RESUMO
Arterial punctures for arterial blood gases (ABGs) analysis are described as the most painful laboratory procedure and are performed without the benefit of pain management. This study originated from one nurse's concern about the level of pain her hospitalized patients endured when she drew their ABGs. A review of the literature found that ABG pain relief has not been studied in hospitalized patients. Therefore, this study explored the question "Can the pain of arterial blood gas draws be reduced through the use of infiltration with a local anesthetic agent?" This study compared the pain scores of 40 hospitalized patients who received either no intervention or one of three analgesic interventions (infiltration of 0.7 ml 1% lidocaine, 0.7 ml buffered 1% lidocaine, or 0.7 ml of bacteriostatic saline at the arterial puncture site). Results showed that, although lidocaine and buffered lidocaine are effective in reducing the pain associated with the arterial puncture, plain lidocaine was the only intervention in which the pain rating score for the overall experience was significantly diminished. This study is limited by partial randomization, small sample size, and patient duress; however, it provides a foundation for further nursing research that explores methods to reduce the pain associated with this very painful procedure. Future studies should be directed at larger, diverse populations, multiple operators, and comparison of interventions to topical analgesics and nonpharmacological measures.
Assuntos
Anestésicos Locais/administração & dosagem , Gasometria/enfermagem , Lidocaína/administração & dosagem , Dor/enfermagem , Dor/prevenção & controle , Flebotomia/enfermagem , Gasometria/métodos , Feminino , Humanos , Masculino , Dor/tratamento farmacológico , Medição da Dor/enfermagemAssuntos
Gasometria/métodos , Cuidados Críticos/métodos , Avaliação em Enfermagem/métodos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Bicarbonatos/sangue , Gasometria/enfermagem , Dióxido de Carbono/sangue , Eletrólitos/sangue , Homeostase/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Oxigênio/sangue , Pressão Parcial , Valores de ReferênciaAssuntos
Desequilíbrio Ácido-Base/enfermagem , Gasometria/enfermagem , Doenças do Prematuro/enfermagem , Desequilíbrio Ácido-Base/fisiopatologia , Bicarbonatos/sangue , Peso ao Nascer , Coleta de Amostras Sanguíneas/enfermagem , Cateteres de Demora , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Valores de ReferênciaAssuntos
Acidose Respiratória/enfermagem , Alcalose Respiratória/enfermagem , Gasometria/enfermagem , Unidades de Terapia Intensiva Neonatal , Equilíbrio Ácido-Base/fisiologia , Acidose Respiratória/diagnóstico , Acidose Respiratória/fisiopatologia , Alcalose Respiratória/diagnóstico , Alcalose Respiratória/fisiopatologia , Bicarbonatos/sangue , Dióxido de Carbono/sangue , Humanos , Recém-Nascido , Diagnóstico de Enfermagem , Sistemas Automatizados de Assistência Junto ao Leito , Valores de ReferênciaRESUMO
PURPOSE/OBJECTIVES: To determine the effectiveness of a computer-based learning module specific to arterial blood gas (ABG) interpretation. DESIGN: A pretest and posttest design was used to assess staff nurses' ability to interpret ABGs before and after engaging in a computer-based module. SETTING: Two community hospitals in northern Illinois. SAMPLE: Fifty-eight staff nurses completed the online learning module and the pretest and posttest measures. METHODS: Subjects consented to participate and completed a pretest measure of their knowledge of ABG interpretation. Subjects participated in a computer-based learning module on ABG interpretation and then completed a posttest. FINDINGS: Staff nurses' knowledge increased significantly after viewing the computer-based learning module (t = 6.3; P < .001). This improvement was irrespective of experience or department. CONCLUSIONS AND IMPLICATIONS: Computer-based, online learning has emerged as a means of providing continuing education to nurses. Such a teaching strategy helps to overcome barriers pertinent to traditional classroom settings.
Assuntos
Gasometria/enfermagem , Instrução por Computador/métodos , Educação Continuada em Enfermagem/métodos , Recursos Humanos de Enfermagem Hospitalar/educação , Desequilíbrio Ácido-Base/sangue , Adulto , Gasometria/métodos , Currículo , Avaliação Educacional , Hospitais Comunitários , Humanos , Illinois , Pessoa de Meia-Idade , Modelos Educacionais , Enfermeiros Clínicos/organização & administração , Avaliação em Enfermagem , Pesquisa em Educação em Enfermagem , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Teoria PsicológicaRESUMO
This is the second of a two-part unit discussing arterial blood gas (ABG) analysis. Part 1 outlined background information on ABG reports and focused on a systematic approach to ABG analysis. This part examines the physiology of the various lines of defence in the body and explores the concept of compensation. A step-by-step guide to interpretation and examples of uncomplicated ABGs are available in the Portfolio Pages for this unit at nursingtimes.net, as well as further practice examples relevant to this part of the unit.
Assuntos
Acidose/sangue , Alcalose/sangue , Gasometria/métodos , Avaliação em Enfermagem/métodos , Acidose/diagnóstico , Alcalose/diagnóstico , Bicarbonatos/sangue , Gasometria/enfermagem , Ácido Carbônico/sangue , Homeostase , Humanos , Concentração de Íons de HidrogênioRESUMO
Following the introduction of new guidelines in February 2006, assessments for long-term oxygen therapy are now being undertaken by respiratory nurse specialists. The key skill required is arterial blood gas sampling. This has traditionally been the role of the doctor, however by using an education and training package along with a competency-based assessment, nurses can now perform this extended role. Sarah Dodds and Graham Williamson describe a competency-based education and training programme for nurses to carry out this procedure.
Assuntos
Gasometria/enfermagem , Educação Continuada em Enfermagem , Gasometria/normas , Humanos , Guias de Prática Clínica como AssuntoRESUMO
Nurses working in perianesthesia care areas use discharge scoring criteria to complete patient assessments and ensure patient readiness for discharge or transfer to the next phase of recovery. However, all discharge criteria have both advantages and disadvantages. Comparative studies on the reliability of the different discharge criteria in use are extremely limited. As the acuity of our aging population increases, as well as the number of annual surgeries performed on an outpatient basis, it is most timely to ensure that we are following evidence-based discharge criteria.
Assuntos
Procedimentos Cirúrgicos Ambulatórios/enfermagem , Avaliação em Enfermagem/organização & administração , Alta do Paciente/normas , Enfermagem em Pós-Anestésico/organização & administração , Atividades Cotidianas , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Período de Recuperação da Anestesia , Índice de Apgar , Gasometria/enfermagem , Pesquisa em Enfermagem Clínica , Estado de Consciência , Humanos , Pesquisa em Avaliação de Enfermagem , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/enfermagem , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/enfermagem , Náusea e Vômito Pós-Operatórios/diagnóstico , Náusea e Vômito Pós-Operatórios/enfermagem , Desempenho Psicomotor , Reprodutibilidade dos TestesRESUMO
Quality improvement programs based on guidelines should change practice and reduce intraindividual and interindividual variations as well as variations between groups of caregivers. We analyzed a quality improvement program in 3 groups of caregivers. The groups modified differently their practice. Less experienced caregivers modified their practice the most, joining the more experienced professionals. This harmonization was achieved only during the last consolidation period. The analysis of practice could identify the quality of the implementation process and the group on which attention should be focused when such a quality improvement program is undertaken.
Assuntos
Gasometria/normas , Fidelidade a Diretrizes/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Gestão da Qualidade Total/organização & administração , Algoritmos , Atitude do Pessoal de Saúde , Gasometria/enfermagem , Gasometria/estatística & dados numéricos , Competência Clínica/normas , Cuidados Críticos/normas , Cuidados Críticos/estatística & dados numéricos , Árvores de Decisões , Retroalimentação Psicológica , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Universitários , Humanos , Capacitação em Serviço/organização & administração , Auditoria Médica , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/normas , Motivação , Auditoria de Enfermagem , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/normas , Seleção de Pacientes , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e QuestionáriosAssuntos
Gasometria/enfermagem , Coleta de Amostras Sanguíneas/enfermagem , Parto Obstétrico/enfermagem , Sangue Fetal/química , Tocologia/educação , Equilíbrio Ácido-Base , Acidose/diagnóstico , Acidose/enfermagem , Gasometria/economia , Coleta de Amostras Sanguíneas/economia , Parto Obstétrico/métodos , Feminino , Sangue Fetal/metabolismo , Doenças Fetais/sangue , Doenças Fetais/diagnóstico , Humanos , Recém-Nascido , Responsabilidade Legal , Tocologia/economia , Gravidez , Reino UnidoRESUMO
Arterial puncture is the most common method used to obtain a sample for the measurement of arterial blood gases (ABGs) and is essential to guide the prescription of long-term oxygen therapy (LTOT) in patients with chronic hypoxic lung disease. However, this procedure is often reported by patients as a painful and unpleasant experience, which to date has not been explored. This audit specifically examines the subjective views of a small group of patients (n = 41) who are receiving LTOT who have experienced repeated ABGs. Results demonstrated that 49% (n = 20) were poorly informed regarding what the procedure involved, almost half the patients 49% (n = 20) recalled pain levels of 5 and above on a visual analogue scale and 66% (n = 27) were totally unaware that the test could make a considerable difference to their treatment. While highlighting the deficits in current practice locally, this audit concludes that the respiratory nurse specialist is in an ideal position to implement changes to improve the patient's experience of chronic disease management.
Assuntos
Atitude Frente a Saúde , Gasometria , Coleta de Amostras Sanguíneas , Gasometria/efeitos adversos , Gasometria/enfermagem , Gasometria/psicologia , Coleta de Amostras Sanguíneas/efeitos adversos , Coleta de Amostras Sanguíneas/enfermagem , Coleta de Amostras Sanguíneas/psicologia , Competência Clínica/normas , Humanos , Consentimento Livre e Esclarecido/normas , Auditoria Médica , Avaliação das Necessidades , Enfermeiros Clínicos/organização & administração , Papel do Profissional de Enfermagem , Auditoria de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Metodológica em Enfermagem , Oxigenoterapia , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor , Educação de Pacientes como Assunto/normas , Seleção de Pacientes , Prescrições , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/psicologia , Doença Pulmonar Obstrutiva Crônica/terapia , Inquéritos e Questionários , Gestão da Qualidade TotalRESUMO
Arterial blood gas analysis has become an essential skill for all healthcare practitioners. It provides important information with regard to adequacy of ventilation, oxygen delivery to the tissues and acid-base balance. Although each patient's clinical presentation will be judged individually, situations that warrant analysis of a blood gas sample include respiratory compromise, post-cardiorespiratory arrest, evaluation of interventions such as oxygen therapy, respiratory support and as a baseline before surgery. This article reviews the different parameters that are measured by various machines, with a focus on basic measurement of arterial blood gases. These include partial pressure of carbon dioxide in arterial blood (PaCO(2)), partial pressure of oxygen in arterial blood (PaO(2)), bicarbonate levels (HC0(3)(-)) in arterial blood and base excess/deficit. The physiology of acid-base balance is reviewed and the causes and presentation of the four acid-base disturbances is described. A systematic method to aid arterial blood interpretation is identified, together with discussion regarding the importance of interpreting PaO(2) readings in relation to the amount of inspired oxygen a patient is receiving (FiO(2)), the practice of temperate correction and the relationship between standardized and actual bicarbonate readings.
Assuntos
Gasometria , Avaliação em Enfermagem/métodos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/classificação , Desequilíbrio Ácido-Base/diagnóstico , Viés , Gasometria/instrumentação , Gasometria/métodos , Gasometria/enfermagem , Interpretação Estatística de Dados , Homeostase , Humanos , Anamnese , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/enfermagem , Consumo de Oxigênio , Exame Físico , Valores de Referência , TemperaturaRESUMO
With increasing use of arterial blood gas analysis in various ward and other hospital settings to aid medical diagnosis and management, nurses who can interpret results are often able to initiate earlier interventions and understand the reasons for medical interventions. This article enables nurses to interpret such results.
Assuntos
Gasometria/métodos , Gasometria/enfermagem , Equilíbrio Ácido-Base/fisiologia , Acidose/sangue , Bicarbonatos/sangue , Dióxido de Carbono/sangue , Humanos , Oxigênio/sangue , Insuficiência Respiratória/sangueRESUMO
Previously in this Clinical Update series we examined how the body regulates acids and bases. If information about acid-base balance is to be useful, we need to know how to interpret arterial blood gases (ABGs) so we can intervene rapidly when the body is unable to restore a normal acid-base balance in the face of an overwhelming derangement.
Assuntos
Gasometria/métodos , Gasometria/enfermagem , Avaliação em Enfermagem/métodos , Cuidados Críticos/métodos , HumanosRESUMO
This paper describes a quantitative study conducted on an intensive care unit in the north of England. It involved the collection of data from the existing records of 65 patients consecutively sampled from a predetermined date provided that they stayed more than 24 hours and had an arterial line in situ. As patient records were used, ethical approval was not necessary. The objectives of the study were to quantify the mean number of blood gas samples taken per patient and estimate the mean blood loss resulting from this, including discard volume. Limitations include reliance on records and lack of an economic evaluation. The results show that blood loss in this study was greater than that reported elsewhere. Patients who were ventilated for 24 hours or more had a statistically significant greater blood loss when compared to those who were not (P < 0.001). A subgroup of patients undergoing renal replacement therapy had the greatest blood loss (mean 55.18 ml per day). This loss was statistically significant when compared to patients not in acute renal failure (P=0.007). When patients undergoing multiple therapies normally associated with increased sampling were compared to patients not receiving such therapies, there was no statistically significant difference in blood loss. The need to change current nursing practice to reduce iatrogenic anaemia is emphasized.