Background. For many reasons, the invasive measurement of systolic and diastolic blood pressure should be accurate. Accuracy is determined, in part, by the damping characteristics of the arterial catheter blood pressure monitoring system. Objectives . To ascertain the damping characteristics of arterial catheter blood pressure monitoring in a large tertiary intensive care unit (ICU) and to elicit any causes of under- or over-damping of the measurement systems. Methods. A cross-sectional, observational study of arterial line measurements in a large general ICU. The coefficient of damping (CoD) was calculated from the waveform generated from a ‘fast flush’. Results . Thirty systems (19%) were adequately damped (CoD 0.4 - 0.8), 56 (37%) were overdamped, and 68 (44%) were underdamped. We did not find that poor damping characteristics were associated with the age of the arterial catheter or the type of catheter used. Conclusion. Most systems observed in this study were inappropriately damped, which would result in the inaccurate display of the waveform and systolic and diastolic pressures.
{"title":"Analysis of damping characteristics of arterial catheter blood pressure monitoring in a large intensive care unit","authors":"W. Rook, J. Turner, T. Clutton-Brock","doi":"10.7196/300","DOIUrl":"https://doi.org/10.7196/300","url":null,"abstract":"Background. For many reasons, the invasive measurement of systolic and diastolic blood pressure should be accurate. Accuracy is determined, in part, by the damping characteristics of the arterial catheter blood pressure monitoring system. Objectives . To ascertain the damping characteristics of arterial catheter blood pressure monitoring in a large tertiary intensive care unit (ICU) and to elicit any causes of under- or over-damping of the measurement systems. Methods. A cross-sectional, observational study of arterial line measurements in a large general ICU. The coefficient of damping (CoD) was calculated from the waveform generated from a ‘fast flush’. Results . Thirty systems (19%) were adequately damped (CoD 0.4 - 0.8), 56 (37%) were overdamped, and 68 (44%) were underdamped. We did not find that poor damping characteristics were associated with the age of the arterial catheter or the type of catheter used. Conclusion. Most systems observed in this study were inappropriately damped, which would result in the inaccurate display of the waveform and systolic and diastolic pressures.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"30 1","pages":"8-10"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85520824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sugar, Pressure and Pregnancy","authors":"W. L. Michell","doi":"10.7196/SAJCC.337","DOIUrl":"https://doi.org/10.7196/SAJCC.337","url":null,"abstract":"","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"67 1","pages":"2-2"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85665384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.319
M. Venter, D. Stanton, N. Conradie, L. Jordaan, C. Venter, W. Stassen
1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa 4 Department of Emergency Medical Care, Faculty of Health Sciences, Cape Peninsula University of Technology, Cape Town, South Africa 5 Critical Care Retrieval Services, ER24, Johannesburg, South Africa
{"title":"The need for setting standards in critical care transfers","authors":"M. Venter, D. Stanton, N. Conradie, L. Jordaan, C. Venter, W. Stassen","doi":"10.7196/SAJCC.2017.V33I1.319","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.319","url":null,"abstract":"1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa 4 Department of Emergency Medical Care, Faculty of Health Sciences, Cape Peninsula University of Technology, Cape Town, South Africa 5 Critical Care Retrieval Services, ER24, Johannesburg, South Africa","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"29 1","pages":"32-32"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86226087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.327
R. Wise, R. Rodseth, L. Correa-Martín, F. M. S. Margallo, P. Becker, G. Castellanos, M. Malbrain
Grant from Extremadura Regional Government through the Plan Regional de Investigacion de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesus Uson).
{"title":"Correlation between different methods of intra-abdominal pressure monitoring in varying intra-abdominal hypertension models","authors":"R. Wise, R. Rodseth, L. Correa-Martín, F. M. S. Margallo, P. Becker, G. Castellanos, M. Malbrain","doi":"10.7196/SAJCC.2017.V33I1.327","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.327","url":null,"abstract":"Grant from Extremadura Regional \u0000 Government through the Plan Regional de Investigacion de Extremadura \u0000 (PRI09A161 to Minimally Invasive Surgery Center Jesus Uson).","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"46 1","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72510892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background . Pregnancy is a natural physiological process that normally ends uneventfully. However, there are instances where admission to an intensive care (ICU) is required. Objectives . To determine the spectrum of disease requiring ICU admission in obstetric patients, condition on discharge, maternal mortality, and the cause of maternal death. Methods . A retrospective study of all pregnant and postpartum patients admitted from January 2008 to December 2011 was conducted. Outcome measures were the spectrum of disease, ICU interventions, and maternal outcomes. Results . In total, 210 patients were reviewed. The mean age was 28.15 (standard deviation (SD) 6.97) years. Twelve (5.7%) patients were admitted at a mean (SD) gestational age of 25.33 (6.56) weeks, 94.2% ( n =198) were postpartum, and 88.6% ( n =186) were post-caesarean section. Pre-existing cardiac disease (44.3%, n =93), eclampsia and preeclampsia (20%, n =42), obstetric haemorrhage (16.2%, n =34), and pulmonary oedema (6.2%, n =13) were the most common causes of admission. Sixty-one percent ( n =128) of patients received ventilatory support. The median length of ICU stay was 24 hours (range 1 - 17 days). Eighty-seven percent ( n =183) of the patients were haemodynamically stable. Maternal mortality was 9% ( n =19). Conclusion . Cardiac disease in pregnancy was the most common diagnosis in patients admitted to our ICU, followed by eclampsia and preeclampsia. Most of the patients (87.1%) were haemodynamically stable and needed minimal intervention, as confirmed by their short periods of stay in ICU. Although the mortality rate in our institution was higher than that observed in developed countries, it was lower than rates reported in other South African studies. This study has found that many of the patients were admitted to ICU for monitoring purposes only and did not require ICU level of care.
{"title":"Obstetric patients admitted to the intensive care unit of Dr George Mukhari Academic Hospital, Ga-Rankuwa, South Africa","authors":"M. Motiang","doi":"10.7196/279","DOIUrl":"https://doi.org/10.7196/279","url":null,"abstract":"Background . Pregnancy is a natural physiological process that normally ends uneventfully. However, there are instances where admission to an intensive care (ICU) is required. Objectives . To determine the spectrum of disease requiring ICU admission in obstetric patients, condition on discharge, maternal mortality, and the cause of maternal death. Methods . A retrospective study of all pregnant and postpartum patients admitted from January 2008 to December 2011 was conducted. Outcome measures were the spectrum of disease, ICU interventions, and maternal outcomes. Results . In total, 210 patients were reviewed. The mean age was 28.15 (standard deviation (SD) 6.97) years. Twelve (5.7%) patients were admitted at a mean (SD) gestational age of 25.33 (6.56) weeks, 94.2% ( n =198) were postpartum, and 88.6% ( n =186) were post-caesarean section. Pre-existing cardiac disease (44.3%, n =93), eclampsia and preeclampsia (20%, n =42), obstetric haemorrhage (16.2%, n =34), and pulmonary oedema (6.2%, n =13) were the most common causes of admission. Sixty-one percent ( n =128) of patients received ventilatory support. The median length of ICU stay was 24 hours (range 1 - 17 days). Eighty-seven percent ( n =183) of the patients were haemodynamically stable. Maternal mortality was 9% ( n =19). Conclusion . Cardiac disease in pregnancy was the most common diagnosis in patients admitted to our ICU, followed by eclampsia and preeclampsia. Most of the patients (87.1%) were haemodynamically stable and needed minimal intervention, as confirmed by their short periods of stay in ICU. Although the mortality rate in our institution was higher than that observed in developed countries, it was lower than rates reported in other South African studies. This study has found that many of the patients were admitted to ICU for monitoring purposes only and did not require ICU level of care.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"7 1","pages":"12-14"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84911025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose . The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results . The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion . DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.
{"title":"Lived experiences of Rwandan ICU nurses caring for patients with a do-not-resuscitate order","authors":"E. Nankundwa, P. Brysiewicz","doi":"10.7196/281","DOIUrl":"https://doi.org/10.7196/281","url":null,"abstract":"Background. Do not resuscitate (DNR) is the policy and practice of deliberately not attempting to resuscitate a person whose heart has stopped beating. Research on nursing care for patients designated with DNR orders has been conducted since the late 1980s; however, no study appears to have been carried out in the Rwandan setting. Purpose . The purpose of this study was to explore the lived experiences of nurses caring for a patient with a DNR order in an intensive care unit (ICU) in Kigali, Rwanda, in order to suggest nursing recommendations. Methods. Using a phenomenological approach, two semi-structured interviews were conducted with each participant to explore their lived experiences of caring for patients with DNR orders. The sample comprised six nurses from an ICU in a large tertiary-level hospital in Kigali, Rwanda. Results . The data were organised into categories based on a review of the data from the interviews of the six participants. The categories were: feeling emotional distress; barrier to optimal care; and not part of decision-making. Conclusion . DNR orders are a fairly new concept in Rwanda and the practice of DNR orders in ICU is very demanding for the staff, especially the ICU nurses. Additional education about DNR orders as well as policies to guide its implementation could assist ICU nurses in their difficult work.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"19-22"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86939151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.280
D. Maharaj, H. Perrie, J. Scribante, F. Paruk
Background . Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods . A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results . A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively ( p =0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively ( p <0.05). Conclusion . Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.
{"title":"Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap","authors":"D. Maharaj, H. Perrie, J. Scribante, F. Paruk","doi":"10.7196/SAJCC.2017.V33I1.280","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.280","url":null,"abstract":"Background . Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods . A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results . A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively ( p =0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively ( p <0.05). Conclusion . Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"8 1","pages":"4-7"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73161357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-07-11DOI: 10.7196/SAJCC.2017.V33I1.274
T. V. D. Heever, M. Spruyt
We report a case of generalised tetanus in a 50-year-old female patient after sustaining a wound to her right lower leg. She developed autonomic dysfunction, which included labile hypertension alternating with hypotension and sweating. The autonomic dysfunction was treated successfully with a combination of morphine sulphate infusion, magnesium sulphate, and clonidine. She also received adrenaline and phenylephrine infusions as needed for hypotension. We then discuss the pathophysiology, clinical features and treatment options of autonomic dysfunction.
{"title":"The treatment of autonomic dysfunction in tetanus","authors":"T. V. D. Heever, M. Spruyt","doi":"10.7196/SAJCC.2017.V33I1.274","DOIUrl":"https://doi.org/10.7196/SAJCC.2017.V33I1.274","url":null,"abstract":"We report a case of generalised tetanus in a 50-year-old female patient after sustaining a wound to her right lower leg. She developed autonomic dysfunction, which included labile hypertension alternating with hypotension and sweating. The autonomic dysfunction was treated successfully with a combination of morphine sulphate infusion, magnesium sulphate, and clonidine. She also received adrenaline and phenylephrine infusions as needed for hypotension. We then discuss the pathophysiology, clinical features and treatment options of autonomic dysfunction.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"25 1","pages":"28-31"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73024042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. V. Heerden, H. V. Aswegen, S. V. Vuuren, R. Roos, A. Dusé
Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence
背景。由重症监护病房(icu)的护士和物理治疗师提供雾化药物，是患者护理的重要组成部分。目标。确定呼吸机回路内使用的雾化器是否受到污染;描述有关这些设备的净化和储存的方案和临床实践;并识别在病人床边被污染的雾化器和周围空气中的微生物。方法。进行了一项横断面多中心观察研究，包括现场和设备取样以确定污染情况。访谈了ICU管理人员，以确定其单位使用的雾化器的净化和储存方案。从喷雾器室中取出拭子并将其纹在血琼脂板(BAPs)上。采用空气采样器采集床边周围环境的空气样本。对BAPs进行细菌和真菌污染孵育。鉴定了这些样品中所观察到的菌落种类。结果。从7个icu中抽取61个雾化器(Micro Mist n =37;Aeroneb n =24)。一半的雾化器(Micro Mist (n =19, 51.4%);Aeroneb (n =12, 50%))和大多数空气样本(n =60, 98%))存在污染。所有参与的icu都报告了净化和储存规程，但对雾化器的目视检查表明没有遵守规程。用酒精冲洗并晾干的雾化器污染率最低。凝固酶阴性葡萄球菌多见于周围空气和Aeroneb样品中，肠球菌多见于Micro Mist雾化器中。结论。虽然雾化器的净化和储存协议已经到位，但雾化器和空气污染很高，可能是由于工作人员的依从性差
{"title":"Contamination of nebulisers and surrounding air at the bedside of mechanically ventilated patients","authors":"L. V. Heerden, H. V. Aswegen, S. V. Vuuren, R. Roos, A. Dusé","doi":"10.7196/295","DOIUrl":"https://doi.org/10.7196/295","url":null,"abstract":"Background . The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care. Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides. Methods . A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n =37; Aeroneb n =24). Half of the nebulisers (Micro Mist ( n =19, 51.4%));Aeroneb ( n =12, 50%)) and most air samples ( n =60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers. Conclusion . Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherence","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"32 1","pages":"23-27"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81692737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-10DOI: 10.7196/SAJCC.2016.V32I2.268
Christopher Stein, Eduardo Caetano
Background . Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. Aim . To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. Method . A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. Results . Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were <1°C. The maximum temperature recorded overall was 13°C and the minimum was −3°C. Conclusion . Low-cost, non-specialised materials used in a HEMS operation were not adequate for the safe transport of blood.
{"title":"Transportation of blood in a helicopter emergency medical service: The importance of specialised equipment","authors":"Christopher Stein, Eduardo Caetano","doi":"10.7196/SAJCC.2016.V32I2.268","DOIUrl":"https://doi.org/10.7196/SAJCC.2016.V32I2.268","url":null,"abstract":"Background . Administration of blood in the pre-hospital environment is becoming more feasible, particularly in helicopter emergency medical services (HEMS) during primary response and critical care transfers of major trauma patients. The main challenge in this environment is maintaining a suitable thermal environment for blood transport during missions that may last several hours. Aim . To investigate whether a simple and cost-effective method of storage in a typical HEMS operation would provide an adequate thermal environment for blood. Method . A commercially available cooler box and ice packs were used to simulate a blood transport environment during HEMS missions over three summer and three winter months. In-box temperature was monitored using an electronic thermometer and data logger. Results . Temperature data were recorded during 146 missions with a mean duration of 02:01:35 (95% confidence interval 01:46:25 - 02:16:46). A total of 344 temperature observations were done in the summer months and 384 in the winter months. All mean temperatures recorded in the cooler box were within the required 1 - 6°C range; however, of the total temperature observations recorded, 30% (102/344) during summer were >6°C while 8% (32/384) during winter were >6°C and 15% (59/384) were <1°C. The maximum temperature recorded overall was 13°C and the minimum was −3°C. Conclusion . Low-cost, non-specialised materials used in a HEMS operation were not adequate for the safe transport of blood.","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"37 1","pages":"62-63"},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81292339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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