venerdì 18 dicembre 2015

BUONE FESTE


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CONOSCERE L'ECOGRAFIA

Vi segnalo post sull'ecografia del noto collega Carlo D'apuzzo sulle risorse del web
Piacevole nella lettura e corredato di link per poter accedere liberamente ai siti descritti.

http://empills.com/2015/12/14/nuove-risorse-ecografiche-sul-web/


Sempre sull' Em Pills ma questa volta di Vincenzo Peloponneso (collega dell'asl di Cn) un articolo sull'ecografia infermieristica, da seguire!

http://empills.com/2015/11/19/ecografia-vescicale-infermieristica/

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IL CAMBIAMENTO PER GLI INFERMIERI IN ECOGRAFIA?

In un post di un lontano settembre di due anni fa, mi domandavo quanti fossero gli infermieri che "praticassero l'ecografia" e devo dire di non essere per niente stupito di  verificare che dopo due anni nessuno si sia fatto avanti.
Ho seguito siti pseudo infermieristici sull'ecografia che si sono fermati dopo pochi mesi, colleghi che commentano nei vari blog ma si guardano bene dall'esporsi troppo magari condividendo le esperienze.
Questa è la fauna infermieristica che si occupa dell'argomento il più delle volte senza che riescano a definire l'ecografia e l'utilizzo infermieristico ma, devo riconoscere, molto bravi a far passare, dopo opportuni camuffamenti,come pratica infermieristica la formulazione di una diagnosi.
Con tutti i limiti che può avere una MIA OPINIONE, si può dire che il feudalesimo professionale è presente e non è colpa di nessuno se la categoria infermieristica continua a non essere in grado di emanciparsi ma di doversi appoggiare a qualcos'altro.
Un plauso a chi, controcorrente come un salmonide, cerca di utilizzare l' ecografia ( NON L'ECOGRAFO!) per fare ricerca nonostante colleghi limitati e divieti all'utilizzo delle apparecchiature da parte di superiori gerarchici ottusi.
Questo blog resta aperto per chi ha voglia di mettersi in discussione e voglia sperimentare...... la bottiglia continua a navigare......

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lunedì 14 dicembre 2015

LOCANDINA ISCRIZIONE MASTER DI ECOGRAFIA


Università degli Studi di Torino Scuola di Medicina Dipartimento di Neuroscienze
MASTER DI PRIMO LIVELLO III°EDIZIONE
METODICHE ECOGUIDATE PER LE PROFESSIONI
INFERMIERISTICHE E OSTETRICHE
ISCRIZIONI

Gli studenti potranno iscriversi al Master on-line sul sito 
www.unito.it
(Home >Didattica >Immatricolazioni e iscrizioni)
Dal 10 Novembre 2015 all' 8 gennaio 2016


 ATTIVITA’ DIDATTICHE
L’attività didattica è articolata in moduli con lezioni frontali
e attività in FAD (Formazione a Distanza). All'interno di ogni modulo
sono previste attività pratiche di utilizzo dell'ecografo.
Sono previsti periodi dedicati a stage presso strutture accreditate.

DURATA, TASSE E COSTI DEL MASTER
Biennale da Febbraio 2016 a Febbraio 2018
Al momento dell' iscrizione Tassa Universitaria 553 euro + 200 euro Aprile 2016: 800 euro
Ottobre 2016: 500 euro

INFORMAZIONI
Per maggiori informazioni visita il sito del Master http://www.master-mepio.unito.it/do/home.pl


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lunedì 5 ottobre 2015

SUMMER SCHOOL BRUCOLI 2015

Per il terzo anno consecutivo la SIMEU ha organizzato a Brucoli, in terra di sicilia, la full immersion per infermieri.
Tra i vari argomenti che si sono trattati non poteva non esserci l' Ecografia?
Due giorni tra un pizzico di teoria e tanta pratica ed i discenti che alla fine, hanno avuto un assaggio di quello che l'ecografia può offrire per la professione!
Nella prima giornata è intervenuta la presidente IPASVI la dott.ssa B.Mangiacavalli, che ha illustrato le nuove prospettive della responsabilità professionale dell'infermiere.
Sono le occasioni di confronto di questo tipo, che fanno pensare che i sacrifici ed i giorni di ferie presi per questo scopo siano ben utilizzati e ben spesi.
Grazie ragazzi per l'impegno ed ora la sonda passa a voi!!!
Ovviamente grazie anche a Luca il maestro





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venerdì 18 settembre 2015

LEZIONE MASTER NOVARA

E' terminata la unit di ecografia nel Master Universitario di Accessi venosi centrali per le professioni mediche ed infermieristiche  dell' Università del piemonte orientale (UPO).
Grazie ai discenti ed ai miei preziosi collaboratori / amici, Angela, Flavio, Fabiana, Riccardo che in due giorni mi hanno aiutato ad utilizzare il tempo concessomi per una full immersion di prove pratiche con Phantom per accessi vascolari e Phantom preparati ad hoc per scovare oggetti nascosti.
Grazie a tutti ed in particolare ad Alessandra, Carla e Luisa ed ovviamente ai discenti per la loro partecipazione!!!




...siamo quasi alla frutta....


prima della prova pratica...




Phantom di Agar Agar
con magica sonda da 18MHz!!!

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lunedì 24 agosto 2015

POLMONI ED ULTRASUONI

Articolo che mette in correlazione l'aspetto ecografico polmonare, valori biochimici e variazione della clinica del paziente.
Interesse infermieristico scarso
J Cardiovasc Med (Hagerstown). 2015 Jan 7. [Epub ahead of print]

Lung ultrasound and transthoracic impedance for noninvasive evaluation of pulmonary congestion in heart failure.

Facchini C1, Malfatto G, Giglio A, Facchini M, Parati G, Branzi G.
aDivisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS bDipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università di Milano-Bicocca, Milan, Italy.

Abstract

BACKGROUND:

In patients with heart failure, many indexes are available for noninvasive identification of pulmonary congestion: E/E' at echocardiography; plasma levels of brain natriuretic peptide (BNP) (pg/ml); number of B-lines at lung ultrasound; and transthoracic conductance [thoracic fluid content (TFC)TT = 1/Ω] at impedance cardiography (ICG).

METHODS:

We obtained 75 measures from 50 patients (72 ± 10 years, NYHA 2.4 ± 0.7, ejection fraction 31 ± 7%), 25 of them studied before and after intravenous diuretics, in whom we assessed the following: E/e' from Doppler echocardiogram; BNP plasma levels; presence and number of B-lines at lung ultrasound; and TFCTT from ICG. We determined the relationship among these indexes and their change with treatment, and compared B-lines and TFC for the diagnosis of pulmonary congestion. Finally, we considered the timing and the personnel required for performing and interpreting each test.

RESULTS:

A mutual relationship was observed between all the variables. After clinical improvement, changes in each variable were of similar direction and magnitude. Congestion (estimated by chest radiograph) was present in 59% of the patients: TFC value and B-line number had the best sensitivity and specificity for its detection. BNP determination and ICG assessment were performed by a nurse (15 min), and echocardiography and lung ultrasound were performed by a cardiologist (15 min).

CONCLUSION:

The correlation between all indexes and their consensual change after improvement of the clinical status suggests that they all detect pulmonary congestion, and that using at least two indexes improves sensitivity and specificity. The choice among the methods may be determined by the patient characteristics or by the clinical setting.
PMID:
25575275
[PubMed - as supplied by publisher]
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giovedì 20 agosto 2015

La formazione in telemedicina è equiparabile alla formazione di persona?

Leggendo questo articolo sembrerebbe proprio così anche se sarei curioso di capire la metodica del corso per via telematica e che tipo di tutoraggio è stato messo in opera......
J Telemed Telecare. 2015 Jun;21(4):235-9. doi: 10.1177/1357633X15575446. Epub 2015 Mar 11.

A comparison of telemedicine teaching to in-person teaching for the acquisition of an ultrasound skill - a pilot project.

Brisson AM1, Steinmetz P2, Oleskevich S3, Lewis J3, Reid A3.

Author information

Abstract

Telemedicine is widely used for medical education but few studies directly investigate how telemedicine teaching compares to conventional in-person teaching. Here we determine whether telemedicine teaching is as effective as in-person teaching for the acquisition of an ultrasound skill important in trauma care. Nurses with no prior ultrasound experience (n = 10) received study material and a teaching session on how to locate and image the hepatorenal space (Morison's pouch). One group of nurses was taught in-person (In-person Group) and the other group was taught via telemedicine (Telemedicine Group). Telemedicine allowed two-way audio and visual communication between the instructor and the nurses. A comparison of the teaching techniques showed that telemedicine teaching was equivalent to in-person teaching for the acquisition of practical and theoretical skills required to locate Morison's pouch. The average time required to locate Morison's pouch after teaching was similar between both groups. The results demonstrate that telemedicine teaching is as effective as in-person teaching for the acquisition of bedside ultrasound skills necessary to identify Morison's pouch. Remote teaching of these bedside ultrasound skills may help in the diagnosis of intra-abdominal bleeding in rural healthcare centers.
© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

KEYWORDS:

Telemedicine; tele-education; telecare; telehealth; teleradiology
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domenica 16 agosto 2015

Ultrasuoni in cardiochirurgia

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lunedì 10 agosto 2015

M.E.P.I.O. 3^ EDIZIONE


Anche quest'anno partirà il master di I livello M.E.P.I.O., è stato modificata la durata che ora è biennale.
Per informazioni si può andare su contatti del link a fondo pagina.
Vi aspettiamo


Il Consiglio di Amministrazione ha approvato, nella seduta del 29 aprile 2015, l'attivazione per l'a.a. 2015-2016 del Master in Metodiche Ecoguidate per le Professioni Infermieristiche ed Ostetriche.
Pur conservando 60 CFU e gli stessi costi di partecipazione, il master MEPIO sarà BIENNALE (2016-17) per consentire che le attività di tirocinio e di tesi siano spalmate su tempi più lunghi e favorire la partecipazione di chi è già occupato.
L'inizio attività è previsto per i primi mesi del 2016.
L'immatricolazione dovrà avvenire entro fine 2015  con le modalità che verranno indicate subito dopo l'approvazione da parte del Consiglio Scientifico e pubblicizzate sui siti istituzionali.


RATE E SCADENZE
- Tre rate: I rata € 200 all’immatricolazione; II rata € 800 entro aprile 2016; III rata € 500 entro ottobre 2016

- sanzioni amministrative: come previsto dal Regolamento Tasse e Contributi a.a. 2015-2016

-la data oltre la quale la non regolarizzazione della contribuzione implica la mancata iscrizione è: 10 gennaio 2016

-le norme di rimborso in caso di rinunce o mancata regolarizzazione della contribuzione: non sono previste norme di rimborso 


 http://www.mepio.altervista.org



Pubblicato da alle 4 commenti:

giovedì 6 agosto 2015

MEGLIO IL LACCIO O IL BRACCIALE?

Am J Emerg Med. 2014 Jul;32(7):761-4. doi: 10.1016/j.ajem.2014.04.020. Epub 2014 Apr 18.

Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access.

Nelson D1, Jeanmonod R2, Jeanmonod D3.

Author information

  • 12. St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA.
  • 22. St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA. Electronic address: rebeccajeanmonod@yahoo.com.
  • 32. St. Luke's University Hospital, 801 Ostrum St, Bethlehem, PA 18015, USA. Electronic address: jeanmono@yahoo.com.

Abstract

BACKGROUND:

Ten percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success.

OBJECTIVES:

We sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in "difficult stick" patients.

METHODS:

This is a prospective, randomized, single-blinded trial. Adult patients requiring PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet on the chosen extremity. The extremity was draped to blind the physician to assignment. Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes, or patient intolerance. If failure occurred, the physician was unblinded; and the patient could be crossed over and reattempted.

RESULTS:

Thirty-eight patients were enrolled. The success rate for the tourniquet group (n = 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure time. Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet.

CONCLUSIONS:

Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.
Copyright © 2014 Elsevier Inc. All rights reserved.
PMID:
24856748
[PubMed - indexed for MEDLINE]
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ASSE LUNGO UGUALE ALL'ASSE CORTO?

Ricerca sul reperimento di accesso vascolare su fantoccio. Sarebbe interessante verificare che tipo di fantoccio fosse perchè se fosse con superficie piana sarebbe uguale la difficoltà nella tecnica d'incannulamento mentre se fosse stato cilindrico,  tecnica in asse corto vs quella in asse lungo, avrebbero difficoltà diverse come sanno i colleghi che impiantano.
Ottimale sarebbe stata una ricerca del genere sul campo con tutte le variabili del caso.


 
West J Emerg Med. 2014 Nov;15(7):824-30. doi: 10.5811/westjem.2014.9.22404. Epub 2014 Oct 21.

Ultrasound-guided small vessel cannulation: long-axis approach is equivalent to short-axis in novice sonographers experienced with landmark-based cannulation.

Erickson CS1, Liao MM2, Haukoos JS3, Douglass E2, DiGeronimo M2, Christensen E4, Hopkins E4, Bender B4, Kendall JL2.


  • 1Oregon Health and Science University, Department of Emergency Medicine, Portland, Oregon.
  • 2Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado ; University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado.
  • 3Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado ; University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado ; Colorado School of Public Health, Department of Epidemiology, Aurora, Colorado.
  • 4Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado.

Abstract

INTRODUCTION:

Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration.

METHODS:

This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber.

RESULTS:

Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7-12) and 10 (95% CI 6-13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1-5.5) and 5.6 (95% CI 5.1-6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%-48%; p=0.009) faster than short-axis attempts.

CONCLUSION:

Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models.
PMID:
25493126
[PubMed - in process]

PMCID:
PMC4251227

Free PMC Article
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Altra applicazione per gli ultrasuoni

Br J Community Nurs. 2015 Jun;20 Suppl 6:S6-8. doi: 10.12968/bjcn.2015.20.Sup6.S6.

Posto quest'articolo per curiosità  anche se non è inerente all'ecografia..... ma ogni tanto me lo concedo

Advances in wound debridement techniques.

Nazarko L1.

Author information

Abstract

Dead and devitalised tissue interferes with the process of wound healing. Debridement is a natural process that occurs in all wounds and is crucial to healing; it reduces the bacterial burden in a wound and promotes effective inflammatory responses that encourage the formation of healthy granulation tissue ( Wolcott et al, 2009 ). Wound care should be part of holistic patient care. Recent advances in debridement techniques include: biosurgery, hydrosurgery, mechanical debridement, and ultrasound. Biosurgery and mechanical debridement can be practiced by nonspecialist nurses and can be provided in a patient's home, thus increasing the patient's access to debridement therapy and accelerating wound healing.

KEYWORDS:

Debridement; Holistic nursing; Treatment
PMID:
26052998
[PubMed - in process]
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Formazione attraverso la simulazione Focused

Articolo recentissimo nel quale si evidenzia l'utilità della formazione  focalizzata ad un' attività specifica....ovviamente con gli ultrasuoni!!!

J Vasc Access. 2015 Jun 20;0(0):0. doi: 10.5301/jva.5000436. [Epub ahead of print]

Focused simulation training: emergency department nurses' confidence and comfort level in performing ultrasound-guided vascular access.

Adhikari S1, Schmier C, Marx J.

Author information

Abstract

STUDY OBJECTIVES:

The objective of this study is to assess Emergency Department (ED) nurses' confidence, comfort level, and competency in performing ultrasound-guided vascular access after a focused ultrasound simulation training session.

METHODS:

A cross-sectional study at an academic medical center. A simulation-based ultrasound training module was used to train ED nurses in ultrasound-guided intravenous (IV) access. The training module consisted of didactics followed by hands-on practice on human models and Blue Phantom ultrasound training block model. All subjects completed a questionnaire after completing the training module.

RESULTS:

A total of 40 nurses were enrolled. All subjects successfully demonstrated competency during the training session by identifying upper extremity sonographic vascular anatomy on a human model and performing real-time ultrasound-guided IV access on Blue Phantom ultrasound training block model. On a scale of 1-10, the average confidence level in performing the ultrasound-guided vascular access was 6.9 [95% confidence interval (95% CI) 6.3-7.46], with 98% (95% CI, 92-102%) reporting no difficulty in recognizing upper limb vascular anatomy on ultrasound. Ninety-two percent (95% CI, 84-100%) agreed that focused training in ultrasound-guided IV access was adequate to learn the procedure.

CONCLUSIONS:

After a focused simulation training session, ED nurses had a high level of comfort using ultrasound for vascular access. Despite having a moderate degree of confidence, ED nurses were accurate in identifying vascular anatomy and performing ultrasound-guided vascular access.
PMID:
26109540
[PubMed - as supplied by publisher]
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Sonographer statunitense: qualche indicazione per chi volesse andare oltreoceano

 

http://study.com/articles/Sonogram_Nurse_Job_Description_Duties_and_Requirements.html#relatedSchoolsList

Essential Information

The job title of 'sonogram nurse' is not a typical one. Licensed nurses can gain training in ultrasound and sonography by pursuing an additional certificate or degree program in diagnostic medical sonography; however, holding a nursing degree and licensure is not a prerequisite for these programs. Some prior healthcare experience does tend to be valuable for aspiring sonographers, though. Nurses who complete a diagnostic medical sonography program might continue their nursing practice, or they may transition into a sonographer role.
Healthcare practitioners who perform sonograms use a transducer to transmit high frequency sound (ultrasound) waves into a patient's body. The transducer takes an image of the body part using reflected echoes, and the sonographer sends the image to the physician for diagnosis of disease and pregnancy health. Sonographers can find employment in hospitals, doctor's offices and laboratories.

Required Education Certificate or degree program
Other Requirements Strong communication skills, expertise with sonogram equipment and in-depth knowledge of anatomy and physiology
Certification and Licensure Certification is recommended for sonographers; licensure is required for sonographers in some states
Projected Job Growth (2012-2022)*19% for all registered nurses; 46% for all diagnostic medical sonographe

Requirements for Nurses Who Want to Become Sonographers

There are several paths open to nurses who want to study sonography.The programs available may take anywhere from 1-4 years to complete. All require some background in anatomy and mathematics.
A certificate program is offered by some hospitals and medical institutes. These programs can vary in length from 1-2 years. Most programs include lectures, on-campus experience with sonographic equipment and off-campus clinical studies. Some programs require prior experience in a healthcare facility; a licensed nurse interested in this type of program would easily fulfill this requirement.
An associate's degree program is offered by many university hospitals and community colleges. This is a 2-year program that usually requires a background in anatomy, physics and college level math. The curriculum generally includes lectures and clinical experience.
Finally, a bachelor's degree program is offered by some 4-year universities. These programs have more extensive prerequisites, including courses in anatomy, physiology, physics and math, as well as general education subjects like English and social sciences. Like associate's degree programs, bachelor's degree programs in diagnostic medical sonography combine classroom discussion with hands-on clinical work and practice on ultrasound equipment.

Certification and Licensure

Although certification isn't mandatory for diagnostic medical sonographers, it's strongly recommended; some insurance companies won't pay for procedures unless certified sonographers perform them, so employers prefer to hire professionals with certification. After graduating from an accredited program, new sonographers can earn certification by passing an exam. Some states require that sonographers be licensed. Eligibility requirements for licensure vary by state, but certification is a common requirement.




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