A National Survey on Peri-interventional Management of Percutaneous Transhepatic Biliary Drainage.

PURPOSE: The purpose of this study is to evaluate knowledge about management of percutaneous transhepatic biliary drainage (PTBD) catheters among nurses taking care of hepato-pancreato-biliary (HPB) patients. METHODS: Six HPB nurses from the Dutch national HPB association created a questionnaire that was complemented by 2 HPB surgeons, 3 HPB interventional radiologists, and a methodologist. Registered nurses working at the department of gastroenterology or gastrointestinal surgery and familiar with the care for HPB patients were invited to complete the questionnaire. RESULTS: In total 120 completed questionnaires from Dutch nurses were returned. The responders were working in 38 of 64 different hospitals. About half of the respondents considered their own knowledge insufficient, which was reflected in the response to the specific questions concerning the PTBD procedure, and 70% rated the knowledge of their immediate nursing colleagues as insufficient. Less than 50% of the respondents knew whether antibiotic-prophylaxis or "pain medication" was required before PTBD procedure. Only a few respondents were aware of the existence of a hospital protocol for PTBD management and its content. CONCLUSIONS: Nursing care for biliary catheters is not standardized nationwide, and consensus on management is lacking. An evidence-based guideline for PTBD management is advised for nursing care of patients with HPB diseases.

Integrar el Rol de Enfermería en nuestra práctica diaria / To integrate the Role of Nurses in our daily practice

Se trata de un estudio que combina métodos cuantitativos y cualitativos. Desde el método el equipo de enfermería inicia un proceso de unificación de conocimientos y lenguaje enfermero. Se ha realizado un estudio transversal identificando necesidades de cuidados a los pacientes ingresados desde el 01-2000 al 05-2000 con diagnóstico de pancreatitis. Se ha realizado una valoración enfermera por patrones funcionales de M. Gordon. Es necesario utilizar un proceso de atención enfermero con enfoque científico dirigido a la solución de problemas que ofrezca un marco conceptual para la organización, planificación y actuación de enfermería. (AU)

The pancreas--hermit of the abdomen.

The pancreas is almost impossible to palpate because it is located in the retroperitoneal space. Life-threatening lesions, therefore, often are not diagnosed until they are very advanced and encroaching on adjacent structures. The pancreas has a large endocrine and exocrine reserve, which also contributes to difficulty in diagnosing pancreatic disease. This article provides an in-depth analysis of the anatomy and physiology of the pancreas and endocrinopathies, allowing nurses to provide optimal care for patients with pancreatic abnormalities.

Biliary and pancreatic stents.

Endoscopic retrograde cholangiopancreatography is one of the most challenging and demanding procedures performed in endoscopy units. Many endoscopy staff nurses become overwhelmed by the complexity of patient management and the realm of equipment necessary in providing endoscopic therapy for patients with biliary and pancreatic disease. The case of Ray, a 45-year-old patient, is used in this article to demonstrate the current value of biliary stenting and its potential impact on a patient's life. An understanding of the indications for and uses of stents in the treatment of biliary occlusion and pancreatic disease will provide a foundation for those assisting in endoscopic retrograde cholangiopancreatography.

Pancreatic disorders in the newborn.

Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.

Nesidioblastosis: a case study.

Hypoglycemia is a frequent problem in the neonatal period requiring close attention and intervention. Severe, persistent hypoglycemia can have various etiologies; one of the most common causes is hyperinsulinism. Nesidioblastosis, although rare, is the most common cause of hyperinsulinism in the neonate. If not detected early, nesidioblastosis can lead to brain damage and death secondary to severe hypoglycemia. The etiology of nesidioblastosis remains unclear. Treatment involves maintaining normal blood glucose levels; treatment modalities include high glucose infusion rates, use of medications, and surgical intervention. The article reviews the pathophysiology and treatment modalities for nesidioblastosis. A case study is also presented that describes the clinical presentation, treatment, surgical intervention, and postdischarge clinical course of an infant with nesidioblastosis.

Nursing management of symptoms influenced by HIV infection of the endocrine system.

Examining the impact of endocrine disregulation is useful in managing symptoms of HIV infection in its later stages. Current studies indicate insults to the endocrine system from a variety of agents present in HIV infection. Establishing direct pathologic, causal effects is difficult; however, the functional domains of the endocrine system provide a good framework for nursing management of the symptoms of later-stage HIV infection.

Pancreatic duct calculi. Treatment by pulsed dye laser.

Endoscopic sphincterotomy with stone extraction has been successful in the majority of patients with biliary stones; however, large biliary stones and pancreatic stones in the smaller pancreatic duct may require a new approach. Pulsed dye laser has proven effective in treating pancreatic duct calculi during ERCP. With an outpatient procedure to eliminate pancreatic duct calculi, patients can be treated safely and effectively without major surgery. The procedure is less invasive for the patient, thereby reducing morbidity and expense.