A biomedical device to improve pediatric vascular access success.

PURPOSE: to evaluate the effectiveness of a vein-viewing device on the success of venipunctures performed by staff nurses on a pediatric surgical unit. METHOD: this prospective, non-randomized study examined pediatric inpatients from the age of newborn to 17 years requiring vascular access at a tertiary care center in northeast Florida. The number of attempts, age of the patient, and time required to establish successful vascular access using a vein-viewing device were self-reported by nursing staff (experimental group, n = 91, mean age 9 years, range 3 days to 17 years) as well as staff, patient, and parental comments about the device. These data were compared to baseline data (control group, n = 150, mean age 5.7 years, range 11 days to 17 years) previously collected on the same unit without using the device. The outcome variables were first-attempt success rate, the number of attempts per patient, and the time to procedure completion. FINDINGS: when comparing the two groups, the first-attempt success rate increased from 49.3% to 80.2%, the mean number of attempts per patient decreased from 1.97 to 1.29, and the percentage of procedures completed in 15 minutes or less increased from 52.8% to 86.7%. Results were statistically significant for all outcome variables between the two groups and also when re-analyzed in subgroups controlling for age. CONCLUSIONS: use of a vein-viewing device significantly improved first-attempt venipuncture success rate, decreased the number of attempts per patient, and decreased procedure time for the study population. The device was well received by patients, families, and staff.

Seizure precautions for pediatric bedside nurses.

Seizures are a common neurologic disorder of childhood, and many pediatric nurses will care for children with epilepsy during their careers. The term "seizure precautions" is used frequently in nursing practice; however, its definition varies among institutions. Childhood epilepsy has many phenotypes, and while some children require airway clearance and ventilatory support in the event of a seizure, many will not. The bedside equipment for a child with seizures should reflect the patient's symptoms. To that end, an algorithm based on seizure classification and current practice in seizure precautions is presented to aid bedside nurses in safely caring for children with seizures. The algorithm may also be used to assist in educating parents about the safest way to care for their child at home, without sending contradictory messages about different needs for equipment in the hospital and in the home.

The use of a pressure ulcer risk assessment tool for children.

The need for pressure ulcer risk assessment has been acknowledged in adult nursing for many years. However, in paediatrics there is a misconception that children do not develop pressure ulcers (Mills, 1998). This misconception has been challenged in recent years with a growing awareness that children have specific risk factors that predispose their skin to pressure damage (Willock et al, 2000; Mills, 1998; Waterlow, 1998, 1997; Jones, 1997; Pickersgill, 1997; Zollo et al, 1996; Bedi, 1993).

Pain assessment in nonverbal children with severe cognitive impairments: the Individualized Numeric Rating Scale (INRS).

Children's Hospital Boston began a major pain assessment and management initiative 3 years ago: Pain assessment and management are considered one of the institution's primary standards of care. The initiative included State of the Science meetings with internationally renowned nursing pain researchers and clinicians. These meetings generated nursing staff interest in specific applications of what is known about pain; how evidence-based knowledge can be used to ask population-specific clinical questions; and how an evidence-based approach can be applied to systematically develop, implement, and assess interventions that suit a population's clinical needs. This article is an example of an evidence-based pain assessment project at Children's Hospital Boston that focused on nonverbal children with cognitive impairments. After developing a clinical question, the authors did a literature review and a benchmarking analysis of best practice. The pilot of an adapted, existing pain assessment tool is described in this article.

Clinical governance and assessing and managing clinical risk.

Joshua worked in paediatrics and was concerned about the frequency of injuries caused to babies as a result of intravenous fluids being pumped into the tissue. It appeared that the mechanical pumps were not sufficiently sensitive to cut out when the vein tissued and there had been several cases where it appeared that serious harm had been caused to a baby.

Clinical benefits of 3M Tempa.DOT thermometer in paediatric settings.

Single-use clinical thermometers provide a safe alternative to the traditional mercury in glass thermometers for routine temperature taking. This article examines the 3M Tempa.DOT Single-Use Clinical Thermometer and discusses its use in the paediatric setting.