American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy.
Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. ⋯ Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.
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Removal of internal jugular and subclavian central venous catheters is a common nursing intervention. Venous air embolism is a serious complication of catheter removal. Although some procedures have been recommended to prevent venous air embolism, whether nurses use these procedures and what complications patients experience are unknown. ⋯ None of the nurses sampled had venous air embolism diagnosed in their patients. They reported observing dyspnea, pain, bleeding from the insertion site, and arrhythmias. Many of the nurses reported that they did not always use all the recommended procedures; only 9 nurses (31%) reported always using all the recommended procedures.
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Recommendations on use of neuromuscular blocking agents include using peripheral nerve stimulators to monitor depth of blockade and concomitantly administering sedatives and/or analgesics. ⋯ Small and large facilities differ in concomitant use of analgesics/sedatives and peripheral nerve stimulators. Education and research are needed to ensure that patients receive adequate monitoring and sedation during administration of neuromuscular blocking agents.