Enfermeria Intensiva最新文献

Objectives

To evaluate the brochure provided to relatives on admission to Spanish Intensive Care Units (ICU) regarding nursing information.

Methodology

Descriptive, cross-sectional, multicentre study from September-December 2019. A total of 280 adult ICUs were included, according to the list of the Spanish Society of Intensive Care. The brochure was requested through personal contact, phone call, twitter, or hospital website.

Analyzed variables

Hospital (public/private), university (yes/no), visiting (open/closed), medical and nurse information. Descriptive statistics and X² test (relations nurse information and other variables).

Results

Data were collected from 228 ICU(81.4%), of which 25(11%) did not have a brochure. A total of 77.8% were public and 49.8% university hospitals. Of the hospitals, 94.1% had closed visiting hours, although 42.4% supplemented it with flexible. All the hospitals included daily medical information with an established timetable, 21.7%(n = 44) contained nurse information, 27.3% with established hours and 38.6% during visits. Of the nursing information, 79.5% referred to care, 29.5% to needs, 13.6% to well-being, 15.9% to the patient's condition, 11.4% to the environment, 9.1% to observations, and 29.5% to clarifications. A total of 17.2% of all ICU offered to collaborate in care. Of the brochures with nurse information, 90.9% were public hospitals and 9.1% were private (P = .02). Of the hospitals, 65.9% were university compared to 34.1% who were not (P = .02).

Conclusions

While medical information is consistently reflected in all brochures, only a few contain nursing information with generic and non-homogeneous and specific content. These results contrast with the reality of the ICU, where the nurse is the professional with the greatest contact with the family. The official provision of nursing information occurs more frequently in public and university hospitals. It is necessary to standardise this information, since as a responsible part of the care process, nurses must communicate their care in a formal manner, and thus help make their work visible.

Continuous renal replacement therapies are used as a means of blood clearance in critically ill patients with acute renal failure. Its effectiveness depends on the permeability of the extracorporeal circuit and filter coagulation is the most frequent cause of treatment interruption. This situation carries a risk of blood loss for the patient.

Sodium heparin is the most widely used anticoagulant in these therapies, but it can increase the risk of bleeding. Regional citrate anticoagulation is a safer method compared to sodium heparin.

Citrate is a substance that works by inactivating ionic calcium that participates in the coagulation cascade. It's infused at the inlet of the circuit and neutralized before reaching the patient with calcium replacement. For this reason, it is considered a regional and non-systemic anticoagulant.

However, this anticoagulation system, despite being indicated as the first option by the KDIGO guidelines (Kidney Disease Improving Outcomes), is not yet widespread due to the complexity of its use. It requires specific training for healthcare personnel, especially nurses, who will be responsible for maintaining the circuit while the therapy lasts.

In this article we want to provide the necessary knowledge about anticoagulation to carry out these procedures safely and effectively.

Extracorporeal purification treatments are a very usual techniques in the intensive care units. Those treatments are essential for critical patients. Their knowledge and skill leads to a more efficient and effective treatment for the patient and the calculation of the filtration fraction adds to all these objectives.

This paper offers some simple calculations of this parameter, taking into account blood flow and fluid in the pre- or post-filter replacement.

If it's possible to simulate the kidney in these treatments, we will be able to work in the most optimal filter conditions and increases the filter lifespan. Finally, and as a consequence of the above, avoid complications derived from the increase in transfusions to these critical patients.

The concept «homeostasis» is related to a normal and relatively constant maintenance in the total volume and distribution of water in the body. For its maintenance it is very important that the excretion of water and electrolytes correspond precisely to its input.

A description of the most important ions is developed in this article. It is structured by describing optimal levels, followed by their main role in the body.

The situation of excess or deficiency of each ion is described. Associated with each situation of abnormality, the most frequent causes, the clinical manifestations, and the appropriate treatments are listed.

It is considered very important to know the function of potassium, calcium, magnesium, phosphorus or sodium and the problems that their imbalances can generate, aiming at the precise application of each of the extracorporeal therapies and the most appropriate treatment bags in each case.

Finally, a table of the composition of some treatment bags in continuous purifying therapies is offered based on the description offered by their own laboratories.

Treatments that aim to return fluid and electrolyte balance to patients with kidney failure need a very important knowledge, which is sometimes uncommon among nurses. This review offers the appropriate tools to deal with complex situations in this context, completes nursing training and offers greater safety in care.

Purifying extracorporeal systems can cause several problems in the internal environment in a way that puts the patient's life at risk. In addition, if the situation of hemodynamic fragility so requires, continuous purification systems may be the best. That situation requires admission to an intensive care unit. Cardiac monitoring, among others, will be necessary to promptly detect any problem related to the imbalance of certain ions. The supply of glucose and essential nutrients, the dosage of certain drugs and the prevention of infections will be some of the fields of follow up and control of the staff in charge of these patients.

Patient safety is a priority for all healthcare systems and is especially relevant in critical patients. Despite its relevance and progress, in recent years there are still many patients who suffer adverse events with harm and negative repercussions for professionals and institutions. Zero projects are presented as strategies to reduce infections related to invasive devices and this type of adverse events, demonstrating their remarkable effectiveness. This article presents the main tools to improve safety in daily ICU care and discusses how to involve professionals in the evaluation through safety indicators.

The Bacteraemia Zero (BZ) Project was the first of the Zero Projects to be implemented in Intensive Care Unit (ICU), achieving a decrease in catheter-related infection rates below those recommended by the quality standards of scientific societies. Following the SARS-CoV-2 pandemic in ICU, a significant increase in these infection rates has been observed. Increase in infection rates and the need to incorporate the best available evidence into clinical practice justifies the need to update the recommendations of the BZ project. A working group formed by members of the different scientific societies considered that the mandatory measures of the project should not be modified due to its proven efficacy. In addition, this group decided to incorporate the following optional measures: use of catheters impregnated with antimicrobials, use of dressings impregnated with chlorhexidine, use of caps with an antiseptic solution in connectors, and daily body hygiene with chlorhexidine.

Introduction

COVID-19 patients admitted to critical care units present an intense inflammatory response and the need to replace organs or systems for long periods of time, which facilitates the presence of infectious complications.

Objectives

To present the national rates of infections related to invasive devices (IRDI) in COVID-19 patients, as well as the rates of multi-resistant bacteria (MBR) acquired during their stay in critical care units.

Method

Retrospective analysis of COVID-19 patients included during the first, second and fourth waves of the pandemic in a national observational and multicenter database (ENVIN-HELICS). Pneumonias related to mechanical ventilation (N-MV), urinary tract infections related to urethral catheter (UTI-SU) and primary bacteremia related to central venous catheters (BP-CVC) were recorded, whose rates are presented as incidence density (ID). The BMRs acquired during the stay in the critical care units were recorded and presented as cumulative incidence (CI).

Results

Seven thousand seven hundred seventy-eight patients were included, 1,525 (19.6%) in the first wave of the pandemic, 3,484 (44.8%) in the second, and 2,769 (35.6%) in the fourth. ICU stay of 21 days in the first and second waves and 19.7 days in the fourth. Intra-ICU mortality in the first wave, decreasing from 31% to 26.3% in the second and 18.9% in the fourth. N-MV rates of 14.31, 13.56, and 19.99 episodes per 1,000 days of MV in each wave. UTI-SU rates of 6.54, 5.63 and 7.97 episodes per 1000 days of SU. BP-CVC rates of 12.42, 7.95, and 8.13 per 1,000 CVC days. The BMR rate was 22.9, 15.3, and 15.3 BMR per 100 admitted patients.

Conclusions

High rates of the different IRDI in COVID patients that are maintained in the three waves analyzed. High rates of BMR acquired during the stay in critical care units with a tendency to decrease in the fourth wave.

During the COVID-19 pandemic, the world's healthcare systems were extremely strained. Intensive care units were stretched to capacity and healthcare facilities were forced to set up spaces to care for critically ill patients. Professionals were required to work in strenuous conditions, completely disrupting their work routines.

In this scenario, hand hygiene and the use of gloves by healthcare professionals became a critical point of transmission risk.

The results of the ENVIN study in 2020 and 2021, corresponding to the pandemic period, showed worrying data on the increase in infection rates, with rates rising by 250% at the worst moments of the pandemic. This suggested that excessive risk situations were occurring for the patient. Any preventive strategy must place correct hand hygiene and proper use of gloves among its priority objectives. For this reason, the Project Zero Advisory Board made a series of adaptations and recommendations based on available evidence and expert opinion related to hand hygiene and glove use during the pandemic situation to promote best practice in extreme situations. This article reviews the key aspects of hand hygiene as part of the WHO safety strategy, the main barriers to compliance and the main adaptations proposed by the Advisory Board of the Zero projects.