Nurses' knowledge, attitude, and practice regarding the use of physical restraints in children in the intensive care setting in China: A cross-sectional multicentre study.

OBJECTIVE: The objectives of this study were to investigate paediatric nurses' knowledge, attitude, and practice (KAP) regarding the use of physical restraints and to explore the factors related to the use of physical restraints. Findings will provide a reference to develop standard procedures and training. BACKGROUND: Nurses' KAP regarding the use of physical restraints affect the use of physical restraints in the paediatric intensive care unit and neonatal intensive care unit. Understanding nurses' decision-making processes should inform strategies and methods for effectively reducing and regulating the use of physical restraints in paediatric patients in the intensive care unit (ICU) in China. METHODS: We conducted a cross-sectional survey of 823 registered ICU nurses from 12 children's hospitals in China between April and June, 2020. ICU nurses' KAP regarding the use of physical restraints in children were evaluated using a structured self-administered questionnaire that was distributed through an online platform. Descriptive and multiple linear regression analyses were used to examine the factors that influenced ICU nurses' KAP regarding the use of physical restraints in children. RESULTS: Overall, 49.8% of respondents were paediatric intensive care unit nurses, 25.0% of respondents were neonatal intensive care unit nurses, and 25.2% of respondents were other ICU nurses; 58.44% of nurses had received some training on the use of physical restraints in children. Mean total scores on the items addressing ICU nurses' knowledge (range, 0 [lowest level of knowledge] -11 [highest level of knowledge]), attitude (range, 11 [least likely to use physical restraint] - 55 [most likely to use physical restraint]), and practice (range, 14 [few skills] - 42 [good skills]) regarding the use of physical restraints in children were 8.00 ± 1.46, 30.67 ± 5.31, and 37.61 ± 3.46, respectively. Multiple linear regression analysis showed a higher level of education and less work experience (years) were related to higher knowledge scores; prior training in the use of physical restraint was related to lower attitude scores; and female, prior training in the use of physical restraints, and a higher level of education were related to higher practice scores. CONCLUSIONS: Nurses would like to use physical restraints without physician approval in an emergency or when they could not pay close attention to a child. There are a few standardised training and lack of clinical guidelines for paediatric nurses. We recommend establishing a standard of care for physical restraints in paediatric patients.

Effect of Neotype Rectal Mild Hypothermia Therapy on Intestinal Bacterial Translocation in Rats with Hypoxic-Ischemic Brain Damage.

BACKGROUND Previous studies have shown that a neotype rectal cooling device can induce mild hypothermia (MH) in Sprague-Dawley rats with ischemic-hypoxic brain damage (HIBD) and inhibit cell apoptosis in the hippocampal CAl region, and does not cause damage to rectal tissues. The present study aimed to investigate the effect of rectal MH on bacterial translocation (BT) in Sprague-Dawley rats with HIBD. MATERIAL AND METHODS A total of 60 Sprague-Dawley rats were randomly divided into 4 groups: a control group (group C), a normothermia group (group NT), a cooling blanket group (group CB), and a rectal cooling group (group RC). Rats in group CB and group RC received MH using a cooling blanket and rectal cooling device after HIBD model establishment. Then, we measured diamine oxidase (DAO) and D-lactate level separately in groups NT, CB, and RC. Finally, the spleen, liver, and mesenteric lymph nodes were collected for bacterial culture, and rectal tissues were collected for H&E staining. RESULTS The therapeutic outcome was better in Sprague-Dawley rats receiving rectal MH without rectal injury compared to rats in group CB. Escherichia coli (E. coli) was found in MLNs in group RC. E. coli, Proteus vulgaris, Stenotrophomonas maltophilia, and Acinetobacter lwoffii were detected in the rats of groups CB and NT. At 12 h following rectal MH, DAO and D-lactate levels were lower than in group NT. CONCLUSIONS The neotype rectal MH cooling method could be a potential strategy to induce rapid, controllable hypothermia, thus reducing the possibility of inflammatory cell infiltration and BT incidence.

Citrate-Based Self-Circulation Anticoagulation Protocol for Discontinuity of Continuous Renal Replacement Therapy.

BACKGROUND/AIMS: Continuous renal replacement therapy (CRRT) has been used widely in the treatment of critically ill children for its continuity. However, sometimes we have to interrupt the continuity for necessary surgeries or blood transfusions. Our objective was to demonstrate a feasible self-circulation anticoagulation protocol based on citrate (CSAP) to address discontinuity during CRRT. METHODS: We conducted a prospective observational study of 57 pediatric patients undergoing 88 CRRT sessions that were receiving CSAP during the treatment discontinuity period by using an anticoagulation regimen containing 5 mL 4% sodium citrate in 50 mL of saline to maintain the continuity. We documented the reasons for CSAP and the total duration of the treatment. We assessed the in-line pressure recordings, blood routine examination, blood electrolytes, and blood gas analysis before, throughout, and after the period of CSAP. RESULTS: The average duration of CSAP was 118.5 ± 45.3 min. There was no significant increase in arterial pressures, venous pressures, and transmembrane pressures and no significant decreases in blood cell counts observed at the end of the CSAP, compared to the data recorded at the beginning of the CSAP. Compared to before the CSAP, there was no significant change in the ratio of total to ionized calcium, Na+, HCO3-, and pH value after CSAP. CONCLUSIONS: CSAP might be a safe, effective, and easy approach for use during the treatment discontinuity of CRRT in children.

Different anatomical sites of the foreign body injury with 2999 children during 2012-2016.

PURPOSE: This study aimed to analyze the clinical characteristic of different foreign body injuries in children and offer the preventions. METHODS: A retrospective study and the demographic information, injury causes, foreign body injury types and other clinical factors were recorded and analyzed. RESULTS: Of the 2999 patients, 1877 (62.6%) were boys and 1122 (37.4%) were girls. The majority (72.8%, n = 2184) of the injuries were found in 1-3 years old children. The most common anatomical site was the respiratory tract (73.4%, n = 2201) followed by the digestive tract (18.6%, n = 558), the genitourinary tract (1.93%, n = 58) and other sites (6.07%, n = 182). There were 60.4% of the in-patients from rural areas and 53.2% of the patients without medical insurance, the rate of cost by medical insurance increased with age. The medians of length of hospital stay and hospitalization cost were four days and 4767.3 CNY respectively. Most of the patients had surgical treatment (90.6%, n = 2717) and 64.9% of them had the complications (n = 1946). The cure rates of the all foreign body injuries types were above 90%, especially in genitourinary tract (98.3%). CONCLUSION: Different types of the foreign body injuries had dissimilar clinical characteristics. The effective prevention and control measures should be taken according to the variety of high-risk population, incidence season and foreign body injury types.

Assessing nursing quality in paediatric intensive care units: a cross-sectional study in China.

BACKGROUND: Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units (PICUs) in China. AIM: To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators. DESIGN: Multi-centre, cross-sectional study. METHODS: Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China. RESULTS: The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care. CONCLUSIONS: This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement. RELEVANCE TO CLINICAL PRACTICE: This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs.

Application of a novel rectal cooling device in hypothermia therapy after cerebral hypoxia-ischemia in rats.

BACKGROUND: A new rectal cooling device for therapeutic hypothermia (TH) therapy is designed and is applied in TH treatment of SD rats with ischemic-hypoxic brain damage. METHODS: Healthy adult SD rats (n = 45) were randomly assigned into four groups: the healthy control group (n = 5), the ischemia and hypoxia group (n = 10), the rectal TH cooling group (n = 18), and the ice blanket TH cooling group (n = 11). The rats in the rectal cooling and ice blanket TH groups received 12 h treatment after hypoxic-ischemic brain damage had been established, while those in the ischemia and hypoxia group did not. Taking the start of TH as the zero point, rats were sacrificed after 24 h and the brain and rectum tissues were sampled for histological analysis. RESULTS: The TH induction time (37.3 ± 14.7 min) in the rectal cooling group was significantly shorter (F = 4.937, P < 0.05) than that in the ice blanket cooling group (75.6 ± 27.2 min). The HE and NISSL staining results showed that rats in the rectal TH cooling group had significantly decreased (P < 0.01) positive neurons cell count compared to those in ischemia and hypoxia group. In addition, TUNEL staining indicated that the number of apoptotic cells (3.9 ± 1.8 cells / × 400 field) and the apoptosis index (4.4 % ± 1.5) were significantly lower in rectal TH cooling group (P < 0.05) than in ischemia and hypoxia group (23.2 ± 12.1 cells / × 400 field, 26.6 % ± 12.1). Also, no rectal frostbite or inflammatory infiltration was observed in rats in the rectal TH treatment groups. CONCLUSION: Our new cooling device realized rapid TH induction in SD rats with ischemic-hypoxic brain damage, inhibited the apoptosis of cells in the hippocampal CAl region, and did not cause histological damage to the rectal tissues.

Effect of mechanical cleaning of endotracheal tubes with sterile urethral catheters to reduce biofilm formation in ventilator patients.

OBJECTIVES: To investigate the effectiveness of mechanical cleaning with sterile urethral catheters to prevent formation of biofilms on endotracheal tubes. METHODS: Forty-five children were randomized in equal numbers to endotracheal tube cleaning group for three times a day (group A), twice daily (group B), or to a control group with no endotracheal tube cleaning (group C). Bacterial studies and confocal laser scanning microscopy were performed to assess bacterial colonization and biofilm thickness on the internal surface of the endotracheal tube. RESULTS: In group B, the quantities of viable bacteria adhering to the endotracheal tube after 1 day of ventilation were similar to the control group but were significantly less by 3 days (p < 0.05). The quantities of viable bacteria adhering to the endotracheal tube in group A were significantly lower than group C from day 1 to day 7 (p < 0.05). The numbers of culture-positive endotracheal tube and lower respiratory tract secretions were both reduced in groups A and B compared with group C. Confocal laser scanning microscopy showed progressive development of mature biofilms in group C. Scattered bacteria were seen in group A with no biofilm formation. In group B, a small amount of extracellular polymeric substance was seen, with more bacterial cells than in group A. The biofilms in group B were significantly thinner than those in group C (p < 0.05). The occurrence of ventilator-associated pneumonia was significantly reduced by endotracheal tube cleaning. CONCLUSION: Mechanical cleaning with sterile urethral catheters reduced bacterial colonization, prevented formation of endotracheal tube biofilm, and reduced the occurrence of ventilator-associated pneumonia.

[Analysis of viral etiology of severe pneumonia in infants and young children in Chongqing area].

OBJECTIVE: To investigate the prevalence of viral infections and putative association of viral infection with illness severity in young children with severe lower respiratory tract infection (LRTI) in Chongqing. METHOD: Respiratory secretion specimens were collected from 119 hospitalized patients with severe pneumonia from December 2006 to March 2008.After being processed, the samples were detected for respiratory viruses including respiratory syncytial virus (RSV), adenovirus (ADV), human metapneumovirus (hMPV), human bocavirus (HBoV), parainfluenza virus 1, 2, 3 (PIV 1, 2, 3), influenza virus A and B (IVA and IVB) either by PCR or RT-PCR. Clinical data were analyzed along with virological data by using appropriate statistical methods. RESULT: Viral pathogens were identified in specimens of 86 (72.3%) cases, among which RSV was detected in 49 (41.2%) patients. More than one virus was detected in 23 individual (26.7%) samples, of which 19 were dual positive for RSV and another virus. Bacterial cultures were performed for 69 patients. Both bacterial and viral pathogens were identified in 53 (76.8%) patients. Bacterial and viral coinfection was demonstrated in samples from 41 (59.4%) cases. CONCLUSION: Viral pathogens are the main etiology of severe pneumonia in young children in Chongqing area during the study period. RSV was the most frequent viral pathogens, followed by ADV and hMPV. Coinfection with respiratory common viruses was relatively common, though co-infection with viruses did not appear to aggravate the patients' condition.