Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient. / Formación de equimosis y/o hematoma tras la administración profiláctica de enoxaparina subcutánea en abdomen o brazo en pacientes críticos.

INTRODUCTION: Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. OBJECTIVE: To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. METHODOLOGY: A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72hours. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families. RESULTS: 301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n(%): 66(44) vs 72(51), P=.25] [haematoma abdomen vs arm, n(%): 9(6) vs 14(10), P=.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm2) abdomen vs arm, median (IQR): 2(1-5.25) vs 20(5.25-156), P=.027]. CONCLUSIONS: In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72hours, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving anti-platelet agents present a higher risk of injury. No relationship was observed in relation to BMI.

[Validating the Spanish version of the Nursing Activities Score]. / Validación de la versión en castellano del Nursing Activities Score.

INTRODUCTION: Validating workload scores ensures that they are appropriate for the purpose for which they were developed. OBJECTIVE: To validate the Nursing Activities Score (NAS) Spanish version. METHODOLOGY: Observational and prospective study. 1,045 patients who were admitted to a medical-surgical unit and a serious burns unit in 2006 were included. The nurse in charge assessed patient workloads by Nine Equivalent of Nursing Manpower use Score and NAS. To assess the internal consistency of the measurements of NAS, item-test correlations, Cronbach's α and Cronbach's α corrected by omitting each of the items were calculated. The intraobserver and interobserver reliability were assessed with the intraclass correlation coefficient by viewing recordings and Kappa (interobserver reliability) was estimated. For the analysis of internal validity, a factorial principal components analysis was performed. Convergent validity was assessed using the Spearman correlation coefficient values obtained from the Nine Equivalent of Nursing Manpower use Score and Spanish-NAS scales. RESULTS: For internal consistency, 164 questionnaires were analysed and a Cronbach's α of 0.373 was calculated. The intraclass correlation coefficient for intraobserver reliability estimate was 0.837 (95% IC: 0.466-0.950) and 0.662 (95% IC: 0.033-0.882) for interobserver reliability. The estimated kappa was 0.371. For internal validity, exploratory factor analysis showed that the first item explained 58.9% of the variance of the questionnaire. For convergent validity 1006 questionnaires were included and a Spearman correlation coefficient of 0.746 was observed. CONCLUSIONS: The psychometric properties of Spanish-NAS are acceptable.

[Interobserver reliability of the Glasgow coma scale in critically ill patients with neurological and/or neurosurgical disease]. / Fiabilidad interobservador de la escala del coma de Glasgow en pacientes críticos con enfermedad neurológica o neuroquirúrgica.

INTRODUCTION: The Glasgow coma scale (GCS) is a common tool used for neurological assessment of critically ill patients. Despite its widespread use, the GCS has some limitations, as sometimes different observers may value differently the same response. OBJECTIVE: To evaluate the interobserver agreement, among intensive care nurses with a minimum of 3 years experience, both in the overall estimate of GCS and for each of its components. METHODS: Prospective observational study including 110 neurological and/or neurosurgical patients conducted in a critical care unit of 18 beds, from October 2010 until December 2012. Registered variables: Demographic characteristics, reason for admission, overall GCS and its components. The neurological evaluation was conducted by a minimum of 3 nurses. One of them applied an algorithm and consensual assessment technique and all, independently, valued response to stimuli. Interobserver agreement was measured using the intraclass correlation coefficient (ICC) for a confidence interval (CI) of 95%. The study was approved by the Ethics Committee for Clinical Trails. RESULTS: The intraclass correlation coefficient (confident interval) for scale was: Overall GCS: 0.989 (0.985-0.992); ocular response: 0.981 (0.974-0.986); verbal response: 0.971 (0.960-0.979); motor response: 0.987 (0.982-0.991). CONCLUSION: In our cohort of patients we observed a high level of consistency in the application of both the GCS as in each of its components.

[Transcultural adaptation into Spanish of the nursing activities score]. / Adaptación transcultural al castellano del nursing activities score.

INTRODUCTION: Assessment of nursing workload is a common practice in the daily work of nursing care. This is usually done using scales that were not designed for Spanish-speaking countries, which may not take into account the characteristics of the environments that differ from one country to another. The Nursing Activities Score (NAS) has been described as being a useful tool for measuring nursing workload among the instruments used for this measurement in intensive care units. OBJECTIVE: It was aimed to adapt the NAS into Spanish for its use in Spanish intensive care units. MATERIAL AND METHODS: The NAS was adapted using translation-back translation method with the participation of both native English speakers who were bilingual in Spanish, and Spanish translators with a high level of English. All of the translators worked individually. A single Spanish version of the scale was obtained, after which a pilot test was made in an Intensive Care Major Burns Unit of the University Hospital of Getafe (Madrid, Spain) with 30 patients and 30 nurses during their regular work shift. We also consulted the primary author of the original description of the NAS regarding items that caused some kind of conflict. RESULTS: Between the original scale and the result of the back-translations to English, we obtained agreement ratings of good in 73%, and appropriate in the remaining 27%. No item was considered to have bad correspondence. CONCLUSION: We have developed a Spanish translation of the NAS that appears well matched to the original English version.