[Measurement of care time in patients with acute myocardial infarction admitted to a general ICU: evaluation and improvement]. / Medición de tiempos en la atención al paciente con infarto agudo de miocardio en una UCI polivalente: estudio de evaluación y mejora.

Acute myocardial infarction (AMI) requires early and safe nursing care, particularly with respect to initiating and following up thrombolytic treatment, the most effective therapy according to the literature. Time is decisive. Recommended door-to-needle time should not exceed 35 minutes (from patient's arrival to injection of the thrombolytic agent in the ICU). This quality of care study centered on the measurement of four partial times and their sum. These times corresponded to different phases a patient with AMI undergoes from arrival at the hospital emergency room center to thrombolysis in the ICU. The intrahospital delay in patient care was examined. Times were recorded on a specific register of all patients with priority I AMI (clear criteria for fibrinolysis) who were seen at our center. Total time to fibrinolysis in the ICU was 60 minutes (excessive intrahospital delay). A corrective intervention plan was designed and implemented, which reduced the delay to an acceptable 30 minutes. This improved the quality of care of AMI patients at our center.

[A new candidate for intensive care: patients undergoing rapid opiate withdrawal, and their care]. / Un nuevo candidato para cuidados intensivos: "el paciente que se va a someter a desintoxicación ultracorta por opiáceos, y sus cuidados".

Withdrawal from drugs currently is and interesting topic because of the repercussions it has on different aspects of life, particularly: health, work, family and social relationships, etc. In this article we report a new system for minimizing the adverse effects of withdrawal from opiates (which usually are prolonged), and for carrying out withdrawal as quickly and effectively as possible. A protocol is described in detail, as well as special nursing care. This protocol is called ultrashort withdrawal (24 hours) and it has been developed and used in the intensive care department of the General University Hospital of Murcia (Spain), in collaboration with the center's hospital detoxification unit.

[Prevention of infections caused by venous catheters in intensive care units]. / Prevención de las infecciones relacionadas con catéteres venosos en cuidados intensivos.

The importance of the prevention of infections related to venous catheters comes from the frequent morbility which derives from these devices in ICU and the foresecable increase of infections which are secondary to them with the consequent increase in the load of Nursing work and costs in Spain, bacteriemias related to central catheters are 8%, under 5% for Swan-Ganz and almost inexistent for peripherals. Germs responsible for infectious incidences caused by catheters are basically Staphylococcus coagulase-negative and Staphylococcus aureus. The most affected veins are the jugular, followed by femoral, antecubital, subclavian and peripheral. The colonization of the patient's skin and the connections of catheters are the most frequent origin of infections and, since certain germs create defensive structures which make them more resistant to treatment, it is very important to carry out protocols of prevention and care which should encompass hand washing efficiency, daily care of the wound, use of suitable disinfectants and, very especially, the protection of catheter connections.