Use of local anesthesia for arterial punctures.

BACKGROUND: Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture. OBJECTIVE: To review the recommendations and studies related to the use of intradermal lidocaine to decrease pain during arterial punctures. METHODS: Articles were identified by doing a systematic computerized search of MEDLINE (1980 to January 2006) to evaluate articles and reference lists of articles and a manual search of the references listed in original and review articles. English-language articles that evaluated any aspect of pain related to arterial puncture and cannulation, pain related to and methods of introducing lidocaine subcutaneously, and perceptions and use of local anesthesia for arterial or intravenous punctures were reviewed. RESULTS: Except among anesthesia providers, the use of a local anesthetic before arterial puncture is not universal, contrary to the standard of practice. A number of false perceptions may prevent wider use of such anesthetics. CONCLUSION: Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses' perceptions of use, actual practice, and currently established local policies.

Maximizing a transport platform through computer technology.

One of the most recent innovations coalescing computer technology and medical care is the further development of integrated medical component technology coupled with a computer subsystem. One such example is the self-contained patient transport system known as the Life Support for Trauma and Transport (LSTAT(tm)). The LSTAT creates a new transport platform that integrates the most current medical monitoring and therapeutic capabilities with computer processing capacity, creating the first "smart litter". The LSTAT is built around a computer system that is network capable and acts as the data hub for multiple medical devices and utilities, including data, power, and oxygen systems. The system logs patient and device data in a simultaneous, time-synchronized, continuous format, allowing electronic transmission, storage, and electronic documentation. The third-generation LSTAT includes an oxygen system, ventilator, clinical point-of-care blood analyzer, suction, defibrillator, infusion pump, and physiologic monitor, as well as on-board power and oxygen systems. The developers of LSTAT and other developers have the ability to further expand integrative component technology by developing and integrating clinical decision support systems.

A method of transporting critical care mass casualties.

The use of a self-contained transport platform can aid in the efforts to care for mass casualty victims. The platform is equipped with critical care equipment and has the capabilities of documenting care electronically. It has been used in a number of different settings and has allowed health care personnel to provide more efficient, individualized care to a larger number of victims.