Evaluación de competencia profesional de enfermería en cuidados intensivos adultos en aspiración endotraqueal / Evaluation of nursing professional competence in adult intensive care in endotracheal aspiration

Se realizó una investigación prospectiva y longitudinal en la Unidad de Cuidados Intensivos de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa, con el objetivo de evaluar la competencia del profesional de enfermería en relación con técnica de aspiración endotraqueal, durante enero 2015- agosto 2016. El estudio se realizó con el total de enfermeras y enfermeros que laboran en la UTIAs, 37. Se realizó un examen teórico y práctico de evaluación de competencia a los profesionales de enfermería de UTIAs y la técnica de aspiración endotraqueal. El mayor por ciento entre Licenciados en Enfermería y verticalizados presentaron una evaluación de mal, las sepsis aumentaron a partir del cuarto día de ingreso de los pacientes. Mostrando un grado marcado de incompetencia en la realización de este proceder invasivo que a su vez influye en la seguridad del paciente(AU)

A prospective and longitudinal investigation was carried out in the Adult Intensive Care Unit of the General Teaching Hospital Octavio de la Concepción y de la Pedraja in Baracoa, with the objective of evaluating the competence of the nursing professional in relation to endotracheal aspiration technique, during January 2015 to August 2016. The study was performed with the total number of nurses working in the ICUs, 37. A theoretical and practical examination of competency assessment was done to the nursing professionals of ICUs and the aspiration technique endotracheal. The highest percent among nursing graduates and verticals presented an evaluation of bad, the sepsis increased from the fourth day of admission of the patients. Showing a marked degree of incompetence in performing this invasive procedure which affects patient safety(AU)

Rapid Aspiration Screening for Suspected Stroke: Part 2: Initial and Sustained Nurse Accuracy and Reliability.

OBJECTIVE: To determine registered nurses' (RNs') ability to obtain and maintain accurate procedural skills and reliable interpretation of the screening items under study to develop the Rapid Aspiration Screening for Suspected Stroke. DESIGN: Prospective, observation study. SETTING: A certified primary stroke center in a major metropolitan medical facility. PARTICIPANTS: RNs (N=15) were recruited and trained in the administration and interpretation of the screening items under study to develop the Rapid Aspiration Screening for Suspected Stroke. INTERVENTIONS: RNs completed a total of 239 screenings of patients admitted with suspected stroke over a 2-year period. RNs administered the swallowing screening items and interpreted the patient's response to each item. Independent of the RN, a speech-language pathologist simultaneously interpreted the response of the participant with stroke to each swallowing screening item. MAIN OUTCOME MEASURES: Reliability of the interpretation and accuracy of the administration of the swallowing screening items. RESULTS: The average accuracy rate for the administration of the Rapid Aspiration Screening for Suspected Stroke was 98.33%, with the overall accuracy rate for each procedural task ranging from 95.42% to 100%. For the specific swallowing screening items that formed the Rapid Aspiration Screening for Suspected Stroke, dysarthria and a positive sign after water swallow, reliability was high (k=.817). The accuracy rate for the administration and reliability of the interpretation of the swallowing screening items improved as RNs gained experience, and both were maximized at 20 screening opportunities. CONCLUSIONS: RNs demonstrate both excellent accuracy of procedural administration and reliability of interpretation of the items of the Rapid Aspiration Screening for Suspected Stroke. With feedback and repeated opportunities to practice, maintenance of skills is achievable.

Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and Validation.

OBJECTIVE: To develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke. DESIGN: Validity study comparing evidence-based swallowing screening items with the videofluoroscopic swallowing study (VFSS) results. SETTING: A certified primary stroke center in a major metropolitan medical facility. PARTICIPANTS: Consecutive patients (N=250) admitted with suspected stroke. INTERVENTIONS: Patients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening. MAIN OUTCOME MEASURES: Validity relative to identifying VFSS-determined aspiration for each screening item and for various combinations of items. RESULTS: Aspiration was identified in 29 of 250 participants (12%). Logistic regression revealed that age (P=.012), dysarthria (P=.001), abnormal volitional cough (P=.030), and signs related to the water swallow trial (P=.021) were significantly associated with aspiration. Validity was then determined on the basis of the best combination of significant items for predicting aspiration. The results revealed that age >70 years, dysarthria, or signs related to the water swallow trial (ie, cough, throat clear, wet vocal quality, and inability to continuously drink 90mL water) yielded 93% sensitivity and 98% negative predictive value. CONCLUSIONS: The final validated tool, Rapid Aspiration Screening for Suspected Stroke, is a valid nurse-administered tool to detect risk of aspiration in patients presenting with suspected stroke.

Implantación de un protocolo de aspiración de secreciones endotraqueales basado en la evidencia científica en una Unidad de Cuidados Intensivos / Implementation of an evidence-based endotracheal secretions aspiration protocol at the Intensive Care Unit

Objetivo: evaluar el impacto que la implantación de un protocolo de aspiración de secreciones endotraqueales basado en la evidencia tiene sobre la realización de dicha técnica.Métodos: estudio de intervención antes-después desarrollado en una Unidad de Cuidados Intensivos (Madrid) en la que se implantó un protocolo para la aspiración de secreciones endotraqueales (ASE) basado en la evidencia tras llevar a cabo sesiones formativas con el equipo de Enfermería. La población de estudio fueron las ASE realizadas a pacientes que precisaran ventilación mecánica más de 48 horas. Variables de estudio: motivo de aspiración, calibre de la sonda utilizada, lavado de manos, uso de mascarilla, hiperoxigenación previa, nivel de sedación y frecuencia de complicaciones. Para la comparación antes-después de la implantación del protocolo se empleó la prueba ji-cuadrado y el exacto de Fisher. Resultados: antes de la implantación del protocolo se realizó observación de 482 aspiraciones procedentes de 11 pacientes y, tras la implantación, de 216 procedentes de 9 pacientes. Se observó una mejoría estadísticamente significativa (p < 0,05) con respecto a lo observado antesde la implantación del protocolo en los cinco ítems de medidas generales en la realización de la técnica. Respecto a los motivos de la aspiración,no se llevó a cabo ninguna aspiración rutinaria, siendo la principal causa la presencia de secreciones (66%). Solo se dieron dos tipos de complicaciones: de saturación (3,7%) y obstrucción del tubo (2,3%).Conclusiones: la aplicación de un protocolo basado en la evidencia para la realización de ASE, el cual ha sido implantado tras sesiones formativas con el equipo de Enfermería, aumenta el cumplimiento de medidas generales de realización correcta de la técnica y disminuye la incidencia de complicaciones, lo cual repercute en una mayor seguridad para el paciente (AU)

Objective: To assess the impact that the implementation of an evidence based endotracheal secretions aspiration protocol has on the applicationof this technique.Methods: Before and after interventional study developed at one Intensive Care Unit (Madrid), where an evidence-based endotracheal aspiration(EA) protocol was implemented after conducting training sessions with the nursing team. The study population consisted of EA patients that required mechanical ventilation for more than 48 hours. Study variables:reason for aspiration, caliber of the catheter used, hand washing,use of mask, prior hyperoxygenation, sedation level, and frequency of complications.For the before-after comparison of the implementation of the protocol the chi-square test and Fisher exact test were used.Results: Before the implementation of the observation protocol, 482 aspirations from 11 patients were observed; and after implantation, 216 aspiration sfrom 9 patients were observed also. A statistically significant improvement (p <0.05) was observed compared to what had been observed before the implementation of the protocol in the five items of general measures relating to the performance of the technique. Regarding the reasons of aspiration, no routine aspiration was performed, the main reason being the presence of secretions (66%). Only two types of complications developed: desaturation (3.7%) and obstruction of the tube (2.3%).Conclusions: The application of an evidence-based protocol for the aspiration of endotracheal secretions implemented after conducting three training sessions with the nursing team increases compliance to the general rules for the correct application of the technique and decreases the incidence of complications, which translates into improved patient safety (AU)

Respecting patient autonomy versus protecting the patient's health: a dilemma for healthcare providers.

A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement. The patient demanded that he be allowed to eat a normal diet despite being told that it could lead to his death. The patient wanted to go home, but there was no one there to care for him. Additionally, neither a nursing home nor hospice would accept him in his present condition. The case is especially interesting because of the symbolic value of food and the plight of the patient who has no alternative to hospitalization. The hospital staff experienced considerable stress at having to care for him. They were uncertain whether their obligation was to respect his autonomy and continue to provide food or to protect his health by avoiding aspiration, pneumonia, and possible death by denying him food. This ethical dilemma posed by the professionals' duty to do what is in the patient's best interest versus the patient's right to decide treatment serves as the focus for this case study. Ethical, legal, and healthcare practitioners' considerations are explored. The case study concludes with specific recommendations for treatment.

[Aspiration of milk in healthy infant--cause of acute respiratory arrest?]. / Atemstillstand bei einem gesunden Säugling durch Aspiration?

We present the case of 4month old female infant, who obviously suffered from a respiratory arrest during bottle-feed ing. After primary successful resuscitation the baby died after 49 days due to large intracranial hemorrages. The diagnosis of shaking trauma was based on the detailed medical examinations and on the case history taken from the police file. The life-threatening shaking trauma is rare as an emergency. Therefore every doctor should be aware of a potential victim in cases of infants who are normal developed without signs of injuries, have no history of a severe disease and show life-threatening symptomes.