CORSO DI CASTELNUOVO DI GARFAGNANA

LA PRESENTE, E LE ALTRE PRESENTAZIONI,  HANNO LO SCOPO DI AIUTARE 

I COLLEGHI E PER LA DIVULGAZIONE FREE DELLE IDEE, CHIEDO SOLO 

LA CORTESIA DI CITARNE LA FONTE.

GRAZIE!!!

LA PRESENTAZIONE AL CORSO ROSMINI

LA PRESENTE, E LE ALTRE PRESENTAZIONI,  HANNO LO SCOPO DI AIUTARE 

I COLLEGHI E PER LA DIVULGAZIONE FREE DELLE IDEE, CHIEDO SOLO 

LA CORTESIA DI CITARNE LA FONTE.

GRAZIE!!!

GLI US IN NEONATOLOGIA

Articolo di un trial randomizzato che si pone la domanda se gli ultrasuoni in mani esperte può ridurre la tempistica e la necessità di radiografie di controllo in neonatologia.... quale sarà la risposta?

J Perinatol. 2013 Jun 13. doi: 10.1038/jp.2013.58. [Epub ahead of print]

A randomized controlled trial of ultrasound-guided peripherally inserted central catheters compared with standardradiograph in neonates.

Katheria AC, Fleming SE, Kim JH.

Source

Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA.

Abstract

Objective:The placement of a peripherally inserted central catheter (PICC) routinely incorporates tip position confirmation using standard radiographs. In this study, we sought to determine whether real-time ultrasound (RTUS) could be used to place a PICC in a shorter time period, with fewer manipulations and fewer radiographs than the use of radiographs to determine accurate placement.Study Design:This was a prospective, randomized,trial of infants who required PICC placement. Catheters were placed using either standard radiograph, with blinded evaluation of the catheters using RTUS or with RTUS guidance, with input on catheter tip location. The number of radiographs required to confirm proper positioning, duration of the procedure and manipulations of the lines were recorded for both groups. Final confirmation of PICC placement was by radiographs in both groups.Results:A total of 64 patients were enrolled in the study, with 16 failed PICC attempts. Of the 48 remaining infants, 28 were in the standardplacement group and 20 were in the RTUS-guided group. The mean±s.d. gestational ages and weight at time of placement were 30±4 weeks and 1229±485 g, respectively. The RTUS use significantly decreased the time of line placement by 30 min (P=0.034), and decreased the median number of manipulations (0 vs 1, P=0.032) and radiographs (1 vs 2 P=0.001) taken to place the catheters. Early identification of the PICC by RTUS was possible in all cases and would have saved an additional 38 min if radiographs were not required.Conclusion:In the hands of ultrasound (US)-experienced neonatologists, RTUS-guided PICC placement reduces catheter insertion duration, and is associated with fewer manipulations and radiographs when compared with conventional placement.Journal of Perinatology advance online publication, 13 June 2013; doi:10.1038/jp.2013.58.

PMID:

 

23765173

 

[PubMed - as supplied by publisher]

FEEDBACK E RIDUZIONE COMPLICANZE

Articolo che mette in evidenza il fatto che l'istruzione ed il tempestivo feedback dei risultati riducono le complicanze......

Da ricordare, SEMPRE, che il catetere venoso periferico può portare a complicanze anche serie!!!!!!!

Peripheral venous catheter care in the emergency department: Education and feedback lead to marked improvements

The study was presented in part at the 51st Annual Meeting of the Interscience Conference for Antimicrobial Agents and Chemotherapy, September 2011, Chicago, IL. Abstract K-1440.

• Mohamad G. Fakih, MD, MPH
, 
• Karen Jones, RN
, 
• Janice E. Rey, MT (ASCP)
, 
• Robert Takla, MD, MBA
, 
• Susanna Szpunar, MPH, DrPH
,
• Karrie Brown, RN
, 
• Arlene Boelstler, RN
, 
• Louis Saravolatz, MD

published online 10 December 2012.

• Abstract
• Full Text
• PDF
• Images
• References

Background

Peripheral venous catheters (PVCs) can be associated with serious complications. We evaluated the effect of education and feedback on processes related to PVC placement.

Methods

We implemented an educational intervention in a 72-bed Emergency Department (ED) over 12 months (4 periods, each a quarter). During preimplementation period, we evaluated PVC placement, condition, accurate documentation, and demonstration of aseptic steps for medication infusion. With implementation, ED nurses had formal education, with direct observations and feedback. For postimplementation periods 1 and 2, we continued direct observations and feedback, reducing the number of audits per week.

Results

Of 2,568 PVCs evaluated in the ED, accurate documentation on dressing improved from 83 of 803 (10.3%) preimplementation to 300 of 476 (63%) at the end of the study (P < .0001). Correct documentation in ED records improved from 498 of 803 (62%) preimplementation to 409 of 476 (85.9%) at the end of study (P < .0001). We observed 273 attempts to place PVC; of them, 220 (80.6%) were completed. The overall compliance with the procedure steps was very poor preimplementation (n = 3/63, 4.8%) and improved in implementation (n = 17/55, 30.9%) and postimplementation periods 1 (n = 19/60, 31.7%) and 2 (n = 14/42, 33.3%, P < .0001). ED health care workers showed significant improvement in knowledge with education.

Conclusion

Education and real-time feedback to ED health care workers are associated with an increased and sustained compliance with processes to reduce the risk of infection from PVCs.

Key Words: Intravenous access, Complications, Compliance, Safety

CASTELNUOVO DI GARFAGNANA

Bel corso di ecografia infermieristica ben organizzato dal collega Luca Romei., nonostante qualche piccolo e fisiologico incidente di percorso e l'ecografo che ha pensato di mettersi a riposo!!!
Ringrazio chi non si è addormentato per il mio intervento e pubblico le foto che ho preso dalla pagina di Luca e prossimamente il pdf delle mie slide.....
Arrivederci alla prossima edizione!!!