Actitudes y percepciones frente a la técnica de punción arterial para gasometría: diferencias entre enfermeras de los servicios de urgencias y de neumología / Attitudes and Perceptions Surrounding Arterial Puncture for Blood Gas Testing: Differences Between Nurses in the Emergency Department and the Pulmonology Department

No disponible

Estimación del error intrínsico del instrumento de medida del laboratorio para las determinaciones analíticas del paciente crítico / Estimate of the intrinsic error of the measuring instrument of the laboratory for analytical determinations of the critical patient

Disminuir las pérdidas sanguíneas asociadas a las analíticas de laboratorio constituye un determinante de seguridad y calidad en la fase preanalítica, para llegar a alcanzar un óptimo nivel asistencial donde las enfermeras poseen gran protagonismo, al ser responsables del cuidado del paciente críticamente enfermo (AU)

Decrease blood loss associated with the analytical laboratory is a determinant of safety and quality in the preanalytical phase, in order to achieve an optimal level of care, where nurses have leading role to be responsible for the care of the critically ill patient (AU)

Aplicación de presión positive continua en la vía aérea con el dispositivo no mecánico de Boussignac / CPAP generation by a non mechanical device: the Bousignac system

La CPAP (presión positiva continua en la vía aérea) consiste en establecer una presión supraatmosférica durante todo el ciclo respiratorio sobre la que el paciente ventila de forma espontánea. Su uso mejora los parámetros clínicos y gasométricos cuando se aplica con criterios adecuados de selección en el contexto de la insuficiencia respiratoria aguda (IRA) hipoxémica. Está demostrado que aplicar la CPAP precozmente disminuye la necesidad de intubación y las complicaciones asociadas, mejora la supervivencia y reduce la estancia hospitalaria y el coste asistencial. La utilización de la válvula de Boussignac para aplicar una CPAP se está extendiendo especialmente en el ambiente extrahospitalario y de urgencias por ser un dispositivo no mecánico, sencillo, de fácil aplicación y transporte, que puede administrar presiones suficientes para manejar al paciente hipoxémico [1]. Su aplicación es tan sencilla que no precisa un adiestramiento exhaustivo y los cuidados generales no difieren de otros métodos de ventilación mecánica no invasiva (VMNI). De hecho, ya existen en España ambulancias medicalizadas dotadas con este dispositivo, que la enfermera puede aplicar y manejar ella sola (AU)

CPAP (continuous positive airway pressure) is to establish a supraatmosferica pressure throughout the respiratory cycle on which the patient vent spontaneously. Its use improves the clinical and gasometrics parameters when applied with appropriate selection criteria in the context of respiratory failure acute (IRA) hypoxemic. It has been demonstrated that applying CPAP early, decreases the need for intubation and associated complications, as well as survival, reducing health care costs and hospital stay. The use of valve Boussignac for applying a CPAP is spreading especially in the delivered environment and emergencies as a device not mechanical, simple, easy to use and transport, which can manage enough pressures to manage the patient hypoxemia [1]. Its application is so simple that it does not need a comprehensive training and general care does not differ from other methods of mechanical ventilation noninvasive (adapted). In fact, already exist in Spain ambulances equipped with this device that can be applied and managed only by the nurse (AU)

Four steps to interpreting arterial blood gases.

This article examines acid-base balance and the interpretation of arterial blood gases (ABG). The article begins with a brief revision of related physiology, followed by a description of the primary disorders associated with acid-base imbalance. The normal ranges and the significance of abnormal ABG results are explored. The article concludes by providing an easy to follow four-step guide to ABG interpretation with practice examples presented in the CPD task section.

Ventilación no invasiva con presión de soporte con volumen asegurado en un paciente con enfermedad pulmonar obstructiva crónica (EPOC) agudizada / No disponible

El paciente con EPOC exacerbado y encefalopatía hipercápnica puede plantear serios problemas al tratarle con ventilación mecánica no invasiva (VMNI). Aun no siendo una contraindicación para la VMNI, la falta de colaboración puede ser motivo de fracaso de la técnica. En la actualidad disponemos de modos ventilatorios limitados por presión que aseguran el volumen corriente aportado al paciente. El modo presión de soporte con volumen asegurado (AVAPS) nos ofrece esta opción. Existen pocas publicaciones sobre el uso de esta modalidad ventilatoria en la situación de fallo respiratorio agudo hipercápnico. Presentamos el caso de un paciente con EPOC exacerbado en situación de encefalopatía hipercápnica, tratado con éxito con este modo ventilatorio

The patient with exacerbated COPD and hypercapnic encephalopathy may pose serious problems regarding treatment with non-invasive mechanical ventilation (NIMV). Although no contraindication has been found for NIMV, lack of collaboration may be a reason for failure of the technique. We currently have ventilatory methods limited by the pressure that ensures the tidal volume provided to the patient. The average volume assured pressure support (AVAPS) offers us this option. There are few publications on the use of this ventilatory modality when there is acute hypercapnic respiratory failure. We present the case of a male patient with exacerbated COPD with hypercapnic encephalopathy who was successfully treated with this ventilatory mode

Topiramato en monoterapia o en combinación como causa de acidosis metabólica en adultos con epilepsia / Topiramate in monotherapy or in combination as a cause of metabolic acidosis in adults with epilepsy

Objetivo. Determinar la frecuencia de acidosis metabólica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y métodos. Análisis transversal de la gasometría arterial de pacientes epilépticos que recibieron topiramato durante 2010 en la clínica de epilepsia del Centro Médico Nacional 20 de Noviembre en México. Se registraron datos clínicos concernientes a la epilepsia y su tratamiento, así como de los síntomas comunes de acidosis metabólica. Resultados. Se estudiaron 32 adultos con epilepsia, quienes recibieron topiramato en monoterapia o en combinación por lo menos durante un mes. Se encontró acidosis metabólica en todos los pacientes (HCO3 < 22 Eq/L); nueve tomaron sólo topiramato y 23 tomaron por lo menos dos fármacos antiepilépticos (FAE). Todos los pacientes fueron asintomáticos. No se encontró correlación entre los niveles de bicarbonato y la dosis del medicamento o la duración del tratamiento. La dosis fue significativamente mayor en el grupo de monoterapia y el nivel de bicarbonato fue más bajo en los pacientes que tomaban más de un FAE. Conclusiones. El uso concomitante de FAE incrementa los efectos conocidos del topiramato sobre los niveles séricos de bicarbonato y la presencia de acidosis metabólica; estos efectos parecen ser independientes del número de FAE utilizados (AU)

Aim. To determine the frequency of metabolic acidosis and its related factors in outpatients taking topiramate in monotherapy or as an adjuvant for the treatment of epilepsy. Patients and methods. Cross-sectional analysis of arterial blood gas test of epileptic patients who received topiramate during 2010 in the Epilepsy Clinic at the National Medical Center ‘20 de Noviembre’ in Mexico. Clinical data regarding epilepsy history and management and the common symptoms of metabolic acidosis were recorded. Results. We studied 32 adults with epilepsy at an outpatient epilepsy clinic who were treated with topiramate in monotherapy or in combination for at least one month. Metabolic acidosis was found in all patients (HCO3 < 22 Eq/L); nine were taking topiramate in monotherapy, and 23 were taking at least two antiepileptic drugs (AEDs). All of the patients were asymptomatic. We found no correlation between bicarbonate levels and the dose of the drug or the duration of treatment. The dose was significantly higher in the monotherapy group, and the bicarbonate level was lower in the patients taking more than one AEDs. Conclusions. The use of concomitant AEDs increases the known effects of topiramate on serum bicarbonate levels and the presence of metabolic acidosis, and these effects appear to be independent of the number of AEDs used (AU)

Reducing pain associated with arterial punctures for blood gas analysis.

Arterial punctures for arterial blood gases (ABGs) analysis are described as the most painful laboratory procedure and are performed without the benefit of pain management. This study originated from one nurse's concern about the level of pain her hospitalized patients endured when she drew their ABGs. A review of the literature found that ABG pain relief has not been studied in hospitalized patients. Therefore, this study explored the question "Can the pain of arterial blood gas draws be reduced through the use of infiltration with a local anesthetic agent?" This study compared the pain scores of 40 hospitalized patients who received either no intervention or one of three analgesic interventions (infiltration of 0.7 ml 1% lidocaine, 0.7 ml buffered 1% lidocaine, or 0.7 ml of bacteriostatic saline at the arterial puncture site). Results showed that, although lidocaine and buffered lidocaine are effective in reducing the pain associated with the arterial puncture, plain lidocaine was the only intervention in which the pain rating score for the overall experience was significantly diminished. This study is limited by partial randomization, small sample size, and patient duress; however, it provides a foundation for further nursing research that explores methods to reduce the pain associated with this very painful procedure. Future studies should be directed at larger, diverse populations, multiple operators, and comparison of interventions to topical analgesics and nonpharmacological measures.

Demonstrating the effectiveness of an online, computer-based learning module for arterial blood gas analysis.

PURPOSE/OBJECTIVES: To determine the effectiveness of a computer-based learning module specific to arterial blood gas (ABG) interpretation. DESIGN: A pretest and posttest design was used to assess staff nurses' ability to interpret ABGs before and after engaging in a computer-based module. SETTING: Two community hospitals in northern Illinois. SAMPLE: Fifty-eight staff nurses completed the online learning module and the pretest and posttest measures. METHODS: Subjects consented to participate and completed a pretest measure of their knowledge of ABG interpretation. Subjects participated in a computer-based learning module on ABG interpretation and then completed a posttest. FINDINGS: Staff nurses' knowledge increased significantly after viewing the computer-based learning module (t = 6.3; P < .001). This improvement was irrespective of experience or department. CONCLUSIONS AND IMPLICATIONS: Computer-based, online learning has emerged as a means of providing continuing education to nurses. Such a teaching strategy helps to overcome barriers pertinent to traditional classroom settings.

Coarctation of the aorta: a case presentation.

Coarctation is a constriction or narrowing of the aorta and presents most commonly within the first two weeks of life. This article reviews a case study of an infant diagnosed with coarctation of the aorta on day 8 of life. It includes an overview of the etiology, clinical presentation, and management plus an account of the infant's transport to a regional pediatric intensive care unit (PICU).

Anestesia local en la punción arterial: actitudes y conocimientos de enfermería / Local anesthesia in arterial puncture: nurses' knowledge and attitudes

OBJETIVO: Aunque se recomienda el uso de anestesia local para la realización de la punción arterial, su empleo es muy escaso. El propósito del estudio ha sido conocer la actitud y los prejuicios sobre el empleo de la anestesia local para la realización de la punción arterial entre los profesionales de enfermería y alumnos de tercer curso de la diplomatura de enfermería en prácticas hospitalarias en nuestro hospital, así como el grado de conocimiento de la técnica. MATERIAL Y MÉTODOS: Se pasó a enfermeros y estudiantes de enfermería un cuestionario que constaba de 15 preguntas, divididas en 2 partes: una hacía referencia al uso de la anestesia local en la extracción de una gasometría arterial, y en la segunda se preguntaba por conocimientos técnicos de la prueba. Se compararon los resultados de los enfermeros de la Unidad de Neumología con el resto de profesionales del hospital, así como de los profesionales y estudiantes de enfermería. RESULTADOS: Contestaron el cuestionario los 131 enfermeros encuestados. De los 19 alumnos de tercer curso de enfermería, fueron válidas 17 encuestas. Del total de profesionales se separó a los enfermeros/as de la Unidad de Neumología (n = 11). Utilizaban habitualmente anestesia local 7 profesionales (5%), de los que 3 (27%) pertenecían a la Unidad de Neumología, mientras que ningún alumno de enfermería la usaba. Entre los profesionales, los principales motivos para no utilizar la anestesia fueron: desconocimiento (54%), necesidad de realizar 2 punciones si se usa anestesia (11%), por considerar que produce el mismo dolor con anestesia (8%) y por acertar en la primera punción (7%). En cuanto a los motivos de los alumnos de enfermería, el principal fue, al igual que entre los profesionales, el desconocimiento (53%), seguido de la falta de uso por éstos (24%). La mayoría de los encuestados (63%) querría que a ellos sí se les aplicase anestesia en la punción arterial. CONCLUSIONES: El uso de la anestesia local es muy escaso. Los conocimientos sobre la realización de la gasometría arterial no son óptimos y deben mejorar tanto entre los profesionales como entre los estudiantes de enfermería. Sin embargo, es de destacar que la mayoría de los entrevistados prefería que a ellos se les realizara la punción arterial con anestesia local. Estos datos deben tenerse en cuenta en el proceso formativo de los profesionales de enfermería sobre la punción arterial

OBJECTIVE: Local anesthesia is rarely used in arterial puncture, even though it is recommended. The aim of this study was to examine attitudes and beliefs among nurses and third-year undergraduate nursing students in hospital training regarding the use of local anesthesia when performing arterial puncture and to assess their knowledge of the technique. MATERIAL AND METHODS: Nurses and nursing students were issued a 15-item questionnaire consisting of 2 parts. The first part contained questions on the nurse's use of local anesthesia when extracting arterial blood for analysis and the second part involved questions regarding technical knowledge of this test. The results of nurses from the respiratory medicine department, nurses from the rest of the hospital, and nursing students were compared. RESULTS: The questionnaire was answered by the 131 the nurses surveyed. Valid questionnaires were returned by 17 of the 19 nursing students surveyed. Questionnaires returned by nurses from the respiratory medicine department (n=11) were separated from those returned by the rest of nurses. Local anesthesia was used routinely by 7 nurses (5%), of whom 3 (27%) belonged to the respiratory medicine department; local anesthesia was not used by any of the nursing students. The main reasons given by nurses for not using local anesthesia were lack of knowledge (54%), need to perform 2 punctures when anesthesia is used (11%), belief that the same amount of pain is caused with anesthesia (8%), and success on the first attempt at arterial puncture (7%). The main reason given by student nurses for not using local anesthesia was also lack of knowledge (53%), followed by the fact that it was not used by the nurses (24%). Most of those surveyed (63%) indicated a desire to receive anesthesia should they undergo arterial puncture. CONCLUSIONS: Local anesthesia is used very little in arterial puncture. Knowledge about how to perform arterial blood extraction for blood gas analysis is insufficient and needs to be improved among both nurses and nursing students. Nonetheless it is noteworthy that most of those surveyed indicated a preference for receiving local anesthesia if they were to undergo the procedure. These data should be taken into consideration when training nurses to perform arterial puncture

Arterial blood gas analysis. 2: compensatory mechanisms.

This is the second of a two-part unit discussing arterial blood gas (ABG) analysis. Part 1 outlined background information on ABG reports and focused on a systematic approach to ABG analysis. This part examines the physiology of the various lines of defence in the body and explores the concept of compensation. A step-by-step guide to interpretation and examples of uncomplicated ABGs are available in the Portfolio Pages for this unit at nursingtimes.net, as well as further practice examples relevant to this part of the unit.