giovedì 31 gennaio 2013

DATA DEFINITIVA CORSO ECO


A causa di problemi organizzativi le date del corso sono state spostate e chiedo scusa ai visitatori del blog.                      Vi aspetto!!!


IMPIEGO DEGLI ULTRASUONI NELL’ASSISTENZA INFERMIERISTICA ED OSTETRICA: ECOGRAFIA DI SUPPORTO E CONTROLLI DI QUALITÀ 

16-17-18 maggio 2013 

 Aula Magna Istituto Rosmini 

 Via Rosmini 4/A - Torino


mercoledì 30 gennaio 2013

ECO VESCICALE


Riguarda la verifica del residuo post minzionale attraverso l'utilizzo dell'ecografo che viene definito come una "terza mano".
Buona lettura

 2003 May 17;32(17):776-80.

[Use in daily urological practice of an ultrasound device for measuring bladder volume].

[Article in French]

Source

Service d'urologie et de transplantation rénale et pancréatique, Groupe Hospitalier Pitié-Salpétrière Université Pierre et Marie Curie, Paris VI 83, boulevard de l'Hôpital 75013 Paris, France. mroupret@club-internet.fr

Abstract

INTRODUCTION:

Bladder volume estimation is an everyday necessity in urology, especially for evaluation of the postvoid residual volume (PVR). TheBladder-Scan is a portable, noninvasive ultrasound device for bladder volume estimation. This study was designed to assess the value of the Bladder-Scan to measure PVR in routine hospital urological practice.

MATERIAL AND METHODS:

A prospective study was conducted from 1/12/1999 to 30/4/2000 with systematic use of the Bladder-Scan to measure PVR. Four operators performed three consecutive measurements of PVR and noted the following data: age, gender, history, type of disease and place of examination. The main endpoint was the need to use a complementary investigation to confirm or invalidate the result obtained.

RESULTS:

PVR was determined in 250 consecutive patients (167 males, 83 females): 191 patients admitted to the urology department, 36 patients seen in the emergency room and 23 patients seen in other departments of the hospital. PVR was estimated to be between 0 and 400 cc (median: 72 cc) for 181 patients (72%), between 400 cc and 750 cc (median: 521 cc) in 50 patients (20%) and between 750 cc and 1000 cc (median: 942 cc) for 19 patients (8%). A control of the measurement was required for 27% of patients (68/250) using catheterism (n = 53) or sonography (n = 15). In this sub-group, the value of the ICC (intra-class correlation coefficient) for the measurement of the bladder volume using the Bladder-Scan and measurement of the volume controlled by sonography or catheterism was of 0.9888 (significance < 0.0001/nil hypothesis ICC = 0).

CONCLUSION:

The Bladder-Scan provides a "third hand" in the urologist's daily practice, by supplying a reliable and rapid assessment of bladdervolume for volumes < 750 cc. It is a good tool for the evaluation of postvoid residual volume.
PMID:
 
12856322
 
[PubMed - indexed for MEDLINE]

lunedì 28 gennaio 2013

ACCESSO PERIFERICO BLIND VS ECOGUIDA


Ann Emerg Med. 2005 Nov;46(5):456-61.

Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficultintravenous access.

Source

Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, PA, USA. tcostantino@yahoo.com

Abstract

STUDY OBJECTIVE:

We assess the success rate of emergency physicians in placing peripheral intravenous catheters in difficult-access patients who were unsuccessfully cannulated by emergency nurses. A technique using real-time ultrasonographic guidance by 2 physicians was compared with traditional approaches using palpation and landmark guidance.

METHODS:

This was a prospective, systematically allocated study of all patients requiring intravenous access who presented to 2 university hospitals between October 2003 and March 2004. Inclusion criterion was the inability of any available nurse to obtain intravenous access after at least 3 attempts on a subgroup of patients who had a history of difficult intravenous access because of obesity, history of intravenous drug abuse, or chronic medical problems. Exclusion criterion was the need for central venous access. Patients presenting on odd days were allocated to the ultrasonographic-guided group, and those presenting on even days were allocated to the traditional-approach group. Endpoints were successful cannulation, number of sticks, time, and patient satisfaction.

RESULTS:

Sixty patients were enrolled, 39 on odd days and 21 on even days. Success rate was greater for the ultrasonographic group (97%) versus control (33%), difference in proportions of 64% (95% confidence interval [CI] 39% to 71%). The ultrasonographic group required less overall time (13 minutes versus 30 minutes, for a difference of 17 [95% CI 0.8 to 25.6]), less time to successful cannulation from first percutaneous puncture (4 minutes versus 15 minutes, for a difference of 11 [95% CI 8.2 to 19.4]), and fewer percutaneous punctures (1.7 versus 3.7, for a difference of 2.0 [95% CI 1.27 to 2.82]) and had greater patient satisfaction (8.7 versus 5.7, for a difference of 3.0 [95% CI 1.82 to 4.29]) than the traditional landmark approach.

CONCLUSION:

Ultrasonographic-guided peripheral intravenous access is more successful than traditional "blind" techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.
PMID:
 
16271677
 
[PubMed - indexed for MEDLINE]

martedì 22 gennaio 2013

APPLICAZIONE DEL CATETERE EPIDURALE

Anche se nella realtà italiana l'infermiere di anestesia non c'è o se è stato creato non ha le competenze, legali,  di quelli d'oltreoceano ecco un articolo sul posizionamento di un catetere epidurale attraverso l'uso dell'ecografo in quelle pazienti "difficili".

 2012 Jun;80(3):223-30.

Update for nurse anesthetists evidence-based anesthesia: The use of preprocedural ultrasonography during labor to facilitate placement of an epidural catheter.

Source

Uniformed Services University of the Health Sciences, Nurse Anesthesia Program, Naval Medical Center San Diego, California, USA. crnaden@yahoo.com

Abstract

Placement of an epidural catheter in parturients can be challenging because the anatomic changes of pregnancy may make it difficult to palpate an ideal insertion point or detect loss of resistance. Preprocedural ultrasonography (U/S-P) is reported to facilitate placement of epidural catheters in parturients. U/S-P provides information on the ideal insertion point, angle of needle insertion, and estimated depth to the epidural space. The purposes of this course are to describe the technique, systematically review the literature, and discuss techniques for integrating U/S-P into practice. It provides evidence demonstrating that U/S-P is a useful adjunct for placement of epidural catheters in obstetrical patients, especially patients with presumed "difficult backs" or obesity.
PMID:
 
22848984
 
[PubMed - indexed for MEDLINE]

giovedì 17 gennaio 2013

ECOGRAFIA URETERALE


Articolo che seleziona un particolare "target" di pazienti e cioè i mielolesi che possono sviluppare, in seguito a cateterismi e fenomeni infettivi, dei diverticoli ureterali.
Ovviamente per lo studio di questa patologia, gli autori, fanno notare che l'eco non può sostituire la metodica diagnostica tradizionale ma, in alcuni casi, può essere utilizzata efficacemente.
Domanda per i colleghi infermieri: tale metodica di studio pre cateterismo vescicale, ed in questo tipo di pazienti, può essere utile per prevedere possibile complicanze nel cateterismo?

 1994 Sep;66(4 Suppl):187-91.

[Urethral diverticuli in patients with spinal cord injury: echographic study].

[Article in Italian]

Source

Università di Roma, Tor Vergata.

Abstract

Urethral diverticula, a not infrequent complication in patients with spinal cord injuries, usually involve the bulbous urethra which is particularly exposed to the trauma of catheterism. Indeed, the frequent association of urethral trauma and infection is often the cause of diverticula in these patients. Diagnosis is made by ascending urethrogram, voiding cystourethrogram and urethroscopy. Eight patients between 20 and 45 years of age with spinal cord injuries who had used an indwelling catheter for periods ranging from 1 to 18 months and who presented urethral diverticula at conventional investigation, underwent transperineal and penile contact ultrasonography using 3.5 and 7.5 MhZ real-time scanners. Ultrasonography was performed during intraurethral injection of saline solution through a catheter positioned near the external urethral meatus. Before the scan all patients had undergone a neuro-urological physical examination, urine analysis and culture, renal and bladder ultrasonography, ascending urethrogram and voiding cystourethrogram, urethroscopy and urodynamic investigation. Ultrasonography identified all urethral diverticula, defined them morphologically, visualized the diverticula filling and emptying phases and evaluated urethral wall and periurethral tissue characteristics, without exposing patients to any dangerous gonadal irradiation. Ultrasonography cannot replace radiological investigation but is a valid alternative in cases of contrast medium allergy, when monitoring inoperable diverticula and in postoperative follow-ups.
PMID:
 
7889059
 
[PubMed - indexed for MEDLINE]

venerdì 11 gennaio 2013

ECOGRAFIA NEL MONITORAGGIO DELLA RITENZIONE URINARIA


Proposta di linee guida attraverso l'analisi della letteratura ed una consensus conference per prevenire danni iatrogeni al paziente attraverso l'uso dell'ecografia per monitorizzare l'eventuali ritenzioni urinarie ed utilizzare il cateterismo solo quando serve

 2012 Aug 30. doi: 10.1111/j.1365-2702.2012.04229.x. [Epub ahead of print]

Guidelines for preventing urinary retention and bladder damage during hospital care.

Source

Authors: Rose-Marie Johansson, RN, PhD Student, School of Health Sciences, Jönköping University, Jönköping; Bo-Eric Malmvall, MD, Professor, Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping and Futurum - The Academy of Healthcare, County Council, Jönköping; Boel Andersson-Gäre, MD, Professor, Futurum - The Academy of Healthcare, County Council and Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University; Bruno Larsson, MD, Urologist, Unit of Urology, County Hospital Ryhov, Jönköping; Ingrid Erlandsson, RN, Developement Officer, Unit of Urology, County Council Ryhov, Jönköping; Märta Sund-Levander, RN, RNT, PhD, Assistant Professor, Unit of Research and Development, Hoegland Hospital, Eksjö; Gunhild Rensfelt, RN, Infection Control Nurse, Infection Control, County Hospital Ryhov, Jönköping, Sigvard Mölstad, MD, Professor, Unit of R&D in Primary Care, Futurum, Jönköping, Lennart Christensson, RN, Associate Professor, School of Health Sciences, Jönköping University Jönköping, Sweden.

Abstract

Aims and objectives.  To develop evidence-based guidelines for adult patients in order to prevent urinary retention and to minimise bladder damage and urinary tract infection. Background.  Urinary retention causing bladder damage is a well known complication in patients during hospital care. The most common treatment for urinary retention is an indwelling urinary catheter, which causes 80% of hospital-acquired urinary tract infections. Appropriate use of bladder ultrasonography can reduce the rate of bladder damage as well as the need to use an indwelling urinary catheter. It can also lead to a decrease in the rate of urinary tract infections, a lower risk of spread of multiresistant Gram-negative bacteria, and lower hospital costs. Design.  An expert group was established, and a literature review was performed. Methods.  On the basis of literature findings and consensus in the expert group, guidelines for clinical situations were constructed. Results.  The main points of the guidelines are the following: identification of risk factors for urinary retention, managing patients at risk of urinary retention, strategies for patients with urinary retention and patient documentation and information. Conclusion.  Using literature review and consensus technique based on a multiprofessional group of experts, evidence-based guidelines have been developed. Although consensus was reached, there are parts of the guidelines where the knowledge is weak. Relevance to clinical practice.  These guidelines are designed to be easy to use in clinical work and could be an important step towards minimising bladder damage and hospital-acquired urinary tract infections and their serious consequences, such as bacteraemia and the spread of multidrug-resistant bacteria in hospitals.
© 2012 Blackwell Publishing Ltd.

sabato 5 gennaio 2013

DURATA DEI CATETERI IN ECOGUIDA


Artticolo recente a riguardo della durata dei cateteri periferici applicati in ecoguida che conclude che la migliore "sopravvivenza" dei catetri è determinata dall'accuratezza della scelta del vaso da incannulare.
Alcune osservazioni: non ho visto riportato la tipologia di terapia utilizzata (continua vs discontinua), la tipologia delle infusioni, il rapporto tra diametro vena e diametro catetere, il numero di tentativi per l'impianto, concomitanza o meno di fenomeni infettivi.
Buona lettura

Am J Emerg Med. 2012 Sep;30(7):1134-40. doi: 10.1016/j.ajem.2011.07.027. Epub 2011 Nov 10.

The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity.

Source

Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA. matthewfields@gmail.com

Abstract

INTRODUCTION:

Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.

METHODS:

A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.

RESULTS:

After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% (36/151) had been removed for routine reasons, and 44% (67/151) remained in working condition yielding a survival probability of 0.63 (95% confidence interval [CI], 0.53-0.70). Survival probability was perfect (1.00) when placed in shallow vessels (<0.4 cm), moderate (0.62; 95% CI, 0.51-0.71) for intermediate vessels (0.40-1.19 cm), and poor (0.29; 95% CI, 0.11-0.51) for deep vessels (≥1.2 cm); P < .0001. Intravenous survival probability was higher when placed in the antecubital fossa or forearm locations (0.83; 95% CI, 0.69-0.91) and lower in the brachial region (0.50; 95% CI, 0.38-0.61); P = .0002. The impact of vessel depth and location was significant after 3 hours and 18 hours, respectively. Vessel diameter did not affect USGPIV longevity.

CONCLUSION:

Cannulation of deep and proximal vessels is associated with poor USGPIV survival. Careful selection of target vessels may help improve success of USGPIV placement and durability.
Copyright © 2012 Elsevier Inc. All rights reserved.
PMID:
 
22078967
 
[PubMed - indexed for MEDLINE]

giovedì 3 gennaio 2013

VERIFICA DEL CORRETTO POSIZIONAMENTO DEL TUBO ENDOTRACHEALE NEI PAZIENTI OBESI


 2012 May;56(5):571-6. doi: 10.1111/j.1399-6576.2011.02630.x. Epub 2012 Jan 19.

Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography.

Source

Akutcentrum/Anestesikliniken, Skåne University Hospital, SUS Malmø, Sweden. peter.pfeiffer@skane.se

Abstract

BACKGROUND:

Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for verifying endotracheal intubation in obese patients.

METHODS:

A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography.

RESULTS:

Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P < 0.0001.

CONCLUSION:

In obese patients, verification of endotracheal tube placement with US is as fast as auscultation alone and faster than the standard method of auscultation and capnography.
© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.
PMID:
 
22260400
 
[PubMed - indexed for MEDLINE]