A randomized clinical trial of the effect of bed position after PTCA.

BACKGROUND: After percutaneous transluminal coronary angioplasty, prolonged supine bedrest with the bed flat frequently causes back pain. This study was conducted to examine whether percutaneous transluminal coronary angioplasty patients could adjust their bed position to make themselves comfortable without increasing the frequency or severity of bleeding complications. OBJECTIVES: To determine whether the risk of bleeding increased in patients who were allowed to use their bed controls to make themselves comfortable, and if the difference in comfort was significant between patients who controlled and elevated their bed position and patients who remained flat in bed. METHOD: A randomized clinical trial was conducted; 54 patients undergoing percutaneous transluminal coronary angioplasty were randomly assigned to either the control group, in which patients remained flat in bed, or the experimental group, in which they controlled their bed position. Outcome measures included amount of bleeding at the catheter sites and patient comfort. RESULTS: No difference in the amount of bleeding at catheter insertion sites was found between the two groups. Few subjects reported pain at any time. Back pain at dinner and bedtime was higher in the control group, but only the bedtime difference was statistically significant. CONCLUSION: We conclude that patients may be allowed to adjust their bed position to 30 degrees for comfort without incurring increased risk of catheter entry site bleeding and that requiring patients to remain flat in bed has no scientific basis.

Factors that influence CNSs' decision about specialization.

Few studies have explored nurses' decision making relative to advanced practice. The purposes of this study were to determine when the decision to prepare as a CNS in a particular specialty is made and to identify the factors that influence that decision. A survey was completed by 257 CNSs. Results indicated that more than half (69%) decided on their specialty after graduation from a basic nursing program. The factors that influenced choice of specialty included experience in first position (47%), clinical role model (37%), and student experience (35%). Critical care was rated the most desirable specialty and psychiatric nursing the least preferred.

Survey of nursing practice related to decanting intravenous solutions.

A survey instrument was mailed to a stratified random sample of 1000 nurses from the membership list of the American Association of Critical-Care Nurses to determine whether there are generally accepted standards for decanting intravenous (IV) solutions before the addition of medication. Four hundred seventy-eight surveys were returned from 47 states and the District of Columbia. Of those, 475 were usable. Seventy-one percent of the respondents did not decant. Of those who did decant (29%), 79% used a needle and syringe to withdraw a volume equal to that of the medication to be added. The results of this study indicate that no generally accepted standards of practice exist for the preparation of IV solutions. Patients may not, therefore, be receiving the dose prescribed by the physician. Nurses need to develop standards for accurate administration of IV solutions.

Temporary atrial pacing after cardiac surgery.

Atrial epicardial wires are used after cardiac surgery for diagnostic and therapeutic purposes. Postoperative dysrhythmias may be diagnosed by using an atrial wire electrogram, and treatment of these dysrhythmias includes atrial pacing. In this article atrial pacing during the post-cardiac surgery period is discussed in relation to the management of supraventricular dysrhythmias, bradydysrhythmias, ventricular dysrhythmias, and low cardiac output.

Policy and procedure manual: keeping a high quality manual.

Policy and procedure manuals are now commonly used in hospitals. The policy and procedure manual provides critical care nurses with a wealth of information. Policies are developed to guide the staff to perform nursing care adequately. Together policies and the corresponding procedures let critical care nurses know how to proceed to meet the organisation and the unit goals. As critical care expands the number of policies increases, which may make it more difficult to find a specific policy quickly. Critical care nurses need to look at other solutions for communicating some necessary pieces of information and check to make sure that policy is stated briefly, to the point and logical. It is also necessary to check to see if the information included in the manual is policy and associated procedures. If it is drug information, equipment usage, standards of care, or patient/family teaching material it could be incorporated in a different format or separate manual. As care givers nurses must monitor policies and procedures that are written and make sure they are simple to read, logically written, and easy to find.

Measurement of pulsus paradoxus.

Pulsus paradoxus is a valuable clinical sign when there is a greater than 10 mm Hg drop in peak systolic blood pressure during normal inspiration. Although the exact mechanism is not known, tense fluid accumulation within the pericardial sac impairs left ventricular filling during inspiration when right ventricular filling is increased. This causes an exaggerated reduction in systolic blood pressure during inspiration. Critical care nurses need to become familiar with the three methods of measuring pulsus paradoxus: palpation, cuff sphygmomanometry, and arterial wave formation. Nurses should practice and become skilled at measuring a greater than 10 mm Hg change.

The use of temporary atrial wire electrodes to record atrial electrograms in patients who had cardiac surgery.

The use of temporary atrial electrodes after surgery provides the medical staff with a valuable diagnostic tool in patients who have undergone open heart surgery. Recording a unipolar or bipolar atrial EG is a simple procedure that can be performed at bedside with an ECG machine. The bipolar recording lead has specific advantages over a unipolar recording lead. The use of a bipolar recording lead simplifies the identification of the P wave during rapid tachycardias and atrioventricular dissociation. The use of unipolar and bipolar atrial EGs recorded simultaneously and sequentially can be used to identify atrial rhythm and ascertain the atrioventricular relationship. Nurses need to integrate unipolar and bipolar EGs as part of their baseline assessment.