Nurse-performed venous sheath removal in patients undergoing radiofrequency catheter ablation for atrial fibrillation: a randomised study.

BACKGROUND: Catheter ablation procedures have recently become a widely accepted method for treating cardiac arrhythmias, and referrals for these procedures have been steadily increasing. As a result, it is now common that sheath removal is handled as a nursing procedure. Regardless of who performs the sheath removal, it is important to extract ablation sheaths without any early or late complications. OBJECTIVE: The aim of this randomised study was to determine the safety of sheath extraction after heparin reversal with low-dose protamine sulfate in patients undergoing radiofrequency catheter ablation for atrial fibrillation and whether these sheaths can be safely removed by nurses. METHODS: Eighty-one patients were randomly assigned to either receiving protamine to reverse heparin after an ablation ( n=40) or to the standard protocol without heparin reversal ( n=41). Nurse-led sheath removal was done in the cath lab (protamine group) or on the ward (standard group) as soon as activated partial thromboplastin time dropped below 60 s. All adverse events, groin compression time, immobilisation time and procedure characteristics were recorded. RESULTS: The manual compression time for the standard group was significantly longer than for the protamine group (15.9 ± 2.5 vs. 21.9 ± 3.1 minutes, P<0.001) as well as the total immobilisation time (13.2 ± 2.4 vs. 20.3 ± 3.8 hours, P=0.01). Minor groin haematomas occurred less frequently in the protamine group (4 vs. 12, P=0.02) and the haematomas tended to be smaller (4.1 ± 2.1 vs. 5.2 ± 2.5 cm, P=0.09). No serious adverse events were observed when the femoral sheaths were extracted by specially trained staff nurses. CONCLUSION: Fewer and milder complications and shorter immobilisation times were reported with protamine reversal compared to the conventional method. Staff nurses can safely remove femoral venous sheaths after a radiofrequency ablation for atrial fibrillation.

Efectividad de la ultrasonografía en la punción venosa periférica: revisión integradora / Efetividade da ultrassonagrafia na puncao venosa periferica: revisão integrativa / Effectiveness of ultrasonography- guided peripheral venous access: an integrative review

Objetivo: Identificar las evidencias producidas en la literatura sobre la efectividad de la ultrasonografía para el éxito en la punción venosa con relación al método tradicional de punción. Método: Se realizó una revisión integradora de literatura en las bases de datos Lilacs y PubMed, en el período de enero de 2009 a febrero de 2015. Fueron incluidas publicaciones en portugués, inglés o español, que contemplaron los objetivos y/o el tema de la investigación en el título o resumen y que utilizaron revisiones sistemáticas, ensayos clínicos o estudios observacionales como metodología. Resultados: Compuesto por 16 artículos, con alto nivel de evidencia, que refuerzan la efectividad de la ultrasonografía para la punción venosa periférica difícil. Hubo reducción del número de intentos de punción cuando se usó la ultrasonografía. La tasa de éxito con el uso de la ultrasonografía quedó entre 70% y 99% y varió de acuerdo con características demográficas (sexo, edad y color de la piel), clínicas (diámetro y profundidad de la vena) y operacionales (elección del catéter y habilidad del profesional que realiza el procedimiento). Conclusión: La ultrasonografía puede aumentar el éxito de este procedimiento, pero es necesario obtener más evidencias sobre el tiempo gastado y el número de intentos para lograr el éxito. La habilidad del operador del equipo ultrasonográfico, así como las características clínicas, técnicas y operacionales se revelaron como factores importantes que deben ser tenidos en cuenta para una punción venosa más efectiva y segura (AU)

Objetivo: Identificar as evidências produzidas na literatura sobre a efetividade da tecnologia ultrassonografia para o sucesso na punção venosa em relação ao método tradicional de punção. Método: Realizou-se revisão integrativa de literatura nas bases de dados Lilacs e PubMed, no período de janeiro de 2009 à fevereiro de 2015. Foram incluídas publicações em português, inglês ou espanhol, que contemplaram os objetivos e/ou a questão de pesquisa no título ou resumo e que utilizaram revisões sistemáticas, ensaios clínicos ou estudos observacionais como metodologia. Resultados: Compôs-se de 16 artigos, com alto nível de evidência, que reforçam a efetividade da ultrassonografia para a punção venosa periférica difícil. Houve redução do número de tentativas de punção quando do uso da ultrassonografia. A taxa de sucesso com o uso da ultrassonografia ficou entre 70 e 99% e variou de acordo com características demográficos (sexo, idade e cor da pele), clínicas (diâmetro e profundidade da veia) e operacionais (escolha do cateter e habilidade do profissional que realiza o procedimento). Conclusão: A ultrassonografia pode aumentar o sucesso deste procedimento, necessitando, contudo de mais evidências quanto ao tempo gasto e número de tentativas para o sucesso. A habilidade do operador do equipamento ultrassonográfico, bem como características clínicas, técnicas e operacionais revelaram-se como fatores importantes a ser considerados para uma punção venosa mais efetiva e segura (AU)

Objective: This study aims to identify the found evidence in the literature on the effectiveness of ultrasound technology for success in venipuncture compared to the traditional method for puncture. Method: An integrative review of literature in Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) - (Latin American and Caribbean Health Sciences) - and Publicações Médicas (PubMed) - (Medical publications) databases was made from January 2009 to February 2015. Publications in Portuguese, English, or Spanish were included addressing the objectives and/or the research question in the title or abstract and that used systematic reviews, clinical essays, or observational studies as methodology. Results: Sixteen publications were reviewed presenting a high level of evidence that reinforce the effectiveness of ultrasound for peripheral venipuncture difficult. There was reduction of number of puncture attempts when using ultrasound. The success rate with the use of ultrasound ranged from 70 to 99% and varied with demographic characteristics (sex, age, and skin color), clinical characteristics (diameter and depth of the vein,) and operational characteristics (choice of catheter and skill of the professional performing the procedure). Conclusion: Ultrasound can increase the success of this procedure, requiring yet more evidence as to the spent time and number of essays for success. The operator ability of the ultrasound equipment as well as clinical, technical, and operational characteristics showed up important factors to be considered for a more effective and safe venipuncture (AU)

Manejo de la vía subcutánea en cuidados paliativos / Management of the subcutaneous way of administration in paliative care

El envejecimiento de la población, el aumento de enfermedades crónico-degenerativas, junto con una mayor esperanza de vida hacen que cada día el número de pacientes que requieren cuidados paliativos sea mayor. La vía de elección para tratar los síntomas en estos pacientes es la oral, pero ciertas circunstancias pueden imposibilitar su uso, siendo necesario recurrir a otras vías. La vía subcutánea supone una alternativa en estas situaciones al tratarse de una técnica sencilla, segura y de fácil manejo. El propósito de este trabajo es contribuir al buen uso de esta técnica y, por lo tanto, a un mejor control de los síntomas, describiendo la técnica, las ventajas y desventajas de su uso en cuidados paliativos, indicaciones y contraindicaciones, las posibles complicaciones, lugares y técnica de inserción, los cuidados posteriores, así como los tipos de administración y fármacos más empleados

The population ageing, the increase of chronic-degenerative diseases, together with a higher life expectancy, have led to an increasing number of patients who require palliative care. The administration way of choice to treat symptoms in these patients will be oral, but certain circumstances may render this impossible, making it necessary to resort to other ways. The subcutaneous way represents an alternative option in these situations, as it is a simple, safe, and easy to use technique. The objective of this paper is to contribute towards the good use of this technique and, therefore, to a better control of symptoms, describing the techniques, the advantages and disadvantages of its use in Palliative Care, indications and contraindications, potential complications, insertion sites and technique, subsequent care, as well as the most widely used types of administration and drugs

Nursing and quality of life in patients with atrial fibrillation before and after radiofrequency ablation.

The importance of nursing and patient quality of life is a top concern for medical professionals. Therefore, participation by medical professionals in raising awareness and continuously supporting improvements in nursing care is an essential part of improving patient quality of life. Modern medical techniques and procedures are changing rapidly, particularly in the field of cardiology. This has resulted in changing roles and increased responsibility for nurses and confirms the necessity for changing the perception of nurses relative to their role in the medical environment and to patient care. This paper presents the results from the first phase of a research project and focuses on quality of life and problematic areas associated with the needs of patients with atrial fibrillation before and after radiofrequency catheter ablation. Atrial fibrillation is one of the most common supraventricular arrhythmias. Its incidence in the general population has risen significantly over the last twenty years. The objective of this research was to assess those areas, which are considered by patients to be problematic before therapeutic intervention. The research was realized through a quantitative survey using a modified questionnaire. Results showed that AF reduced the quality of life both physically and psychologically (i.e. increased levels of anxiety and depression). Results also showed that radiofrequency catheter ablation was able to alleviate symptoms associated with AF and was also able to increase patient quality of life.

Acciones y/o intervenciones de enfermería para la prevención de infecciones hospitalarias en pacientes gravemente enfermos: una revisión integrativa / Ações e/ou intervenções de enfermagem para prevenção de infecções hospitalares em pacientes gravemente enfermos: uma revisão integrativa / Shares and / or nursing interventions for prevention of nosocomial infections in critically ill patients: an integrative review

Objetivo: Identificar en la literatura publicada desde 1997 las acciones o intervenciones de enfermería para la prevención de las infecciones nosocomiales en pacientes adultos en estado crítico. Método: Revisión integradora de las fuentes de información por parte de la BVS (Biblioteca Virtual en Salud), incluyendo IBECS LILACS, Cochrane Library, MEDLINE y PubMed y SciELO. Se utilizaron las siguientes palabras clave: Infección hospitalaria, unidad de cuidados intensivos y enfermería, en un recorte temporal de 1997 a 2011. Resultados: Se analizaron 29 artículos, 28 estaban disponibles en línea completa y la revista está disponible en la biblioteca. Para analizar los datos obtenidos se utilizó la lectura interpretativa y el análisis temático emergiendo las siguientes categorías: higiene de las manos, intervenciones educativas, introducción de las Nuevas Tecnologías en Salud, Higiene Bucal, aspiración de contenido gástrico, decúbito y el cambio de elevación de la cabecera de la cama. Conclusión: Es posible concluir que las acciones o intervenciones de enfermería para la prevención de las infecciones nosocomiales que con mayor frecuencia aparecen en la literatura están relacionadas con las topografías torrente sanguíneo y tracto respiratorio además de lavado de manos y ejercen influencia en la reducción de la incidencia de infecciones nosocomiales. Existen pocos estudios en Brasil, siendo necesarios incentivar las nuevas investigaciones en esta área (AU)

Objetivo: identificar na literatura existente publicada a partir do ano de 1997, as ações e/ou intervenções de enfermagem para prevenção de infecções hospitalares em pacientes adultos criticamente enfermos. Método: revisão integrativa através das fontes de informação BVS (Biblioteca Virtual em Saúde) incluindo LILACS, IBECS, Biblioteca Cochrane, SciELO e MEDLINE e PubMed. Foram utilizados os seguintes descritores: infecção hospitalar, unidade de terapia intensiva e enfermagem utilizando um recorte temporal do ano de 1997 a 2011. Resultados: foram analisados 29 artigos sendo que 28 estavam disponíveis na íntegra online e um de revista disponível na biblioteca. Para analisar os dados encontrados utilizou-se a leitura iterpretativa e a análise temática emergindo as seguintes categorias: Higienização das Mãos, Intervenções Educacionais, Introdução de Novas Tecnologias em Saúde, Higiêne Oral, Aspiração do Conteúdo Gástrico, Mudança de Decúbito e Elevação da Cabeceira do Leito. Conclusão: é possível concluir que as ações e/ou intervenções de enfermagem para prevenção de infecções hospitalares que mais aparecem na literatura estão relacionadas as topografias corrente sanguínea e trato respiratório além da lavagem das mãos e, exercem influência na redução da incidência de infecções hospitalares. Existem poucos estudos realizados no Brasil, sendo necessário incentivo à novas pesquisas nesta área

Objective: To identify the literature published from 1997, the actions and / or nursing interventions for prevention of nosocomial infections in critically ill adult patients. Method: an integrative review of information sources by VHL (Virtual Health Library) including LILACS IBECS, Cochrane Library, MEDLINE and PubMed and SciELO. We used the following keywords: hospital infection, intensive care unit and / nursing using a time frame of 1997 to 2011. Results: We analyzed 29 articles and 28 were available in full online and magazine available in the library. To analyze the data obtained the interpretative reading and the thematic analysis was used, arising the following categories: Hand Hygiene, Educational Interventions, Introduction of New Technologies in Health, Oral Hygiene, Aspiration of Gastric Contents, Decubitus and Elevation Change of the headboard of the bed. Conclusion: It is possible to conclude that the actions and / or nursing interventions for prevention of nosocomial infections that most often appear in the literature are related topographies bloodstream and respiratory tract than washing of hands and influence in reducing the incidence of nosocomial infections. There are few studies in Brazil, being necessary incentives for further research in this area (AU)

Catéter central de inserción periférica. Complicaciones en pacientes neurológicos / Complications of the picc in neurologic patients of the hospital Ramon y Cajal

Se abordan, a través de un estudio descriptivo, las complicaciones derivadas del uso del PICC (Peripherally Inserted Central Catheter / catéter central de inserción periférica) en una muestra de pacientes ingresados en la Unidad de Neurocirugía del Hospital Ramón y Cajal. Tras recopilar y analizar la información acerca del sexo y edad de los pacientes, indicación de implantación del PICC, grosor del mismo, días de permanencia hospitalaria, complicaciones encontradas, causa de retirada del catéter, y fecha de implantación y retirada del mismo, no se han encontrado complicaciones significativas derivadas de su uso. Este hecho demuestra que el PICC es un sistema seguro y viable para la administración de tratamiento intravenoso de larga duración y para cuyo uso cada vez está más capacitado el personal de enfermería. Estas circunstancias permiten la administración de un tratamiento intravenoso preservando la anatomía vascular del paciente, cumpliendo, de este modo, con la finalidad de todo catéter de larga duración(AU)

Descriptive study focused on the complications arising from the use of the PICC (peripherally inserted central catheter) in a sample of patients admitted to the neurology unit of the «Hospital Ramón y Cajal».After collecting and analyzing the information about the sex and age of the patients, indication of implantation of the PICC, thickness of the same, days of permanence, complications found, cause of withdrawal of the catheter, and date of introduction and removal of the same, we not found significant complications arising from the use of the same. PICC is a safe and viable system for the administration of intravenous treatment of long duration and nursing personnel is more qualified for which. This allows the administration of intravenous treatment while preserving the vascular anatomy of the patient, that is the purpose of all long-term catheters (AU)

Conocimiento del equipo de enfermería sobre la inserción y mantenimiento del catéter central de inserción periférica en recién nacidos / Knowledge of the team of nursing on insertion and maintenance of the central catheter of peripheral insertion in just born

Objetivo: Evaluar el conocimiento del equipo de enfermería sobre la inserción y manipulación del PICC. Método: Estudio descriptivo, documental y de campo. El escenario fue la Unidad de Cuidados Intensivos Neonatal (UTIN) del Hospital Universitario Clemente de Faria, de Montes Claros, Minas Gerais, Brasil entre julio y diciembre de 2011. Participaron 48 profesionales de enfermería. Resultados: Se comprobó que una parte de los profesionales desconocen la definición correcta del PICC, tienen dudas sobre la vena de primera elección para la punción, período de permanencia, tipo de jeringa a ser utilizada y permeabilización del catéter. Conclusión: La formación contínua es capaz de llenar las lagunas, formar parte del proceso de trabajo, proporcionar reflexión y actualización de las prácticas en el cotidiano del profesional (AU)

Objective: To evaluate the knowledge of the nursing team on the insertion and the handling of the PICC. Method: Descriptive, documentary and field study. The locale was the ICU Newborn of the HUCF, July to December of 2011. 48 professionals of the nursing staff were part of the study. Results: It was observed that part of the professionals are unaware of the correct definition of PICC, have doubts on the vein of first choice for punction, period of permanence, syringe to be used and permeabilization of the catheter. Conclusion: The permanent education is able to fill the gaps, to be part of the work process, to provide reflection and updating of the daily practices of the worker (AU)

[Atrial fibrillation ablation: application of nurse methodology]. / Ablación de fibrilación auricular: aplicación de la metodología enfermera.

Ablation of pulmonary veins for treatment of atrial fibrillation involves applying radiofrequency energy wave by a catheter that causes a circumferential lesion to achieve electrical isolation and voltage drop in the interior. It is mainly applied when there is resistance to treatment and recurrence of symptoms affecting the quality of life of patients. The nurse is an important part of the multidisciplinary team who care for patients who undergo this procedure. The provision of comprehensive nursing care should include nursing procedures prior to, during, and after treatment to ensure the careful and systematic quality required. The aims of this article are: to provide specialised knowledge on the procedure of atrial fibrillation ablation, to describe the preparation of the electrophysiology laboratory, analyse nursing care and develop a standardized care plan for patients on whom this procedure is performed using the NANDA (North American Nursing Association) taxonomy and NIC (Nursing Intervention Classification).

Periprocedural pain of radiofrequency ablation for hepatocellular carcinoma.

Although radiofrequency ablation has been accepted as a safe and effective treatment for small hepatocellular carcinoma, there are few studies addressing periprocedural pain. Our study aims were to investigate periprocedural pain and evaluate its related factors. Ninety-nine patients diagnosed as having hepatocellular carcinoma and who underwent radiofrequency ablation were consecutively enrolled. The pain intensity, mental preparation status for radiofrequency ablation, and demographic and clinical characteristics were investigated. We used an 11-point numerical rating scale to assess for pain. Forty-three percent of subjects reported the intensity of periprocedural pain as more than a level of six (severe pain). The longer duration of ablation (r(s) = .29, p = .004), the number of ablations (r(s) = .27, p = .008), higher pain anxiety (r(s) = .42, p < .001), and difficulty sleeping on the previous day (r(s) = .24, p = .019) were factors related to experiencing more severe pain. The major related factors to severe periprocedural pain were the longer duration of ablation and the more anxiety about pain. Clinicians should offer better information to radiofrequency ablation patients regarding pain expectations and carefully consider periprocedural analgesia requirements.

Sellado de catéteres con gelafundina versus heparina sódica / Sealing catheters with gelafundin compared to sodium heparin

La mayor parte de los pacientes que actualmente inician diálisis, son de edad avanzada con patologías crónicas y complicaciones vasculares, requiriendo de la utilización de catéteres venosos centrales para la realización de hemodiálisis. Esta realidad de nuestros centros, ha determinado que enfermería tenga que adaptar su trabajo al cuidado de dichos catéteres asegurando poder acceder a un flujo de sangre suficiente para realizar una diálisis eficaz. Tras un cambio producido en nuestra unidad respecto al sellado de las ramas de los catéteres, pasando de un protocolo tradicional con suero fisiológico y heparina sódica al 5%, a otro constituido por suero fisiológico y gelafundina, se planteó como objeto de estudio realizar una comparación de ambos protocolos valorando aspectos como incidencia de infecciones, disfunciones del catéter por obstrucción e ingresos hospitalarios. Del estudio comparativo constituido por 1248 sesiones de diálisis de 16 pacientes portadores de catéteres permanente (624 sesiones con cada protocolo) se obtuvo: que no hubo ningún ingreso hospitalario derivado de la disfunción del catéter; que con protocolos diferentes aparecieron infecciones, siendo éstas en su mayoría locales; que tuvieron lugar incidencias relacionadas con el fl ujo sanguíneo en ambos tipos de protocolos, siendo más frecuente la utilización de inversión de ramas en caso de cebado con heparina sódica y necesitándose más uso de protocolo con urokinasa en la fase de cebado con gelafundina (AU)

Most patients who currently commence dialysis are of advanced age and have chronic diseases and vascular complications, requiring the use of central venous catheters to carry out haemodialysis. This situation in our centres has meant that nursing staff have had to adapt their work to the care of these catheters ensuring access to a blood fl ow that is suffi cient for effi cacious dialysis. After a change in our unit in the sealing of catheter branches, from a traditional protocol with physiological serum and 5% sodium heparin to another made up of physiological serum and gelafundin, it was suggested that a study be carried out to compare the two protocols, evaluating aspects such as incidence of infections, dysfunctions of the catheter due to obstruction and hospital admissions The following results were obtained from the comparative study carried out over 1248 dialysis sessions of 16 patients with permanent catheters (624 sessions with each protocol): there were no admissions to hospital deriving from catheter dysfunction; with different protocols infections appeared, mostly local; there were incidents related to blood fl ow in both types of protocol, with the use of branch inversion being more frequent when primed with sodium heparin and with greater user of protocol with urokinase in the phase of priming with gelafundin (AU)

Cloruro de etilo. Anestesia local mediante frío / Ethyl chloride. Local anesthesia by cold

El control de los síntomas en general y del dolor en particular sigue siendo un tema actual en los congresos y reuniones científicas, y objeto de debate en las recomendaciones de las sociedades científicas [1]. No sufrir un dolor innecesario debido al tratamiento es un derecho de todo enfermo y facilitar las medidas que lo controlen, por parte de las enfermeras, supone una expresión de respeto hacia ese derecho. Un procedimiento habitual de los cuidados de enfermería consiste en la punción venosa y arterial para realizar extracciones sanguíneas o colocar catéteres con distintos fines; estos procedimientos resultan dolorosos para el paciente y muchas veces desagradables por la necesidad de realizarlos de forma repetida. Existen diferentes técnicas de relajación que pueden contribuir a la disminución de este efecto en el paciente pero también disponemos de intervenciones farmacológicas que contribuyen a disminuir el dolor asociado a las punciones vasculares [2]. Una de ellas, fácil de utilizar, rápida de actuar y sin efectos secundarios consiste en la utilización de anestesia tópica mediante frío con cloruro de etilo(AU)

The control of symptoms in general and pain in particular, remains a current topic in scientific conferences and meetings, and discussed the recommendations of the Scientific Societies [1]. Do not suffer unnecessary pain because the treatment is a right of every patient and facilitating action to control it, by nurses, is an expression of respect for that right. A common procedure nursing care consists of venous and arterial puncture for blood samples or to place catheters for different purposes, these procedures are painful for the patient and sometimes unpleasant by the need to perform them repeatedly.There are different relaxation techniques that can help to reduce this effect in the body but also have pharmacological interventions to help decrease the pain associated with vascular punctures [2]. One of them, easy to use, quick to act and no side effects is the use of topical anesthesia by cold ethyl chloride(AU)

Material para la anestesia regional / Nursing basics in anesthesia: material to carry out. Regional anesthesia technics

Enfermería tiende a una gran especialización en las distintas áreas asistenciales; por este motivo, la introducción de la figura de la enfermera de anestesia obliga a un conocimiento específico de todo cuanto influya en esta disciplina. La continua evolución de la tecnología aplicada al diseño de nuevas agujas, ecógrafos u otro tipo de aparataje para la realización de técnicas anestésicas regionales, hace imprescindible la actualización de nuestros conocimientos en este campo. Este artículo pretende mostrar al lector interesado (enfermeras que se dedican al campo de la anestesiología y profesionales que pueden verse vinculados en áreas quirúrgicas o de dolor) una visión actual sobre el material y otro aparataje que más se utiliza en la realización de los distintos tipos de bloqueos nerviosos en anestesia regional; siendo su objetivo proporcionar a quien se inicia en esta disciplina una herramienta útil y rápida de introducción a la anestesia regional, y a los profesionales más expertos una actualización contrastada. El trabajo se estructura de forma clásica: introducción, bloqueos centrales (subaracnoideo y epidural), blo-queos periféricos, anestesia regional intravenosa, bloqueo del ojo, asepsia y conclusiones(AU)

Nursing career tend to specialize more each time in the different specialties, for this reason the introduction of the specialist nurse in anaesthesia required a specific knowledge on this medical discipline. The evolution of technologies applied to the design of new needles, echography machines and other equipment for regional anaesthesia techniques make essential to update of our knowledge in this area. This piece of work pretend to show the readers (nurses working in anaesthesia and others practitioners involved in surgical areas or pain management) a current view about the material and other instruments, mostly used in the different types of nerve blocks in regional anaesthesia. The aim of this, is provided an easy introduction of the regional anaesthesia to the junior practitioners, and updated evidence to the senior practitioner. The work is structured in a classic way: introduction, central blocks (subarachnoid and epidural), peripheral blocks, regional intravenous anaesthesia, eye block, asepsis and conclusions(AU)

Menos dolor en la punción de un catéter venoso periférico Una revisión bibliográfica en población adulta / Less pain during puncture by a peripheral venous catheter; a bibliographical review adults

La canalización de vías venosas es una técnica habitual entre los profesionales de enfermería. La inserción de una cánula venosa periférica origina dolor. La importancia de una buena calidad en los cuidados de enfermería lleva implícito el bienestar de la persona. En la práctica diaria, no se utiliza ninguna intervención dirigida a disminuir el dolor de la inserción de una vía venosa periférica. Se observa la necesidad de efectuar una revisión bibliográfica con la finalidad de conocer todos los métodos utilizados para disminuir el dolor ocasionado por ello. Seis ensayos clínicos con asignación aleatoria y un metaanálisis evalúan la efectividad de: maniobra de Valsalva, pomada anestésica que contiene dos anestésicos locales de tipo amino-amida, la lidocaína y la prilocaína (EMLA®) en comparación con otra pomada anestésica (Myolaxin®); un metaanálisis de veinte estudios evalúa la magnitud de la disminución del dolor de uno de los métodos: pomada EMLA®, apósito cutáneo antiinflamatorio (diclofenaco), apósito de diclofencaco versus pomada anestésica EMLA®, inyección subcutánea de 0,25 ml mepivacaína 1% (anestésico local tipo amida) y fotografía directa justo antes de la punción (efecto de la luz del flash). Todos los métodos estudiados son efectivos para reducirlo. Las pomadas y apósitos resultan poco agresivos pero necesitan tiempo previo de aplicación. La luz del flash, la inyección subcutánea de mepivacaína y la maniobra de Valsalva pueden ser alternativas eficaces para la disminución del dolor en la punción del paciente que requiere atención urgente(AU)

Canalizing veins is a habitual technique carried out by nurses. Inserting a catheter in a peripheral vein causes pain. The importance of fine quality in nursing treatment implicitly bears on a person’s well-being. In daily practice, health professionals do not use any method to reduce pain when inserting a catheter. The authors observations led them to believe in the need to carry out a bibliographical review whose objective was to discover all the methods used to reduce pain caused by puncturing a peripheral vein.Six randomly assigned clinical tests and a meta-analyisis evaluate the effectiveness of: The use of Valsalva , an analgesic cream which contains two local amino-amide anesthetics ; lidocaine and prylocaine (EMLA®) compared to another analgesic cream, Myolaxin®;a meta-analyisis of twenty studies evaluates the degree by which pain is diminished by one such method: an EMLA® cream; an anti-inflammatory skin dressing (diclofenaco), a diclofenaco dressing versus an EMLA® anesthetic dressing, 0.25 ml subcutaneous injection of 1% mepivaína, an amida type local anesthetic; and direct photography moments before puncture occurs to use the effects of a flash of light. All these methods studied proved effective in reducing pain. Creams and dressing prove to be unaggressive methods but require some time for application prior to puncture. Using a camera flash, subcutaneous injection of mepivacaine and the application of Valsalva can be effective alternatives to reduce pain when puncturing veins in patients who require emergency care(AU)

Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF. AIMS: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation. METHODS: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used. RESULTS: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered. CONCLUSION: HRQOL is improved in AF patients with severe symptoms after PVI intervention.

Proyecto Bacteriemia Zero. Reducción de bacteriemia provocada por catéteres venosos centrales (CVC) en las UCI de España(AU) / Bacteriemia Zero Project. Reduction of bacteriema provoked by central vascular catheters in Intensive Care Units in Spain

Presentación. España, país de demostración para reducir las bacteriemias por catéteres centrales. El Ministerio de Sanidad y Política Social (MSPS) a través de la Agencia de Calidad, en colaboración con la Alianza Mundial para la Seguridad del Paciente de la OMS, ha puesto en marcha un proyecto para la prevención de las infecciones relacionadas con los catéteres centrales en las Unidades de Cuidados Intensivos (UCI). Este proyecto se enmarca dentro de la Estrategia de Seguridad de Pacientes que el MSPS viene desarrollando desde el año 2005 que incluye como uno de sus objetivos prioritarios impulsar prácticas seguras en los centros sanitarios del Sistema Nacional de Salud (SNS). El proyecto, realizado en coordinación con las Comunidades Autónomas (CCAA) y liderado a nivel técnico por la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), utiliza una estrategia multifactorial basada en la experiencia llevada a cabo en Michigan por el grupo liderado por el Dr. Peter Pronovost de la Universidad Johns Hopkins. La Alianza Mundial por la Seguridad del Paciente junto con el Quality Safety Research Group de la Universidad de Johns Hopkins promueven la aplicación de dicha estrategia de manera global con la intención de obtener resultados similares a los conseguidos en el Estado de Michigan. España ha sido el primer país en sumarse a dicha iniciativa por lo que ha sido designado por la OMS para ser país «demostración» en la reducción de infecciones relacionadas con los catéteres centrales en las unidades de cuidados intensivos (UCI)(AU)

IntroductionSpain, A Showcase Country for the reduction of bacteriemas caused by the use of central catheters The Health and Consumer Affairs Ministry by means of its Quality Control Agency in collaboration with the World Alliance for Patient Safety Programme, promoted by the World Health Organization (WHO), has initiated a project to prevent infections related with central catheters in intensive care units. This project forms part of the Strategy for Patient Safety which the Health and Consumer Affairs Ministry has been developing since 2005; this strategy includes as one of its main objectives to promote safe practices in the health care centers run by the National Health Service. This project, carried out in coordination with the Spanish Autonomous Communities and lead at the technical level by the Spanish Society of Intensive, Critical and Coronary Care Medicine, SEMICYUC, utilizes a multifaceted strategy based on the experiences carried out in Michigan by Dr. Peter Pronovost of John Hopkins University. The World Alliance for Patient Safety Programme together with John Hopkins University Quality & Safety Research Group promote the application of the aforementioned strategy on a world-wide scale in the hopes of obtaining results similar to those obtained in the State of Michigan. Spain is the first country to join in on this initiative and therefore the WHO has designated Spain a "show case country" in the reduction of infections related to central catheters in intensive care units(AU)