The Impact of Cold Spray and Ice Application During Intravenous Access on Pain and Fear in Children Aged 7-15 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial.

INTRODUCTION: Many strategies have been developed to prevent procedural pain in pediatric emergency units, where nurses play a vital role in ensuring patient comfort. Easy-to-use and inexpensive nonpharmacologic analgesic methods are important in emergency units. This study was conducted to determine the effect of cold spray and ice applied during venipuncture on the level of fear and pain in children aged 7 to 15 years. METHODS: This was a randomized controlled experimental study of 96 children between the ages of 7 and 15 years (cold spray group, ice group, and control group) who were scheduled to have venous access in the pediatric emergency clinic and met the sampling criteria. RESULTS: Evaluations of the children, parents, and observers in the groups found a statistically significant difference between the pain and fear scores after the intervention compared with the preintervention (P < .001). The pain and fear scores of the children in the control group were higher than the scores of those in the spray and ice groups (P < .001); the pain and fear scores of the children in the spray group were lower than the scores of the children in the ice group and statistically significant (P < .001). DISCUSSION: In conclusion, cold spray applied during intravenous access in children aged 7 to 15 effectively reduces pain and fear and should be used in the emergency unit.

Effect of Pressure Injury Prevention Guides Used In a Pediatric Intensive Care.

The aim of this study was to determine the effectiveness of a pressure injury prevention guide used in a pediatric intensive care unit (PICU) on the occurrence of pressure injuries. The design is a pre-post intervention with a control group and a prospective intervention group. Pressure injuries occurred on 9.4% of children in the nontreatment group, and in 3.6% of children in the treatment group. There was a statistically significant difference in the occurrence of pressure injuries between the nontreatment group and the treatment group (p = .033). The average Braden Q pressure injury score was 12.20 ± 2.280 at the beginning of the intensive care hospitalization, and 13.73 ± 3.312 at discharge in the treatment group (p < .001). The results show that the risk of pressure injuries was reduced and pressure injuries occurred later when an evidence-based pressure injury prevention guide was used.

Umbilical Cord Care and Infection Rates in Turkey.

OBJECTIVE: To compare the efficacy of umbilical cord sponging with 70% alcohol, sponging with 10% povidone-iodine, and dry care on the time to umbilical cord separation and bacterial colonization. DESIGN: Prospective, interventional experimental study design. SETTING: Three different family health centers in Istanbul, Turkey. PARTICIPANTS: In total, 194 newborns were enrolled in one of three study groups: Group 1, 70% alcohol (n = 67); Group 2, 10% povidone-iodine (n = 62); and Group 3, dry care (n = 65). METHODS: Data were collected between January 2015 and July 2015. Umbilical separation time and umbilical cord bacterial colonization were considered as the study outcomes. RESULTS: The most commonly isolated bacteria were Staphylococcus aureus, Escherichia coli, and enterococci. There was no significant difference among the groups for umbilical cord separation times (p > .05). CONCLUSION: Dry care may be perceived as an attractive option because of cost benefits and ease of application.

The Effects of Bundles on Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit.

BACKGROUND: There are few studies in the literature from developing countries regarding the rates of catheter-associated urinary tract infection (CAUTI), which is frequently encountered in pediatric intensive care units (PICUs). AIM: The aim of this study is to evaluate the 2-year rates of CAUTI in a PICU where a CAUTI Prevention Bundle was implemented. DESIGN: This was an interventional prospective study. METHODS: The study was conducted with 390 patients in the PICU of Istanbul Faculty of Medicine, Turkey, from July 2013 to July 2015. The patients were selected based on the diagnostic criteria of the Centers for Disease Control and Prevention. RESULTS: Urinary colonization occurred in 8 (2.2%) patients in the prebundle group and 3 (0.8%) patients in the postbundle group, and contamination occurred in 10 (2.8%) patients in the prebundle group and 6 (1.5%) patients in the postbundle group. The CAUTI incidence and rates were 5.8% and 6.1 per 1000 urinary catheter days and 1.5% and 1.8 per 1000 urinary catheter days prebundle and postbundle, respectively. There was a statistically significant difference between the prebundle and postbundle CAUTI rates. CONCLUSION: Our findings support that clinical nurse specialists in developing countries should consider the use of CAUTI bundles to prevent CAUTIs.

Effect of two different feeding methods on preventing ventilator associated pneumonia in the paediatric intensive care unit (PICU): A randomised controlled study.

BACKGROUND: For infants and children who require intubation in the paediatric intensive care unit (PICU), ventilator-associated pneumonia (VAP) is a significant cause of secondary morbidity and mortality linked with extended use of intubation. Nurses are primarily responsible for the prevention of VAP and there are a number of procedures that contribute towards this end. Although enteral nutrition has been reported to be effective in the prevention of VAP, this remains controversial. OBJECTIVE: To compare and evaluate the effects of intermittent feeding through a nasogastric catheter with those of continuous feeding through a nasoduodenal catheter in preventing VAP in the PICU. DESIGN: The research design was a randomised, controlled experimental study. METHODS: Forty paediatric patients were randomised and divided into two groups of 20: one group for nasoduodenal (ND) feeding and the other for nasogastric (NG) feeding. Patients were assessed for the development of VAP using the clinical pulmonary infection score and Centers for Disease Control and Prevention criteria while working in accordance with the VAP prevention bundles introduced within the unit. RESULTS: The incidence of paediatric VAP was 15%. The rate of VAP in patients who were ND fed was 10%, whereas the rate of VAP in patients who had NG feeding was 20%. No statistically significant difference was observed between the ND- and NG-fed patients (p=0.661). CONCLUSION: Although the results of our study were not statistically significant, nasoduodenal feeding helped to reduce the incidence of VAP.

Assessment of pain during endotracheal suction in the pediatric intensive care unit.

This research was planned as a two-level definitive and comparative study to evaluate pain during endotracheal suction (ETS) in pediatric intensive care units (PICUs). This study was comprised of patients admitted to and the nurses working in the PICU. Cases were selected among PICU patients (N = 65) who met the study criteria and nurses (N = 18) who cared for them from January 1 to July 2, 2008. Routine ETS was applied as the first level of the study. For the second level, an inquiry on the knowledge of nurses about suction was given to the nurses, and they were asked to apply suction according to the guidelines they were given. All the obtained data were evaluated by statistical package for the social sciences (SPSS) for Windows 14.0. In summary, 33.8% (n = 22) of the patients were between ages 1 and 12 months, and 64.6% (n = 42) were boys. Although group 2 patients (patient who is in experimental group) had higher scores on the Wong-Baker faces pain rating and Face, Legs, Activity, Cry, Consolability scales, no statistical difference was found between the two groups (p > .05). Patients who received bolus doses of analgesia and sedative drugs had lower Wong-Baker faces pain rating (4.38 ± 0.96; n = 4) and Face, Legs, Activity, Cry, Consolability scores (4.61 ± 1.94; n = 4) (p > .05). According to these findings, the patients were distressed because of the pain related with suction. Therefore, it is recommended that suction guidelines be used in PICUs during ETS.