Bedside placement of postpyloric feeding tubes.

Postpyloric placement of feeding tubes into the duodenum or jejunum is often recommended to support early feeding, improve tolerance of enteral nutrition, and decrease the risk of aspiration pneumonia. Achieving small bowel feeding tube placement can be a difficult, time-consuming, and costly process that may delay the initiation of enteral nutrition. Various bedside techniques, including air insufflation, pH assisted, and spontaneous passage with or without motility agents are available to facilitate transpyloric feeding tube passage. A discussion of these methods is presented in this article, including a hospital-based quality initiative project designed to facilitate early enteral nutrition.

The quick relaxation technique: effect on pain associated with chest tube removal.

Documentation shows that conventional methods used to prepare patients for chest tube removal (CTR) are not effective in reducing pain associated with this procedure. The quick relaxation technique (QRT) was used on 24 primary aorta-coronary bypass surgical patients. Subjects rated their pain on the visual analog scale immediately following CTR and 30 minutes later. Results indicated that men > or = 70 years of age who received QRT in conjunction with analgesics reported less than half the amount of pain experienced by those who did not receive QRT. In comparison, women 70 years old or older reported much higher pain intensity scores when QRT was used. Preliminary results suggest that for most patients, the combination of analgesics and relaxation exercises is not more effective in decreasing pain during CTR than when analgesics are administered without relaxation exercises.

Tissue oxygenation and routine nursing procedures in critically ill patients.

Maintaining adequate oxygenation to promote vital organ functions represents a common challenge for the critical care nurse. Critically ill patients with impaired cardiac function may be particularly vulnerable to tissue oxygen deprivation because they have limited ability to increase oxygen delivery when oxygen demands increase. Consequently, routine nursing procedures that increase oxygen requirements may have adverse effects on tissue oxygenation. Interventions that enhance patient tolerance to nursing procedures by supporting the balance between oxygen supply and demand promote physiologic adaptation and may prevent complications associated with hypoxia such as cardiac dysrhythmias, hypotension, and cardiac arrest. This discussion will focus on the principles of tissue oxygenation, the effects of nursing interventions on oxygen demand, and interventions that may enhance patient tolerance to routine nursing interventions.

Balloons, beds, and breakdown. Effects of low-air loss therapy on the development of pressure ulcers in cardiovascular surgical patients with intra-aortic balloon pump support.

There is limited research related to pressure ulcers in the ICU patient population and even less has focused on patients who have undergone cardiovascular surgery and IABP support. The objective of this article was to determine the incidence of pressure ulcers in the postoperative CVS patient with IABP support and to determine if LAL therapy was more effective in the prevention of pressure ulcers in this patient population. In a quasiexperimental design, a convenience sample of 36 adults was used. Patients who were placed on IABP support the day of surgery were enrolled into the study within 24 hours of admission to the cardiovascular recovery room. Data collection was daily for 4 days and continued if the patient developed a pressure ulcer. Final measurements were obtained on the day of hospital discharge. Instruments used were demographic data form, APACHE II, Patient Identification for Rotation Therapy, and the Braden Scale. The most common surgical patient in this pilot underwent aortocoronary bypass with IABP support. Pressure ulcers developed in 9 of 36 (25%) patients for a total of 17 ulcers. Patients who developed pressure ulcers were generally older, had a history of cerebrovascular disease, renal insufficiency, a higher APACHE II score, and Braden score of 9 on POD 1. In addition, these patients generally had a lower hemoglobin level, higher serum creatinine level, and an altered level of consciousness on POD 1. The results suggest that LAL therapy does make a difference in the prevention of pressure ulcers in the aortocoronary bypass patient with IABP support.

Fast Track recovery after aortocoronary bypass surgery: early extubation and intensive care unit transfer.

Fast Track is a practical method of delivering care to aortocoronary bypass (ACB) patients with minimal risks to the patients or their care providers. A prospective study designed by an interdisciplinary practice team will evaluate the effects of an accelerated recovery program on clinical and financial outcomes of ACB patients. Essential components of the accelerated recovery program include early extubation, accelerated activity, and appropriate patient selection. Preliminary results on early extubation are discussed.