Nursing
Review: Prevention and Management of Device-Associated Complications in the Intensive Care Unit – The BMJ
17 Aug, 2024 | 20:04h | UTCIntroduction:
This review article, published by experts from the David Geffen School of Medicine at UCLA, focuses on the complications associated with invasive devices commonly used in the Intensive Care Unit (ICU). While these devices are essential for managing critically ill patients, they also pose significant risks, necessitating a thorough understanding of their potential complications and strategies for prevention and management.
Key Points:
1 – Central Venous Catheters (CVCs):
– CVCs are widely used in ICU patients but carry risks like vascular injury, pneumothorax, thrombosis, and infection.
– Use of real-time ultrasound guidance and careful operator technique are crucial for minimizing these risks.
– Prompt removal of unnecessary CVCs is essential to reduce the risk of complications.
2 – Arterial Catheters:
– Commonly used for hemodynamic monitoring, these catheters can lead to complications such as vascular occlusion, nerve injury, and infection.
– Ultrasound guidance is recommended to reduce the risk of complications, and catheters should be discontinued as soon as clinically feasible.
3 – Airway Devices (Endotracheal Tubes and Tracheostomies):
– Complications include laryngeal injury, tracheal stenosis, and tracheomalacia.
– Strategies to reduce these risks include minimizing intubation attempts, ensuring proper tube placement, and managing cuff pressures carefully.
4 – Extracorporeal Membrane Oxygenation (ECMO):
– ECMO is associated with significant complications, including bleeding, thromboembolic events, and neurologic injuries.
– Proper cannulation technique and vigilant monitoring are essential to mitigate these risks.
5 – Infection Control:
– Strict adherence to aseptic techniques and the use of chlorhexidine-impregnated dressings are recommended to prevent device-associated infections.
Conclusion:
This review underscores the importance of judicious use and timely removal of invasive devices in the ICU to minimize complications. Healthcare professionals must remain vigilant and employ best practices to prevent and manage these complications effectively.
News Release – FDA Approves First Nasal Spray for Anaphylaxis Treatment: Neffy (Epinephrine Nasal Spray) – U.S. Food and Drug Administration
17 Aug, 2024 | 15:43h | UTCThe U.S. Food and Drug Administration (FDA) has approved Neffy, the first epinephrine nasal spray for the emergency treatment of anaphylaxis and other severe allergic reactions (Type I) in both adults and pediatric patients weighing at least 30 kilograms (approximately 66 pounds). This approval introduces a non-injectable option for the rapid administration of epinephrine, which is critical in managing life-threatening allergic reactions.
Key Points for Healthcare Providers:
– Alternative to Injection: Neffy provides a new option for patients who may delay or avoid epinephrine injections due to needle phobia. This could be particularly beneficial for children and others reluctant to use injectable epinephrine.
– Efficacy and Safety: Neffy’s approval is supported by studies comparing its pharmacokinetics and pharmacodynamics to traditional epinephrine injections. These studies showed comparable blood epinephrine levels and similar physiological effects, such as increased blood pressure and heart rate.
– Administration: Neffy is a single-dose nasal spray, administered into one nostril. If symptoms do not improve or worsen, a second dose may be administered in the same nostril. Patients should still seek emergency medical care to monitor the anaphylactic reaction.
– Warnings: Certain nasal conditions, such as nasal polyps or a history of nasal surgery, may impair Neffy’s absorption. In these cases, injectable epinephrine might be a more reliable option. The product also carries typical warnings for epinephrine use, particularly in patients with coexisting conditions.
– Side Effects: Common side effects include throat irritation, nasal discomfort, headaches, and jitteriness. Healthcare professionals should discuss these with patients to ensure informed use.
Clinical Implications:
Neffy may reduce barriers to the timely treatment of anaphylaxis, potentially improving outcomes by increasing the likelihood of rapid epinephrine administration. Healthcare providers should consider Neffy as an alternative for patients who are needle-averse or have difficulty using injectable epinephrine, while also ensuring patients understand the importance of prompt medical attention following its use.
Approval Background:
Neffy was granted Fast Track designation by the FDA, emphasizing the need for an alternative to injectable epinephrine. The approval was awarded to ARS Pharmaceuticals.
Source: FDA News Release: FDA Approves First Nasal Spray for Treatment of Anaphylaxis
New AHA Guidelines for Managing Elevated Blood Pressure in Acute Care Settings – Hypertension
13 Aug, 2024 | 13:13h | UTCIntroduction:
The American Heart Association (AHA) has released a scientific statement focusing on the management of elevated blood pressure (BP) in acute care settings. This guideline addresses the significant variation in practice due to a lack of robust evidence for managing BP in such environments, particularly in emergencies or when elevated BP is asymptomatic.
Key Points:
1 – Classification of Elevated BP: Elevated BP in acute care settings is categorized into asymptomatic elevated BP and hypertensive emergency, the latter requiring immediate treatment due to acute target-organ damage.
2 – Hypertensive Emergency: Immediate treatment is necessary for patients with BP >180/110–120 mm Hg and evidence of new or worsening target-organ damage, typically using intravenous antihypertensive medications in a closely monitored environment.
3 – Asymptomatic Elevated BP: In cases where elevated BP is present without symptoms or target-organ damage, the use of antihypertensive medications should be approached cautiously. Recent studies suggest potential harm from aggressive treatment, highlighting the importance of verifying BP readings and identifying reversible causes before intervention.
4 – Proper BP Measurement: Accurate BP measurement is crucial. The guidelines stress using recently calibrated devices and following correct measurement techniques to avoid unnecessary treatment due to erroneous readings.
5 – PRN Orders: The use of “as needed” (PRN) antihypertensive medications for asymptomatic elevated BP is discouraged due to the risks of overtreatment and variability in BP control, which can lead to adverse outcomes.
6 – Treatment Thresholds: The guidelines recommend a high threshold for initiating or intensifying antihypertensive treatment in asymptomatic patients, emphasizing the need for repeated measurements and assessment of underlying causes.
7 – Post-Discharge Care: It is crucial to maintain prehospital antihypertensive regimens and avoid intensification at discharge unless clearly indicated. Effective care coordination and patient education are vital for successful transitions from hospital to home care.
Conclusion:
These guidelines represent a significant step toward standardizing BP management in acute care settings. By focusing on accurate measurement, cautious treatment of asymptomatic elevated BP, and proper follow-up, clinicians can reduce unnecessary interventions and improve patient outcomes.
Guideline Reference: Bress, A.P., et al. (2024). “The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement from the American Heart Association.” Hypertension, 81–e106.
Retrospective Analysis: 7% of outpatients in Massachusetts experience adverse events, predominantly drug-related – Ann Intern Med
25 May, 2024 | 19:37h | UTCThis retrospective study reviewed electronic health records from 11 outpatient sites in Massachusetts during 2018 to assess the incidence and nature of adverse events (AEs) in 3,103 patients. AEs were identified in 7.0% of the patients, translating to 8.6 events per 100 patients annually. Adverse drug events were the most frequent type of AE, constituting 63.8% of events, followed by healthcare-associated infections (14.8%) and surgical or procedural events (14.2%). The severity of these events was notable, with 17.4% being serious and 2.1% life-threatening, though none were fatal. Notably, 23.2% of these events were deemed preventable. The risk of experiencing at least one AE varied significantly by age and race, with higher rates observed among older adults and Black patients compared to other demographics. The study highlights the pressing need for targeted interventions to reduce AEs in outpatient settings.
Reference (link to abstract – $ for full-text):
Crossover RCT | Using one-size cuff results in major inaccuracy in BP readings across varying arm sizes
11 Aug, 2023 | 15:41h | UTCEffects of Cuff Size on the Accuracy of Blood Pressure Readings: The Cuff(SZ) Randomized Crossover Trial – JAMA Internal Medicine (free for a limited period)
Commentaries:
When it comes to blood pressure cuffs, size matters – MedicalResearch.com
One-size-fits-all blood pressure cuffs ‘strikingly inaccurate,’ study says – CNN
Related:
Commentary on Twitter
Using a regular blood pressure (BP) cuff regardless of individual’s arm size resulted in 3.6 mmHg lower systolic BP when a regular cuff was one size too-large, and 4.8 and 19.5 mmHg higher when a regular cuff was one and two sizes too small. https://t.co/ZKnGfWc9fy
— JAMA Internal Medicine (@JAMAInternalMed) August 7, 2023
M-A | Community-based interventions using holistic assessment and care planning improve independent living in older adults
9 Aug, 2023 | 15:13h | UTC
M-A | Approximately 25 min/day of walking can boost function and cut adverse events in acutely hospitalized elders
8 Aug, 2023 | 13:35h | UTC
M-A | Updated evidence supports incisional negative pressure wound therapy for surgical site infection prevention
1 Aug, 2023 | 14:15h | UTC
Systematic Review | Organizational changes likely decrease physical restraint usage in long-term care
31 Jul, 2023 | 13:53h | UTC
Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide
19 Jul, 2023 | 14:33h | UTC
Retrospective Analysis | Inconsistencies in pediatric drug dosing found in over half of prehospital emergency drug administrations
17 Jul, 2023 | 13:50h | UTCCommentaries:
Children and Drug Dosing Variations When in Transit to the Hospital – AAP Journals Blog
Variation Seen in Dosing of Meds at Prehospital Pediatric Encounters – HealthDay
Review | A health systems approach to critical care delivery in low-resource settings
17 Jul, 2023 | 13:29h | UTC
Commentary on Twitter (thread – click for more)
1/ @yourICM's highlights:
?OPEN ACCESS~ Health systems approach to #CriticalCare delivery in low-resource settings? https://t.co/W7d3q7UP1D
?OPEN ACCESS~ #ICU #Sepsis-associated #AKI? https://t.co/gLCXjcH2ah
?Myocarditis: a primer for intensivists? https://t.co/UUga5lYX0q pic.twitter.com/tB8am5zEny— ESICM (@ESICM) July 14, 2023
Consensus Paper | Implementing strategies to prevent infections in acute-care settings
14 Jul, 2023 | 13:03h | UTCNews Release: New guidance for infection prevention in acute care settings – Society for Healthcare Epidemiology of America
Related:
Practice Recommendation | Strategies to prevent MRSA transmission and infection in hospitals
Consensus Paper | Strategies to prevent surgical site infections in acute-care hospitals
Consensus Paper | Strategies to prevent Clostridioides difficile infections in acute-care hospitals
Consensus Statement | Aerosol therapy in adult critically ill patients
14 Jul, 2023 | 13:01h | UTC
RCT | Swallowing and oral-care program enhances oral-feeding resumption and reduces pneumonia post-extubation
14 Jul, 2023 | 12:44h | UTC
Practice Guidance | Six steps to better care for older people in acute hospitals
12 Jul, 2023 | 14:00h | UTCSix steps to better care for older people in acute hospitals – British Geriatrics Society
News Release: New guidance outlines ‘Six steps to better care for older people in hospital’ – British Geriatrics Society
Recommendations on the structure, personal, and organization of intensive care units
11 Jul, 2023 | 13:56h | UTC
Review | Human-centered visualization technologies for patient monitoring are the future
11 Jul, 2023 | 13:34h | UTC
Practice Recommendation | Strategies to prevent MRSA transmission and infection in hospitals
10 Jul, 2023 | 14:02h | UTCCommentary: New guidelines recommend antibiotic stewardship for preventing MRSA – CIDRAP
RCT | Personalized eHealth program hastens return to normal activity post major abdominal surgery
7 Jul, 2023 | 16:20h | UTCInvited Commentary: Individualising the recovery process through eHealth – The Lancet Digital Health
SR | Medical equipment that improve safety and outcomes of inter-facility transportation of critically ill patients
30 Jun, 2023 | 14:48h | UTC
M-A | Interventions using wearable activity trackers to improve patient physical activity in adults who are hospitalized
30 Jun, 2023 | 14:46h | UTCAuthor Interview: Wearable Activity Trackers to Improve Physical Activity and Outcomes – JAMA
News Release: Wearable activity trackers accelerate hospital patient recovery – University of South Australia
Qualitative Study | International perspectives on modifications to the surgical safety checklist
21 Jun, 2023 | 13:36h | UTCInternational Perspectives on Modifications to the Surgical Safety Checklist – JAMA Network Open
Invited Commentary: Modifications of the World Health Organization’s Surgical Safety Checklist—Ways Forward to Ensure Sustainable Implementation – JAMA Network Open
Commentary on Twitter
Qualitative study: >10 years after the surgical safety checklist was developed, systems should consider checklist modification to improve safety, teamwork & buy-in. https://t.co/5xisRqzWkf @N8turl3y @MaryEBrindle @ucalgarymed @ariadnelabs
— JAMA Network Open (@JAMANetworkOpen) June 7, 2023
An integrative review on the acceptance of artificial intelligence among healthcare professionals in hospitals
16 Jun, 2023 | 13:46h | UTC
Cluster RCT | Effects of implementation of a supervised walking program in veterans affairs hospitals
14 Jun, 2023 | 14:17h | UTCEffects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals: A Stepped-Wedge, Cluster Randomized Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary: Supervised Walking Program Benefits Veterans Admitted to Hospital – Physician’s Weekly
Commentary on Twitter
A supervised #WalkingProgram known as #STRIDE reduced skilled nursing facility admissions among older adults. https://t.co/nvkzcx5eVE pic.twitter.com/UJnJMtaxXG
— Annals of Int Med (@AnnalsofIM) June 8, 2023