Placing a Central Vascular Access Device in a Patient With Substance Use Disorder: The Ethical Position of the Infusion Nurse.

When infusion nurses place central vascular access devices in patients with substance use disorder (SUD), they are both enabling treatment and making the patient more vulnerable to his or her addictive illness. Using the lens of rescue enables an exploration of the ethical position of the infusion nurse regarding these patients, even though rescue, per se, is inadequate to the complexity of the situation. Suggestions are offered to both the infusion nurse and the health care team for improving their ethical stance, as well as their care of patients with SUD.

Combinación de maniobras quirúrgicas útiles para optimizar la sutura vascular / Combined useful surgical maneuvers to optimize the vascular suture

Se informan 3 maniobras quirúrgicas conjuntas para realizar accesos vasculares para hemodiálisis (n= 270) y trasplantes renales (n= 54) desde septiembre de 2000 hasta diciembre de 2008. Estas son: aplicación de compás goniométrico para optimizar afrontamiento de los vasos a suturar, práctica de punto de anclaje para la eversión de la pared posterior en la sutura vascular y sustitución de presillas por ligaduras de goma en la cirugía vascular. La práctica sistemática de estas maniobras permitió incrementar la efectividad de los accesos vasculares en el 20 por ciento y disminuir las complicaciones vasculares y los trasplantes renales a la mitad de los reportados anteriormente, en beneficio de la supervivencia y calidad de vida de los pacientes(AU)

Three combined surgical maneuvers to create vascular approach for hemodialysis (n = 270) and renal transplantation (n = 54) from September, 2000 to December, 2008 including the use of a goniometer compass to optimize the facing of vessel to be sutured, practice of anchorage point for eversion of posterior wall in the vascular suture and replacement of clips for gum ligatures in vascular surgery. The systemic practice of these maneuvers allowed to increase the effectiveness of the vascular approaches in a 20 percent and to decrease the vascular complications and the renal transplantation to the half of those previously reported for the good of the survival and the quality of life of the patients(AU)