American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study Clinical Trial
Shivering and rewarming after cardiac surgery: comparison of ventilator circuits with humidifier and heated wires to heat and moisture exchangers.
Detrimental physiologic effects of shivering in the cardiac surgery patient have been well documented. Rewarming techniques have been compared, with noted differences in the incidence of shivering. Ventilator circuits have not been examined independently from other rewarming variables. ⋯ These data suggest that use of heated wire humidified ventilator circuits with heated water blankets in adult cardiac surgery patients significantly reduces the incidence of shivering and results in a more rapid return to normothermia.
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Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of five methods of temperature measurement in febrile intensive care patients.
A clinically useful temperature measurement method should correlate well with the body's core temperature. Although previous investigators have studied temperature readings from different sites in hypothermic and normothermic patients, none have compared methods specifically in febrile patients. ⋯ Rectal temperature measurement correlates most closely with core temperature. If the rectal site is contraindicated, oral or ear-based temperatures are acceptable. Axillary temperature does not correlate well with pulmonary artery temperature. These results underscore the importance of consistency in method when establishing temperature trends, and of awareness of method when interpreting clinical data.
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Review
Normal saline instillation before suctioning: helpful or harmful? A review of the literature.
This research utilization paper reviews the body of published literature on the practice of normal saline instillation before endotracheal suctioning of mechanically ventilated adult patients. Although normal saline instillation before suctioning is a common clinical practice, the research literature does not demonstrate any physiologic benefit to this procedure. Moreover, normal saline instillation may decrease oxygen saturation values (via pulse oximetry) after suctioning. ⋯ Further research studies using larger, more diverse samples, adhering strictly to recommended guidelines for endotracheal suctioning, and examining additional physiologic parameters of oxygenation are necessary. In addition, long-term outcomes of normal saline instillation such as respiratory infection and complications, as well as atelectasis, should be evaluated. Until scientific data can be presented to support the physiologic benefit of this practice, normal saline instillation should be discontinued as a routine or standard practice.
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Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. ⋯ Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.
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Analysis of chest roentgenograms performed before spontaneous fragmentation and distal embolization of an implanted subclavian vein catheter revealed discontinuity of the catheter's radiopaque marker in addition to kinking of the area proximal to the breakage point. To the authors' knowledge the case presented in this article is the first report of this imaging sign before catheter fragmentation. Lateral catheter placement and early recognition of subtle imaging signs may assist in decreasing the incidence of this significant complication.