Delivery room continuous positive airway pressure and early pneumothorax in term newborn infants.

OBJECTIVE: To assess the association between delivery room (DR) continuous positive airway pressure (CPAP) and pneumothorax (PT) in term newborns. METHODS: Two studies performed in community hospitals used data extracted from computerized records of term newborns. Infants receiving positive pressure ventilation in the DR were excluded. Tabulated data included receipt of DR CPAP, PT on the day of birth, and gestational age (GA). In a case-control study from 2001-2013, infants with PT were compared to controls without PT but with respiratory distress or hypoxia persisting from birth for receipt of DR CPAP. In a cohort study from 2014-2016, infants receiving and not receiving DR CPAP were compared for the incidence of PT. RESULTS: In the case-control study, data were obtained for 169 cases and 850 controls. Compared to controls, PT infants were more likely to have received DR CPAP (16.8% vs. 40.2%, respectively, P < 0.001). Logistic regression revealed DR CPAP (Adjusted Odds Ratio [AOR] = 3.30, 95% confidence interval [CI] = 2.31, 4.72, P < 0.001) and GA (AOR = 1.21, 95% CI = 1.05, 1.39, P = 0.009) to be independent predictors of early PT.In the cohort study, PT was observed in 0.1% of 9255 control infants not receiving DR CPAP and 4.8% of 228 infants receiving DR CPAP (P < 0.001). In logistic regression analyses, DR CPAP significantly predicted PT (OR = 59.59, 95% CI = 23.34, 147.12, P < 0.001) and remained a significant predictor of PT after controlling for gestational age. CONCLUSION: Respiratory conditions treated with CPAP in delivery rooms are associated with increased risk of PT. A cause-and-effect relationship between CPAP and PT cannot be claimed in this study. Further research is needed to better understand this relationship.

Tension pneumothorax recurrence in COPD: a care study.

This care study concerns a patient with chronic obstructive pulmonary disease, who endures the recurrence of a tension pneumothorax. A holistic and evidence-based approach is employed to critically discuss his assessment, pathophysiology, and nursing care. These discussions facilitate extrapolation of implications pertinent to nursing practice.

Cuidados enfermeros al paciente portador de drenaje torácico / Nursing care for patient with thoracic drainage

El drenaje torácico consiste en la colocación de una sonda en el espacio pleural para evacuar la presencia de aire, líquido o sangre, lo cual produce un colapso pulmonar de grado variable con repercusión clínica en función de la reserva ventilatoria previa del paciente y el grado de colapso. Existen varios modelos de tubos torácicos, así como de sistemas de drenaje pleural. Los sistemas cerrados de drenaje torácico actuales son desechables y garantizan un manejo óptimo y seguro para el paciente. Los cuidados de Enfermería son fundamentales durante todo el proceso de instauración de dichos drenajes, tanto en la preparación del paciente, inserción y mantenimiento adecuado para el éxito del tratamiento, como durante la extracción y posterior atención, por lo que conocerlos principios técnicos básicos para una correcta utilización permitirá un mantenimiento eficaz y eficiente del sistema de drenaje y el control, el seguimiento y la evaluación del paciente

Thoracic drainage consists of placing a tube in the pleural cavity to evacuate air, fluid or blood, which leads to pulmonary collapse of a variable degree with a clinical repercussion depending on the patient’s previous ventilation reserve and the extent of collapse. There are several models of thoracic tubes, as well as pleural drainage systems. Current thoracic closed drainage systems are disposable and guarantee optimal and safe patient management. Nursing care is fundamental throughout the process of placement of drainage systems, both in terms of preparation of the patient, insertion and proper maintenance for the success of the treatment, as well as the removal and after-care; therefore, knowledge of the basic technical principles for correct use thereof will enable effective and efficient maintenance of the drainage system and the control, follow-up and evaluation of the patient

Blunt chest trauma.

Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

Managing common neonatal respiratory conditions during transport.

As neonatal care in the tertiary setting advances, neonatal transport teams are challenged with incorporating these innovations into their work environment. One of the largest areas of advancement over the last decade involves respiratory support and management. Many major respiratory treatments and the equipment required have been adapted for transport, whereas others are not yet feasible. This article reviews the history of respiratory management during neonatal transport and discusses current methodologies and innovations in transport respiratory management.

Initiation of a neonatal nurse practitioner competency activity in needle thoracostomy.

Pneumothorax is a potentially life-threatening condition in a neonate, requiring emergency intervention. The neonatal nurse practitioner (NNP) must be able to respond quickly and competently to prevent significant potential complications or death. The purpose of this practice improvement project was to implement procedure review for NNP competency maintenance in needle thoracostomy for a tension pneumothorax and to evaluate the effectiveness of procedure review on competency through simulation performance. Eighteen NNPs participated (procedure review = 10, no review = 8). Results showed that procedure review had a small impact on total performance score. The simulation performance increased self-efficacy for all participants, and participants supported simulation-based procedural competency maintenance activities.

Radiographic confirmation of feeding tube placement: a diagnostic tool identifying gastrointestinal anomalies.

Feeding tubes are commonly used in neonatal intensive care units, and their abnormal position seen on radiographs may indicate underlying serious problems. We recently cared for two infants who presented with clinical deterioration. An abnormally placed feeding tube seen on the chest radiograph revealed underlying serious conditions. The first case was an infant 29 weeks of age who presented with right-sided pneumothorax after birth. By history and a right-side-displaced orogastric (OG) tube, iatrogenic esophageal perforation was diagnosed. The second case was a 16-day-old infant who presented with recurrent vomiting. An OG tube extending into a cystic mass at the right cardiophrenic angle resulted in diagnosis of a herniated stomach with organoaxial-type volvulus, which required surgical repair. Both cases recovered uneventfully. As illustrated in these two rare cases, feeding tube position is not only important for feeding practice, but it also has diagnostic implications in newborn infants.

Drenaje pleural / Pleural drainage nursing care

Los indicadores mas habituales para la colocación de un drenaje toracico son neumotorax espontaneo o a tension, neumotorax, derrame pleural en post operado de cirugia cardiaca, con el objetivo de drenar y liberar la cavidad pleural o mediastino de la presencia anomala de aire, sangre o liquido excesivo. En la actualidad se dispone de avanzados y diversos sistemas cerrados de drenaje toracicos desechables, que garantizan un manejo optimo y seguro para el paciente. Conocer los principios tecnicos basicos pra su correcta utilizacion y los cuidados de enfermeria, nos permitira una actuacion eficiente en la valoracion, control y seguimiento y evolucion del paciente con este dispositivo y preservarlo de las posibles complicaciones.(AU)

Drenaje pleural / Pleural drainage nursing care

Los indicadores mas habituales para la colocación de un drenaje toracico son neumotorax espontaneo o a tension, neumotorax, derrame pleural en post operado de cirugia cardiaca, con el objetivo de drenar y liberar la cavidad pleural o mediastino de la presencia anomala de aire, sangre o liquido excesivo. En la actualidad se dispone de avanzados y diversos sistemas cerrados de drenaje toracicos desechables, que garantizan un manejo optimo y seguro para el paciente. Conocer los principios tecnicos basicos pra su correcta utilizacion y los cuidados de enfermeria, nos permitira una actuacion eficiente en la valoracion, control y seguimiento y evolucion del paciente con este dispositivo y preservarlo de las posibles complicaciones.

Drenaje pleural / Pleural drainage nursing care

Los indicadores mas habituales para la colocación de un drenaje toracico son neumotorax espontaneo o a tension, neumotorax, derrame pleural en post operado de cirugia cardiaca, con el objetivo de drenar y liberar la cavidad pleural o mediastino de la presencia anomala de aire, sangre o liquido excesivo. En la actualidad se dispone de avanzados y diversos sistemas cerrados de drenaje toracicos desechables, que garantizan un manejo optimo y seguro para el paciente. Conocer los principios tecnicos basicos pra su correcta utilizacion y los cuidados de enfermeria, nos permitira una actuacion eficiente en la valoracion, control y seguimiento y evolucion del paciente con este dispositivo y preservarlo de las posibles complicaciones.(AU)

Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

OBJECTIVES: Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. METHODS: We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. RESULTS: The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. CONCLUSIONS: Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

Implementation of a clinical pathway in primary spontaneous pneumothorax patients treated by wedge resection surgery.

PURPOSE: This study was conducted to develop a clinical pathway for primary spontaneous pneumothorax (PSP) patients treated by wedge resection surgery. The authors also aimed to evaluate the effects of the implementation of the PSP clinical pathway on (1) complication occurrence rates, (2) self-efficacy with respect to PSP recurrence prevention, (3) patient-perceived quality of life, and (4) patient treatment satisfaction. DESIGN: This study was conducted using a quasi-experimental, nonequivalent study design. SAMPLE: The study subjects were 60 PSP patients admitted to the thoracic surgery departments at 2 university hospitals located in Seoul, South Korea. METHODS: A retrospective medical record review was conducted to develop a PSP clinical pathway, and the developed clinical pathway was then applied to the treatment group (n = 30). Complication occurrence rates, self-efficacy with respect to PSP recurrence prevention, perceived quality of life, and patient treatment satisfaction were measured. FINDINGS: The developed PSP clinical pathway is comprehensive and includes self-care and recurrence prevention education in addition to common protocols, such as medication and diagnostic tests. The pathway significantly improved self-efficacy with respect to preventing PSP recurrence, health-related quality of life, and patient treatment satisfaction, but did not reduce complication rates. IMPLICATIONS: The present study offers a new comprehensive clinical pathway for PSP patients who have undergone wedge resection surgery. This study may be useful in the clinical nursing field by providing guiding standards for PSP-related education with respect to diet, exercise, self-supervision, complication, stress control, and recurrence prevention.

Nursing care and management of patients with intrapleural drains.

Most nurses working in an acute hospital setting will encounter patients with chest drains and underwater seal drainage at some point in their careers. This article is primarily written for the non-specialist nurse who requires a good working knowledge of chest drain insertion and underwater seal drainage. The article discusses the indications for chest drain insertion and the merits of different approaches, and provides a detailed analysis of the nursing care of a patient with a chest drain.