ABSTRACT
BACKGROUND: Many critically ill patients have invasive arterial catheters inserted for blood pressure monitoring. Whether catheter leveling method and alternative transducer location affect the accuracy of blood pressure measurements is unknown. OBJECTIVE: To determine whether the use of alternative transducer locations and visual alignment versus laser device leveling significantly affect the accuracy of blood pressure measurements. METHODS: A convenience sample of 36 participants were randomly assigned to 1 of 3 experimental groups with different transducer locations: taped to the upper arm, next to the upper arm taped to a rolled cloth, or at the wrist. Participants served as their own controls; the control condition was having the transducer on the intravenous pole. Four blood pressure measurements were recorded for each patient (2 from each of the experimental and control conditions) using visual alignment and then laser device leveling. RESULTS: Only diastolic blood pressure (DBP) differed significantly between leveling methods (P = .01); no pressures differed significantly by transducer location. Covariate analysis indicated expected relationships between (1) age and DBP (P = .001), (2) Simplified Acute Physiology Score II and both DBP (P = .003) and mean arterial pressure (P = .03), and (3) duration of mechanical ventilation and DBP (P = .05). CONCLUSION: The findings indicate that any of the transducer locations evaluated may be useful in clinical prac-tice. Also, visual alignment rather than laser device leveling may be acceptable, except for DBP in the control location. More research is needed to strengthen these findings.
Subject(s)
Arterial Pressure , Blood Pressure Determination , Arterial Pressure/physiology , Blood Pressure , Humans , Monitoring, Physiologic , TransducersSubject(s)
Clinical Protocols , Myocardial Infarction , Outcome and Process Assessment, Health Care/organization & administration , Patient Care Team/organization & administration , Total Quality Management/organization & administration , Angioplasty, Balloon, Coronary , Electrocardiography , Emergency Nursing/organization & administration , Emergency Treatment/standards , Humans , Myocardial Infarction/diagnosis , Myocardial Infarction/therapy , New Jersey , Practice Guidelines as Topic , Time Factors , United StatesSubject(s)
Thromboembolism/drug therapy , Thromboembolism/prevention & control , Venous Thrombosis/drug therapy , Venous Thrombosis/prevention & control , Anticoagulants/adverse effects , Anticoagulants/pharmacology , Anticoagulants/therapeutic use , Drug Interactions , Heparin/adverse effects , Heparin/physiology , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/adverse effects , Heparin, Low-Molecular-Weight/pharmacology , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Risk Factors , Thromboembolism/diagnosis , Thromboembolism/physiopathology , Venous Thrombosis/diagnosis , Venous Thrombosis/physiopathologyABSTRACT
Review practical DVT screening considerations to enhance assessment skills.
Subject(s)
Venous Thrombosis , Anticoagulants/therapeutic use , Bandages , Causality , Drug Interactions , Embolectomy , Humans , Magnetic Resonance Imaging , Nurse's Role , Nursing Assessment/methods , Phlebography , Plethysmography, Impedance , Primary Prevention/methods , Sensitivity and Specificity , Thrombolytic Therapy , Ultrasonography, Doppler, Duplex , Vena Cava Filters , Venous Thrombosis/diagnosis , Venous Thrombosis/epidemiology , Venous Thrombosis/therapyABSTRACT
PURPOSE: To examine the benefits of an advanced practice nurse (APN) driven, hospital-based heart failure center. DATA SOURCES: Selected multidisciplinary studies, review articles, Heart Failure Society of America practice guidelines, and American College of Cardiology/American Heart Association clinical practice guidelines. CONCLUSIONS: APN specialists in this hospital-based heart failure center provide heart failure patients with high quality multidisciplinary health care in a single environment, which leads to optimal outcomes. Patients experience positive outcomes as evidenced by spared hospitalizations, improved scores on the Minnesota Living With Heart Failure Survey, and the 6-min walk. IMPLICATIONS FOR PRACTICE: APNs with prescriptive authority can effectively direct heart failure care for outpatients by utilizing multidisciplinary resources of the hospital. Treatment strategies include titrating medication, frequent symptom monitoring, tracking medication and dietary compliance, telemonitoring, and providing aggressive multidisciplinary education. This approach is highly effective for reducing hospital readmissions as well as for improving quality of life and functional status for outpatients with left ventricular systolic dysfunction.