[The role of nursing in right heart catheterization. Advantages from peripheral venous access]. / Papel de enfermería en el cateterismo cardiaco derecho. Ventajas del acceso venoso periférico.

INTRODUCTION: Pulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access. OBJECTIVE: To analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures. METHOD: A retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions. RESULT: A total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm2 vs 12.5Gycm2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001). CONCLUSIONS: The RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient.

Con E de enfermera Unidad de hipertensión pulmonar / With E for nurse... Pulmonary hypertension unit

Ana Mª Ramírez es enfermera en la Unidad de Hipertensión Pulmonar del Hospital Clínic (CSUR) de Barcelona y miembro de la Asociación Hipertensión Pulmonar España. Esta patología consiste en un “trastorno grave e incapacitante, que se caracteriza por el aumento de la presión arterial pulmonar, disminución del gasto cardiaco y aumento de la resistencia vascular pulmonar que puede originar insuficiencia cardiaca y muerte, se considera en general una enfermedad minoritaria y no tiene cura”, según explica, destacando la importancia de la adherencia al tratamiento de los pacientes para favorecer una buena evolución. Nos atiende para hablar de la enfermedad, de las labores enfermeras en su abordaje y de la necesidad de la educación para la salud en el manejo de la misma.(AU)

Pulmonary Hypertension: Overview and Case Study.

This article provides a broad overview of pulmonary hypertension, including classifications, risk factors, signs and symptoms, diagnosis, and treatment options. Nursing considerations and optimization of hemodynamic values in patients with pulmonary hypertension in a critical care unit are reviewed through the lens of a case study. Preventing decompensation is essential in the successful care of these patients.

Pulmonary Arterial Hypertension Emergency Complications and Evaluation: Practical Guide for the Advanced Practice Registered Nurses in the Emergency Department.

Pulmonary hypertension (PH) complicates common diseases and can lead to worsening symptoms and increased mortality. A specific group of PH, pulmonary arterial hypertension (PAH), World Health Organization Group 1, may present to the emergency department (ED). We review common ED presentations of patients with PAH such as cardiac arrest/sudden death, right ventricular failure, syncope, hypoxemic respiratory failure, arrhythmias, hemoptysis, pulmonary embolism, chest pain/left main compression syndrome, infection, and considerations for PAH medication administration. We include a case study to illustrate a real example with a positive outcome, and an algorithm for evaluating and triaging patients with PAH in the ED. The ability to recognize, triage, and communicate changes in PAH disease status in a multidisciplinary team approach between the patient, family, specialty pharmacy, and specialized health care providers such as the PH team, is essential for ED providers who are evaluating and treating patients with PAH.

Síndrome de aspiración meconial: Avances científicos de los últimos veinticinco años / Meconium aspiration syndrome: twenty-five years of scientific developments

El síndrome de aspiración meconial (SAM) se refiere a los problemas respiratorios que sufre un recién nacido cuando inhala meconio, su primera excreción intestinal, durante o después del parto, y este llega hasta los pulmones. La presencia de meconio en el líquido amniótico es un signo de sufrimiento fetal que precisa una cuidadosa supervisión tanto del parto como de la salud fetal. Con el objetivo de resaltar la importancia de una minuciosa supervisión durante el parto y de una adecuada evaluación de la salud del bebé, se prevé realizar una revisión bibliográfica que permita resumir los principales avances médicos de los últimos veinticinco años, partiendo de una conceptualización teórica, con el fin de subrayar que aquellos recién nacidos que lo padecen presentan una serie de signos y síntomas sobre los cuales será necesario incidir en caso de producirse

Meconium aspiration syndrome (MAS) refers to respiratory problems experienced by newborns after inhaling meconium, their first intestinal excretion, reaching the lungs during or after childbirth. The presence of meconium in the amniotic fluid is a sign of fetal distress that requires close monitoring of labor and fetal health. In order to emphasize the importance of careful supervision during childbirth, together with an adequate evaluation of the newborn's health, a bibliographic review has been carried out to present the main medical advances achieved over the last twenty-five years on the matter. The aim is to establish a theoretical framework based on a series of signs and symptoms, which must be monitored in order to identify and tackle the syndrome in its early stages

Pulmonary Arterial Hypertension: A Focus on Infused Prostacyclins.

Pulmonary arterial hypertension (PAH) is characterized by vasoconstriction and cell proliferation in the pulmonary vasculature. Guideline-driven interventions with infused prostacyclin treatment are the mainstay for patients with advanced symptoms. Infused prostacyclin therapy is complex. It is critical to manage prostacyclin therapy with precision because boluses or interruptions can be fatal. Education of patients and inpatient staff nurses is necessary to prevent negative outcomes. Nurses are an essential part of the multidisciplinary team caring for patients with PAH. The diagnostic evaluation and treatment of PAH are reviewed here, and challenges associated with the care of patients on prostacyclin therapy are discussed.

Psychosocial Burdens of Pulmonary Arterial Hypertension: A Discussion Paper.

Pulmonary arterial hypertension is an uncommon and devastating chronic illness with no known cure. Little is known about the disease, and even less about the psychosocial burdens. While it is important to create awareness about the physical aspects of the disease, it is equally important to create awareness about the psychosocial burdens patients and their families face. We reviewed the literature to better understand these psychosocial burdens, which include impact from physical limitations, emotional strains, financial burdens, social isolation, lack of intimacy in relationships, and an overall lack of information. The findings can be used to assist health care providers to understand the psychosocial challenges that are being experienced by patients and families in order to better provide supportive care. The creation of a standardized tool to assess the psychosocial burdens at each clinic visit can benefit health care providers by addressing challenges faced and facilitate subsequent referral to appropriate specialists.

Developmental and Initial Validation of the Pulmonary Arterial Hypertension Symptom Inference Scale.

BACKGROUND: Pulmonary arterial hypertension is a chronic illness that produces multiple symptoms and impairs quality of life. PURPOSE: The purpose of this study was to describe the initial psychometric properties of the Pulmonary Arterial Hypertension Symptom Interference Scale (PAHSIS). METHODS: Participants completed a sociodemographic and clinical data form: the PAHSIS and the Medical Outcomes Study Short Form-36 (SF-36). Data analysis included descriptive statistics, principal component analysis (PCA), and Pearson r correlations. RESULTS: PCA revealed a 3-factor solution: Cardiopulmonary, Weary, and Gastric. Correlations between the 3 factors and the SF-36 subscales and composite summary scores ranged from acceptable to high. CONCLUSIONS: These findings support the initial validity and reliability of the PAHSIS. Nursing can use the PAHSIS to assess the impact of patient symptoms to deploy effective, targeted interventions.

A Patient with Pulmonary Hypertension on a Medical-Surgical Unit.

The medical-surgical nurse is positioned to provide safe, clinical care to patients with pulmonary hypertension (PH). An-overview of the pathophysiology, diagnostic studies, and treatments associated with PH is described.

Management of the patient with pulmonary arterial hypertension receiving intravenous prostacyclin: an expert nurse practical guide.

Pulmonary arterial hypertension (PAH) is a severely disabling disorder characterized by elevated pulmonary artery pressure ultimately leading to right heart failure and death. Treatment options have significantly increased over the past decade. Intravenous prostacyclins remain the treatment of choice for advanced PAH, leading to long-term clinical benefits and improved survival. Their administration requires a high level of nursing competency and presents considerable challenges for patients and caregivers. This article reviews the characteristics of currently available intravenous prostacyclins and provides a practical guide for nurses who may have had limited exposure to intravenous prostacyclins and their unique dosing, side effects, and titration characteristics.

Cyber support: describing concerns of caregivers of people with pulmonary hypertension.

The purpose of this study was to gain an understanding of how caregivers of people with pulmonary hypertension are using an online discussion board. The chronicity and complex medical needs of people with pulmonary hypertension warrant a holistic nursing approach combining the patient and caregiver concerns to adequately address their needs. A qualitative descriptive approach was utilized. A convenience sample over an 18-month period of those caregivers who posted Internet messages to the Pulmonary Hypertension Discussion Board was included. Sociodemographics collected were age and gender of the person with pulmonary hypertension and the relationship of the caregiver to the person with pulmonary hypertension. Clinical variables collected were medications and oxygen use and years since diagnosis. Thematic analysis was used to identify themes. A total of 98 caregivers posted to the discussion board during the 18-month period; 46% of those posting were mothers of children with pulmonary hypertension. Four themes emerged: fear and frustration, questions and concerns, someone to listen to, and moving on with life. These themes characterize how caregivers of people with pulmonary hypertension were using the discussion board. Caregivers of people with pulmonary hypertension may need more information and support from their healthcare providers to adequately care for those with pulmonary hypertension.

Safety recommendations for administering intravenous prostacyclins in the hospital.

Prostacyclins are a high-risk category of continuous intravenous infusions increasingly used in hospitals to treat advanced pulmonary arterial hypertension, a rare condition characterized by vasoconstriction and vascular proliferation of the pulmonary arteries. Prostacyclins are given in doses of nanograms per kilogram per minute and have a narrow therapeutic dosing range for each patient. Sudden increases or decreases in dose can be life threatening. Previous studies revealed errors in the administration of these high-risk infusions, which in some instances led to serious adverse events, including death. The literature was reviewed for safety measures in administration of high-risk intravenous medications and input was obtained from leading experts in pulmonary arterial hypertension to create a set of safety recommendations for infusion of prostacyclins.

A review of the management of pulmonary arterial hypertension associated with congenital heart disease.

Approximately 5-10% of adolescent and adult patients with congenital heart disease (CHD) will develop pulmonary arterial hypertension (PAH). Patients with PAH associated with CHD (PAH-CHD) exhibit several similarities to those with idiopathic and other associated forms of PAH, especially with regards to their non-specific, cardinal symptoms. The development of PAH-CHD can lead to lifelong impairment although, paradoxically, survival may be better versus idiopathic PAH. Patients with PAH-CHD may experience social limitations, and emotional and psychological issues, arising from their disease burden. Nurses and other allied healthcare professionals are well placed to deliver the individually-tailored care that patients with PAH-CHD require. Activities known to be of particular benefit include patient engagement and education, patient empowerment, colleague training, and ensuring effective communication across the multidisciplinary team. Recent developments in the management of PAH-CHD have led to changes in the medical needs and optimal care of this patient population. This review aims to provide an overview of the natural course, diagnosis, symptoms and impact of PAH-CHD. We also aim to communicate the current standards in management of patients with PAH-CHD, and how their outlook can be improved in the future.

The experiences of patients with pulmonary arterial hypertension receiving continuous intravenous infusion of epoprostenol (Flolan) and their support persons.

OBJECTIVE: Little is known about the day-to-day experiences of patients and their support persons during the course of epoprostenol treatment for pulmonary arterial hypertension (PAH). The study objective was to describe the experiences of patients and their support persons adjusting to PAH and continuous intravenous epoprostenol. METHODS: A qualitative descriptive design with semistructured interviews was conducted jointly with the patient and his/her support person. Seven patients and their support persons (spouse, child, friend) were included. RESULTS: Patients demonstrated personal growth and resilience as they adapted to PAH. Four patient themes emerged: initial shock, figuring it out, giving life, and ongoing struggles. Themes specific to the support person included "their life is in my hands," pressure to perform, and continuation of my role. CONCLUSION: Nurses may assist these patients and support persons by teaching technical skills, problem-solving and troubleshooting strategies, mobilizing social support, and providing opportunities to reflect on lifestyle changes and long-term adjustment to PAH.

Pulmonary arterial hypertension.

PAH is a chronic disease requiring lifelong therapy, regardless of chosen treatment options. Nurses and other providers must allow for open, honest discussion on the risks and benefits of each therapy. Determining the best treatment option for patients requires consideration of the patient's overall function and social support. These patients benefit from comprehensive and collaborative support from facilities or centers trained in the management of the disease.

Under pressure: pulmonary arterial hypertension . . . A mother's struggle.

Nursing grand rounds is a way for staff nurses to present an interesting case through evidence-based practice. Idiopathic pulmonary arterial hypertension is an incurable syndrome that can devastate a patient. This article describes a patient's experience with idiopathic pulmonary arterial hypertension and outlines the pathophysiology, treatment, psychosocial issues, and nursing implications that were presented in a nursing grand rounds presentation at a hospital.

Nursing considerations in the care of patients with pulmonary hypertension.

Pulmonary hypertension is a potentially lethal condition that may be encountered during the entire life span of patients with many forms of congenital or acquired heart disease, pulmonary disorders, and other diseases. Each pulmonary hypertensive patient requires anticipatory interventions geared to prevent severe exacerbations of the pulmonary hypertensive condition, promote pulmonary vasodilation, and optimize ventricular function. Patients with pulmonary hypertension are at higher risk for developing pulmonary hypertensive episodes in the immediate postoperative period after cardiac surgery, as well as during nonsurgical admissions. Nurses are in a critical position to provide anticipatory care to prevent the development of pulmonary hypertensive events. Nurses can be instrumental in optimizing outcomes for patients with pulmonary hypertension by providing immediate care upon the development of a pulmonary hypertension event and by monitoring ongoing responses to adjustments in therapeutic interventions.