Técnica de inyección intravenosa push-aspire-push para la administración no dolorosa de medicación. Estudio piloto sobre su efectividad / Push-aspire-push intravenous injection technique for non-paining medication administration. Pilot study on its effectiveness

Una de las funciones de quienes nos dedicamos a la anestesia es tratar el dolor en los pacientes. En consecuencia, hay que evitar que la administración de medicación en la inducción anestésica lo provoque. De los distintos modos de administrar medicación intravenosa, en este estudio sólo haremos referencia a la administración mediante jeringa. A partir de la técnica Push-Stop-Push y con una determinada velocidad de administración, se ha diseñado una nueva técnica de administración intravenosa a la que se ha llamado «Push-Aspire-Push». Esta técnica consiste en inyectar un cierto volumen de medicamento, aspirar y volver a inyectar otro volumen; todo ello en un tiempo determinado. Al administrar la medicación de esta manera, se consigue que esté más tiempo en contacto con la pared vascular de la zona de punción, en la medida en que se crean turbulencias en el lecho. De este modo, la medicación analgésica y/o anestésica local podrá hacer más efecto en la zona de inserción del catéter. Se ha podido verificar que con la técnica Push-Aspire-Push ha desaparecido, independientemente del calibre de catéter o zona de punción, el dolor en los pacientes estudiados, sin que haya aumentado el tiempo de inducción anestésica ni se hayan utilizado técnicas molestas

One of the functions of those who dedicate ourselves to anesthesia is to treat pain in patients. Therefore, it is necessary to avoid that the administration of medication in anesthetic induction causes it. Of the different ways of administering an intravenous medication, we are only going to refer to administration by syringe. Based on the Push-Stop-Push technique and with a certain administration speed, a new intravenous administration technique has been designed which has been called «Push-Aspire-Push». This technique consists of injecting a certain volume of medication, aspirating and re-injecting another volume; all this in a certain time. By administering the medication in this way, we achieve that it is in longer contact with the vascular wall of the puncture area, as certain turbulences are created in the bed. In this way, the analgesic and / or local anesthetic medication may have more effect in the catheter insertion area. It has been verified that, with the Push-Aspire-Push technique, pain has disappeared, regardless of the catheter size or puncture site, in the patients studied, without increasing the anesthetic induction time or using annoying techniques

Dilution is no solution.

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.

Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial.

AIM AND OBJECTIVES: To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. BACKGROUND: An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. DESIGN: A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. METHODS: One hundred and thirty-six children aged 7-12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). RESULTS: Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. CONCLUSION: Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. RELEVANCE TO CLINICAL PRACTICE: The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.

Práticas de medicações injetáveis: conduta referida de profissionais de enfermagem / Prácticas de medicaciones inyectables: conducta referida de los profesionales de enfermería / Injectable medications: self-reported practices of nursing professionals

RESUMO Objetivo: Identificar a conduta referida de profissionais da enfermagem, do estado de São Paulo, sobre Práticas de Medicações Injetáveis. Método: Estudo tipo survey que identificou a frequência referida sobre Práticas de Medicações Injetáveis mediante resposta de questionário eletrônico, validado, entre setembro e dezembro de 2017. Resultados: Considerando as 1.295 respostas computadas, foram identificadas inconformidades como compartilhamento de frascos multidoses para dois ou mais pacientes (10,8%), reutilização de insumos de uso único, como seringas para salinização de pacientes diferentes (1,2%) e reencape de agulhas após uso (4,9%). Foram referidas maior adesão ao uso de luvas para administração de injeções endovenosas (80,5%) e falta de treinamento para manipulação de dispositivos de segurança (13%). Dados correlacionais apontaram que, quanto maior a idade, melhor era a conduta referida na prática de injetáveis. Conclusão: Embora a maioria das condutas configure-se dentro das Boas Práticas de Medicações Injetáveis, há relatos de práticas de risco, como compartilhamento de insumos de uso único. O treinamento para uso de dispositivos de segurança ainda não é uma realidade para todos os profissionais, visto que muitos o referiram como raro.

RESUMEN Objetivo: Identificar la conducta de profesionales de enfermería del estado de São Paulo sobre Prácticas de Medicaciones Inyectables. Método: Se trata de un estudio tipo survey, el cual identificó la frecuencia de Prácticas de Medicaciones Inyectables mediante respuesta de un cuestionario electrónico, validado entre septiembre y diciembre de 2017. Resultados: Teniendo en cuenta las 1.295 respuestas computadas, se identificaron inconformidades como el uso de frascos de dosis múltiples para dos o más pacientes (10,8%), la reutilización de insumos de un solo uso, como jeringas para la salinización de diferentes pacientes (1,2%) y el reencapuchado de agujas después de su uso (4,9%). Sobresalió la adhesión al uso de guantes para las inyecciones intravenosas (80,5%) y la falta de capacitación sobre la manipulación de dispositivos de seguridad (13%). Los datos correlativos señalaron que, a mayor edad, mejor la conducta referida en la práctica de los inyectables. Conclusión: Aunque la mayoría de las conductas se configuran dentro de las Buenas Prácticas de Medicaciones Inyectables, se informa sobre la existencia de prácticas de riesgo, como el compartir insumos de un solo uso. La capacitación en el uso de dispositivos de seguridad aún no es una realidad para todos los profesionales y muchos han declarado que raramente se los entrena en esa área.

ABSTRACT Objective: To identify the self-reported injectable medications of nursing professionals in the state of São Paulo. Method: Survey study that assessed the self-reported frequency of injection medications through a validated electronic questionnaire, applied from September to December 2017. Results: The 1,295 computed responses showed non-compliances such as sharing multidose vials for two or more patients (10.8%), reusing single-use supplies, such as use of saline flush syringes for different patients (1.2%) and needle recapping after use (4.9%). Greater adherence to glove use for administration of intravenous injections (80.5%) and lack of training for handling safety devices (13%) were reported. Correlational data showed that, the older the age, the better the self-reported injecting practices. Conclusion: Although most practices are within Safe Injecting practices, there are reports of risky practices, such as sharing single-use supplies. Training for the use of safety devices is not yet a reality for all professionals, since many reported it as rare.

Guía de práctica clínica enfermera sobre hemocultivos / Nurse's clinical practice guide on blood cultures

El hemocultivo es un método diagnóstico para la detección de bacterias y otros microorganismos en sangre. Es una de las pruebas más eficientes para el diagnóstico de las bacteriemias. La extracción de hemocultivos está recomendada cuando existe infección o sospecha de infección en pacientes de todas las edades (neonatos, adultos y ancianos). Un cultivo positivo ofrece información fundamental para el diagnóstico y tratamiento de una infección: por un lado, supone un diagnóstico definitivo de una infección y, por otro, permite establecer un tratamiento antimicrobiano específico para el microorganismo detectado. A pesar de que esta prueba diagnóstica es sencilla, existe el riesgo de contaminación (es decir, hemocultivos falsos positivos) por un inadecuado procedimiento de extracción y/o procesamiento de la muestra. Por lo tanto, la recogida de un hemocultivo requiere de una técnica de preparación y ejecución minuciosas para evitar la contaminación por microorganismos, así como posibles consecuencias, tanto para el paciente como para el servicio sanitario. Las enfermeras juegan un papel fundamental en la prevención, cuidado y seguimiento del paciente con infección, ya que son los profesionales sanitarios que realizan la recogida de muestras sanguíneas para hemocultivos, y en caso de diagnóstico de infección, administran el tratamiento. En este sentido, se precisa de normas o guías que puedan unificar y estandarizar los aspectos que ayuden a definir el papel de las enfermeras en el cuidado del paciente con infección o sospecha de infección, como medio para garantizar la seguridad de los pacientes. Por ello se trata de la primera guía de práctica clínica realizada por enfermeras para dar respuesta a las preguntas más habituales.

Factors related to medication errors in the preparation and administration of intravenous medication in the hospital environment.

BACKGROUND: Medication errors have long been associated with low-quality medical care services and significant additional medical costs. OBJECTIVE: The aim of this study was to culturally adapt and validate the questionnaire on knowledge, attitudes and behaviors in the administration of intravenous medication, as well as to explore these factors in a hospital setting. METHODS: The study was divided into two phases: 1) validation and cross-cultural adaptation, and 2) cross-sectional study. A total of 276 hospital-based nursing professionals participated in the study. RESULTS: A Cronbach's alpha value of 0.849 was found, indicating good internal consistency. In the multivariate analysis, statistically significant differences were found between knowledge and attitudes, demonstrating that having greater suitable knowledge correlates with having a more positive attitude. It was also discovered that having a positive attitude as well as the necessary knowledge increases the possibility of engaging in adequate behaviors. CONCLUSIONS: The knowledge, attitudes and behavior questionnaire has a satisfactory internal consistency in order to be applied to the Spanish context. Implications for nursing management: Knowledge acquisition and positive attitude are both factors which promote adequate behavior, which in turn seems to have an impact on medication errors prevention. Health institutions must encourage continuous education for their employees.

Medication Errors Involving the Intravenous Administration Route: Characteristics of Voluntarily Reported Medication Errors.

Characteristics of medication errors involving the intravenous (IV) route of administration were analyzed in reports from 1995 to 2013. This was accomplished through a voluntary medication error reporting program. A retrospective case study design analyzed reports by practitioners or consumers on IV-associated medication errors (N = 975) affecting patients. Patterns in error accounts reflected cultural changes in health care organizations. Equipment, labeling, incorrect route of administration, types of errors, patient outcomes, and causal agents represented major codes. Results point to health care provider and consumer knowledge, the need for ongoing education of nursing staff, and interdisciplinary strategies for preventing IV-associated medication errors.

Quantifying Eye Tracking Between Skilled Nurses and Nursing Students in Intravenous Injection.

In nursing education, it is important that nursing students acquire the appropriate nursing knowledge and skills which include the empirical tacit knowledge of the skilled nurses. Verbalizing them is difficult. We paid attention to the eye tracking at the time of the skill enforcement of expert nurses and the nursing students. It is said that the sight accounts for 70% higher than of all sense information. For the purpose of the learning support of the tacit nursing skill, we analyzed the difference of both including the gaze from an actual measured value with the eye mark recorder. In the results the nurses particularly address the part related to inserting a needle among the other actions, they should move their eyes safely, surely, and economically along with the purposes of their tasks.

Intravenous administration: frequent errors.

A prospective study conducted in Australia examined the errors made by 107 nurses during 568 intravenous drug administrations in hospitals. About 100 administrations had at least one serious error; most were administration rate errors.

[Preparation and administration of injectable antibiotics: a tool for nurses]. / Préparation et administration des antibiotiques injectables, un outil au service des infirmiers.

Nurses, the main caregivers to administer medications, often find themselves lacking the information which is nevertheless essential for the preparation of injectable antibiotics. This problem, frequent in hospitals, impacts on patient safety. On the initiative of the pharmacy and nursing staff, a tool has been created in the Percy Army Teaching Hospital in Clamart.

Nivel de conocimientos y práctica adquiridos durante un curso-taller de terapia intravenosa / Level of knowledge and practice acquired during a workshop on intravenous therapy

Objetivo: Analizar el nivel de conocimientos adquiridos durante el desarrollo de un curso-taller de terapia intravenosa y su relación con la aplicación práctica del procedimiento. Material y métodos: Estudio cuasiexperimental, descriptivo y de corte transversal. Muestra total de 30 enfermeras operativas de los servicios donde se realiza esta técnica. Se utilizó como instrumentó de evaluación un cuestionario y una guía de observación estructurada que se aplicó en 3 ocasiones. El procesamiento estadístico se realizo a través del programa Excel y SPSS, utilizándose un análisis descriptivo. Resultados: el 63.3% del profesional de enfermería obtuvo un nivel medio de conocimiento, en lo que respecta al mantenimiento y prevención de complicaciones predominó el nivel alto con un 83.8%. Conclusión: El presente estudio permite identificar que la preparación constante del personal de enfermería mediante la aplicación de cursos-talleres incrementa de manera positiva el manejo de conocimiento y la práctica pero sobre todo garantiza al usuario una atención con el menor riesgo y una mayor calidad (AU)

Aim: To analyse the level of knowledge acquired during the development of a workshop on intravenous therapy and its relation to the practical application of the procedure. Material and methods: quasi-experimental, descriptive, transversal study applied to 30 operational nurses who worked in the services where this technique is carried ou. For evaluation a questionnaire and a structured guide of observation was used, which was applied on 3 occasions. The statistical analysis was performed in Excel and SPSS, using descriptive analysis. Results: 63.3% of nursing professional obtained a mean level of knowledge, with regard to maintenance and prevention of complications, thee was a high level, 83.8%. Conclusion: This study identifies that the constant preparation of nurses through the implementation of workshops increases positively management knowledge and practice but especially guarantees the user a lower risk and higher quality attentio (AU)

Evaluation of practical exercises using an intravenous simulator incorporating virtual reality and haptics device technologies.

This study confirmed the educational effectiveness of practical exercises (PE) using intravenous (IV) simulators incorporating virtual reality (VR)/haptics (based on the sense of touch) device technologies. First-year nursing students (n=114) were randomly divided into three PE groups: Group A, utilizing a conventional arm model (IV arm); Group B, utilizing a VR/Haptics IV Simulator (IV sim); and Group C, utilizing both the IV arm and IV sim. Group C scored highest on procedures for conducting venipuncture. Group B was more successful in performing injections than Groups A and C. Group C required significantly less time than Group B to complete a venipuncture injection and was faster than Group A, although this difference was not significant. In conclusion, a new paradigm of PE is suggested using both IV sim and IV arm.

Nurse-administered ketamine sedation in an emergency department in rural Uganda.

STUDY OBJECTIVE: We determine whether, after a brief training program in procedural sedation, nurses can safely independently administer ketamine sedation in a resource-limited environment. METHODS: This is an observational case series of consecutive sedations performed in an emergency department in rural Uganda at approximately 5,000 feet above sea level. The data were collected prospectively in a quality assurance database. As part of a larger training program in emergency care at Karoli Lwanga Hospital in rural Uganda, nurses with no sedation experience were trained in procedural sedation with ketamine. All sedations were monitored by a nonphysician research assistant, who recorded ketamine dosing, duration of each procedure, adverse events, and nurse interventions for each adverse event. In accordance with standard definitions in the emergency medicine sedation literature, adverse events were defined a priori and classified as major (death, need for bag-valve-mask ventilation, or unanticipated admission to the hospital) or minor (hypoxia, vomiting, emergence reactions, hypersalivation). The primary statistical analysis was descriptive, with reporting of adverse event rates with 95% confidence intervals (CIs), using the nurse as the unit of analysis. RESULTS: There were a total of 191 administrations by 6 nurses during the study period (December 2009 through March 2010). Overall, there was an 18% adverse event rate (95% CI 7% to 30%), which is similar to the rate reported in resource-rich countries. These events included hypoxia (22 cases; 12%), vomiting (9 cases; 5%), and emergence reaction (7 cases; 4%). All adverse events met our a priori defined criteria for minor events, with a 0% incidence of major events (1-sided 97.5% CI with the nurse as unit of analysis 0% to 46%). The procedural success rate was 99%. Sedation was practitioner rated as "excellent" in 91% of cases (95% CI 86% to 94%) and "good" in 9% (95% CI 6% to 14%). Patients reported they would want ketamine for a future procedure in 98% of cases (95% CI 95% to 100%). CONCLUSION: In resource-limited settings, nurse-administered ketamine sedation appears to be safe and effective. A brief procedural sedation training program, coupled with a comprehensive training program in emergency care, can increase access to appropriate and safe sedation for patients in resource-limited settings.

Anthracycline extravasations: prevention and management.

This article highlights the importance of being knowledgeable about anthracycline extravasations, including their prevention, early detection, and prompt and effective management. It also emphasizes the need for chemotherapy nurses to document and report all extravasations when they occur, summarizes the current management options, and offers recommendations for clinical practice. Extravasation refers to the unintentional administration of an agent into the surrounding tissue instead of the venous system; in this case, vesicant chemotherapy. Anthracycline extravasations can lead to significant and lasting tissue damage, infection, pain, and functional impairment; they remain a feared consequence for both the patient receiving the chemotherapy and the nurse administering it. The management of anthracycline extravasations remains a constant challenge to the professionals caring for the patient. One of these challenges is the lack of evidence for many of the treatment options available. The systemic antidote Savene® is the only approved treatment for anthracycline extravasations. It has proved highly efficacious and well-tolerated in prospective clinical studies and in routine clinical practice. Despite national and international professional organizations recommending Savene in their extravasation guidelines, many cancer networks in England still exclude it from their local protocol. Funding decisions regarding the use of supportive treatments are often made on the basis of clinical need; it is, therefore, imperative that nurses promptly report all extravasations or they will remain unknown and management of extravasations will not improve.