Intravenous catheter blood cultures: utility and contamination.

OBJECTIVE: In pediatrics, blood cultures (BCs) are often drawn as intravenous (IV) catheters are placed. This routine minimizes the number of painful and often difficult punctures a child must undergo but results in the discarding of multiple BC bottles when these cultures are later determined to be unnecessary. If the contamination rate of BCs drawn through an indwelling IV did not exceed the contamination rate of BCs drawn at the time of IV placement, BCs could be drawn from the IV without subjecting the patient to another venipuncture. This study was done to compare the contamination rates of BCs drawn by these two methods. Additionally, we sought to determine if the collection of two BCs enhances pathogen recovery. METHODS: Prospective comparison of contamination and bacteremia rates of BCs drawn by two different methods: the first BC was drawn at the time of IV line placement and the second BC was drawn from the previously placed IV at a later time. Setting. Urban pediatric emergency department with an annual census of 40 000. PARTICIPANTS: One thousand five hundred sixty-four patients between the ages of 3 days and 22.1 years. The median age was 2.2 years. Sixty-four patients were excluded because we were unable to draw the second BC. Forty-six percent of eligible patients (n = 690) were girls. RESULTS: Fifty-seven (1.9%) of 3000 grew contaminants: 27 in the first and 30 in the second BC for contamination rates of 1.8% and 2.0%. Thirty-eight (1.3%) of 3000 BCs grew pathogens: 24 represent 12 patients with growth in two out of two cultures and 14 represent 14 patients with growth in one out of two cultures. Pathogen rates were 1.1% (16/1500) with one BC per patient and 1.7% (22/1500) with two BCs per patient. CONCLUSIONS: There is no difference in the contamination rates of two BCs drawn from the same site at two different times. The collection of two BCs per patient may enhance pathogen recovery.

Interdisciplinary faculty and student practice in a nurse-managed campus wellness program.

The concept of nurse-managed care in centers for nursing is a growing phenomenon in this era of health care reform. Nursing faculty are utilizing nurse-managed centers as alternative sites for clinical experiences and faculty practice. In this paper the authors highlight interdisciplinary faculty and student practice for a Campus Wellness Program at a midwestern university. Empowering faculty and students, and offering needed health promotion services to the university community, are addressed. Historical background, administrative, practice and educational challenges, and triumphs will be presented.

Community elderly. A nursing center's use of change theory as a model.

1. Despite functional limitations, independent elders usually voice satisfaction with the quality of their lives. However, life satisfaction can have a negative impact on self-care. As a result, older adults may become complacent about personal health practices. 2. Improvement in health behaviors and self-care practices increases the probability that older persons will be able to maintain independent functioning for a longer period. 3. Change theory can be used to determine client readiness to change health behaviors. The first stage, unfreezing, involves a desire for change. During the second stage, moving, new behaviors are identified that are perceived as problem-solving approaches. During the last stage, refreezing, new behaviors are integrated and internalized, while advice, reinforcement, and support are offered by the change agent. 4. Health screening alone is insufficient to create the discomfort necessary for change; unfreezing does not occur and health attitudes and behaviors remain unchanged. As valuable as health screening sessions are in raising participants' awareness, the study reported on suggests that it is the combination of health screening and nursing visits over time that creates the atmosphere in which change can occur.