[Nursing approaches to improve extracorporeal membrane oxygenation (ECMO) care in a pediatric intensive care unit].

BACKGROUND: Medical technology advances have led to the increasingly frequent use of extracorporeal membrane oxygenation (ECMO) in intensive care unit applications. Four of the 26 patients treated using ECMO in 2009 at our hospital were under 18 years of age. Limited nurse experience with ECMO and resultant nursing staff nervousness / pressure when using this technique encouraged us to establish an ad hoc group to explore ECMO care and related issues. PURPOSE: Improvement measures were implemented to (1) raise the pre- ECMO placement integrity of order sheets to 98%; (2) reduce materials preparation time to below 60 minutes; and (3) enhance nursing care ECMO cognitive accuracy to 99%. RESOLUTION: We implemented the following intervention measures: (1) A dedicated ECMO vehicle was deployed to enhance clinical work convenience and safety; (2) a ECMO technique preparation checklist was developed to improve tubing placement and reduce preparation time; (3) an ECMO care in-service education program was developed to enhance nurses' ECMO care awareness and skills; (4) an ECMO trainee system was established to increase nurses ECMO care experience and reduce negligence-related errors. RESULTS: Project results included: material preparation order sheet accuracy rose from 25% to 100%; average materials preparation time fell from 90 to 40 minutes, and nursing staff ECMO cognitive accuracy increased from 51.2% to 99.2%. The program achieved all stated objectives. CONCLUSIONS: This program enhanced the quality of ECMO care for pediatric patients, reduced materials preparation times, and improved the nursing approach to ECMO care.

Near-infrared light device can improve intravenous cannulation in critically ill children.

BACKGROUND: Vascular access in critically ill children can be a real challenge for medical staff. METHODS: To evaluate the effectiveness of a near-infrared light vein-viewing device for critically ill children, 60 pediatric inpatients were enrolled in a randomized prospective observation trial for intravenous cannulation. The patients' demographic data, mean time required to find the first available vessel, first-attempt success rate, mean number of attempts per patient, and the total time taken on the attempts per patient were compared. RESULTS: Less time was required to find the first available vessel in the near-infrared light device group compared with the control group (126.37 vs. 383.61 seconds; p = 0.027). In addition, the near-infrared light device group had a fewer number of attempts compared with the control group (median 1 vs. 2; p = 0.004), and also a shorter total time of attempts per patient compared with the control group (186.16 vs. 497.23 seconds; p = 0.014). CONCLUSION: The use of a near-infrared light vein-viewing device for vascular access in critically ill children can decrease the total medical time and cost.