Claridad de las recomendaciones al paciente en el informe de alta hospitalaria / Clarity of recommendations for patients in the hospital discharge report

Fundamento. Las recomendaciones al paciente (RP) son una de las partes fundamentales del informe de alta hospitalaria. El objetivo del estudio fue conocer la frecuencia de RP en los informes de distintas especialidades y la proporción de ellas consideradas de fácil comprensión. Material y método. Estudio observacional transversal. Ámbito: hospital general de agudos. Se revisó una muestra de informes de alta con análisis de la frecuencia y tipos de RP según su contenido y claridad. Resultados. Se analizaron 840 informes y 2.097 RP con un promedio de 2,5 RP por informe. Las RP más habituales se referían al seguimiento del paciente (46% del total), seguidas de las recomendaciones específicas para los días inmediatos al alta (37%), solo el 16% se referían a estilos de vida. Los informes de especialidades quirúrgicas contenían 3,2 RP por alta, frente a 2,3 de las especialidades médicas. Un 90,3% de las RP se consideraron de comprensión clara para un paciente medio. Conclusiones. Los informes de alta analizados contenían pocas RP, en especial las referidas a estilos de vida. Una proporción apreciable de las RP no estaban expresadas con suficiente claridad(AU)

Background. Recommendations for patients (RP) are one of the key parts of the hospital discharge report (HDR). The objective was to study the frequency of RP in the HDR of different specialties and the proportion of them considered to be easy to understand. Material and method. Observational and cross-sectional study. Setting. General acute care hospital. Interventions. Review of a sample of HDR, analysis of the frequency and types of PR based on their content and clarity. Results. A total of 840 HDR and 2,097 PR were analysed with an average of 2.5 RP per report. The most common RP referred to the patient follow-up (46% of total), followed by specific recommendations for the days immediately following discharge (37%), with only 16% related to lifestyle. Reports by surgical specialties contained 3.2 RP compared to 2.3 in medical specialties. The large majority (90.3%) of the RP were considered clear to understand for a standard patient. Conclusions. The HDR analysed contained few RP, in particular those related to lifestyles. A substantial proportion of the RP were not expressed with enough clarity(AU)

[Ultrasound-guided infraclavicular axillary vein cannulation]. / Canalización de la vena axilar infraclavicular guiada por ecografía.

BACKGROUND AND OBJECTIVE: Percutaneous central venous cannulation is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. We wanted to evaluate an ultrasound-guided technique for the axillary vein cannulation, looking specifically at the ease of use, success rate and decreased complications. METHODS: Sixty consecutive surgical patients scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding an in plane puncture of axillary vein was used. After locating the vessels, an echo-guided sterile procedure was performed to cannulate the vein. RESULTS: Cannulation was successful in all patients, and there were no complications during insertion of the catheters. Both axillary veins were cannulated, and the vein was punctured successfully at first attempt in 95% of the patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 (7- 135) seconds. CONCLUSION: This ultrasound-guided technique for inserting central venous catheters in axillary vein was easy to apply. This procedure could increase precision and safety in patients undergoing axillary vein cannulation.

Canalización de la vena axilar infraclavicular guiada por ecografía / Ultrasound-guided infraclavicular axillary vein cannulation

Introducción y objetivos. La canalización venosa central percutánea es un procedimiento que puede ser difícil. Tradicionalmente se han utilizado técnicas basadas en referencias anatómicas externas para identificar los sitios de punción. Hemos evaluado una técnica guiada por ultrasonidos para la canalización de la vena axilar infraclavicular. Método. Se incluyeron pacientes quirúrgicos programados para la colocación de un catéter venoso central. Utilizamos una sonda lineal de ultrasonidos, 12MHz, para guiar la punción en plano de la vena axilar infraclavicular. El miembro superior ipsilateral fue colocado en abducción a 90° del eje cráneo-caudal. Se analizó el número de intentos, el tiempo empleado en la técnica (desde punción de la piel hasta aspiración de sangre) y la incidencia de complicaciones. Resultados. Fueron incluidos 60 pacientes. Fueron escaneadas ambas venas axilares infraclaviculares y el catéter se pudo colocar en un primer intento en el 95% de los pacientes. No hubo fallos de canalización. La mediana de tiempo de la técnica fue de 15 (rango 7-135) segundos. No hubo complicaciones mayores durante el procedimiento de inserción del catéter. Conclusión. La visualización por ultrasonidos de la vena axilar infraclavicular permitió su canalización con un mínimo cambio de posición del paciente, incluso durante la cirugía, en un tiempo clínicamente adecuado y sin complicaciones inmediatas(AU)

Background and objective. Percutaneous central venous cannulation is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. We wanted to evaluate an ultrasound-guided technique for the axillary vein cannulation, looking specifically at the ease of use, success rate and decreased complications. Methods. Sixty consecutive surgical patients scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding an in plane puncture of axillary vein was used. After locating the vessels, an echo-guided sterile procedure was performed to cannulate the vein. Results. Cannulation was successful in all patients, and there were no complications during insertion of the catheters. Both axillary veins were cannulated, and the vein was punctured successfully at first attempt in 95% of the patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 (7 - 135) seconds. Conclusion. This ultrasound-guided technique for inserting central venous catheters in axillary vein was easy to apply. This procedure could increase precision and safety in patients undergoing axillary vein cannulation(AU)

[Clarity of recommendations for patients in the hospital discharge report]. / Claridad de las recomendaciones al paciente en el informe de alta hospitalaria.

BACKGROUND: Recommendations for patients (RP) are one of the key parts of the hospital discharge report (HDR). The objective was to study the frequency of RP in the HDR of different specialties and the proportion of them considered to be easy to understand. MATERIAL AND METHOD: Observational and cross-sectional study. SETTING: General acute care hospital. INTERVENTIONS: Review of a sample of HDR, analysis of the frequency and types of PR based on their content and clarity. RESULTS: A total of 840 HDR and 2,097 PR were analysed with an average of 2.5 RP per report. The most common RP referred to the patient follow-up (46% of total), followed by specific recommendations for the days immediately following discharge (37%), with only 16% related to lifestyle. Reports by surgical specialties contained 3.2 RP compared to 2.3 in medical specialties. The large majority (90.3%) of the RP were considered clear to understand for a standard patient. CONCLUSIONS: The HDR analysed contained few RP, in particular those related to lifestyles. A substantial proportion of the RP were not expressed with enough clarity.