where transfer into ICU may be necessary.
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Outcomes in the management of critically ill patients may be improved using goal-directed peri-operative haemodynamic monitoring. A conservative approach may no longer be acceptable but in view of the significant morbidity associated with balloon tipped flow directed pulmonary artery catheters a non-invasive approach would be preferable. In this review we consider the different non-invasive techniques available and discuss the advantages and disadvantages of each technique.
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Intensive care unit (ICU) patients have complex oral care needs. Inadequate oral care may predispose ICU patients to nosocomial infections. Recent initiatives have sought to improve the quality and evidence base of ICU oral care provision. ⋯ Most oral care methods were appropriate, based on the available evidence. A small minority of nurses gave oral care a low priority and were not using evidence-based oral care methods recommended in the local ICU protocol. Encouraging the general use of oral needs assessment tools is a priority, and further oral care training is required.