Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Oct 2009
Nurse reports of adverse events during sedation procedures at a pediatric hospital.
The purpose of our study was to examine the reliability of nurse reports of adverse events related to procedural sedation in children. A descriptive, correlational design was used to analyze for inter-rater agreement between prospective adverse event reporting and that identified on independent review of the medical record. All sedation documentation at a pediatric hospital over one calendar year was reviewed, and inter-rater reliability of reporting was analyzed using K statistics. ⋯ Although overall agreement between nurse reports and independent review was greater than 99%, subanalysis suggested greater agreement for serious events than for minor ones (K values: 0.85 vs 0.49, P < .01). The results of our study revealed that minor adverse events associated with procedural sedation were under-reported, despite clear perianesthesia documentation in the medical record that an event had occurred. Improved education for perianesthesia nurses regarding the importance of monitoring both for serious and minor adverse events will help to identify opportunities to improve sedation protocols.
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J. Perianesth. Nurs. · Oct 2009
Innovative use of perianesthesia nurses in imaging services: meeting the needs of children with disabilities.
A new imaging center was established within a children's specialty hospital that provides services for children and adults with childhood-onset disabilities. New services in this advanced imaging center include computed tomography, magnetic resonance imaging, fluoroscopy, and ultrasound. ⋯ Perianesthesia nurses developed an advanced imaging screening process to prepare patients for sedation during imaging services. With these processes, the new Advanced Imaging Center is providing timelier and better coordinated imaging services.
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J. Perianesth. Nurs. · Aug 2009
Randomized Controlled TrialThe effect of needle bevel position on pain for subcutaneous lidocaine injection.
It is a common practice for medical practitioners to use subcutaneous infiltration of lidocaine to alleviate the pain of intravenous cannulation or line insertion. Although previous studies have assessed several factors affecting the pain associated with local anesthetic infiltration, there is a paucity of data on the effects of needle bevel position. ⋯ Significantly higher pain scores were observed when the needle was placed bevel down compared with bevel up (P = .02). No significant differences in pain scores were noted between the groups for age and gender.
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J. Perianesth. Nurs. · Aug 2009
ReviewA review of the incidence, causes, consequences, and management of gastrointestinal effects associated with postoperative opioid administration.
Opioid analgesics are commonly used to manage moderate to severe postoperative pain. Classic mu-opioid receptor agonists, such as morphine, meperidine, and fentanyl, provide excellent analgesia. However, their use in the postoperative setting is often limited by adverse effects such as nausea, vomiting, and reduced gastrointestinal motility. ⋯ If these effects are not managed effectively, opioid-related complications may significantly increase patient morbidity, have a negative impact on patient outcomes, and increase the burden on the nursing staff. Strategies are available to minimize and treat opioid-related adverse effects. Implementation of these strategies should result not only in increased patient comfort and satisfaction, but also in decreases in lengths of stay, more effective nursing care, and decreases in associated hospital costs.