The impact on patients of a nurse-led clinical service in gastroenterology.

Higher rates of chronic liver disease have resulted in a significant increase in the number of patients needing regular abdominal paracentesis for ascites. Waiting times for admission at the Royal Wolverhampton NHS Trust had become longer and delays in intervention and treatment became inevitable. In 2014, the Trust developed a nurse-led abdominal paracentesis day-case service. A qualitative evaluation of the service was conducted using in-depth patient interviews and surveys to determine the impact of the service, including how the new nursing role affected the patient experience. The results show that the nurse-led clinical service in gastroenterology positively impacts patients' experiences. Following this innovation, the service was extended to provide intravenous infusions for gastroenterology patients via the day-case unit. With appropriate training and competency assessments, nurses can now perform selected medical procedures safely and effectively, thereby facilitating nursing staff to expand and develop their roles. This development has substantial implications for nursing and is an important contribution to the debate on the future direction of the nursing profession.

Advanced nurse practitioner-led abdominal therapeutic paracentesis.

Liver disease is a common cause of death in England and Wales, and ascites is associated with a 50% mortality rate. Most patients who present with ascites have underlying liver cirrhosis, and often require therapeutic paracentesis for symptomatic relief. This article describes a competency framework that was developed to enable advanced nurse practitioners to perform therapeutic paracentesis in an ambulatory care unit.

Effects of Rapid Vaccine Injection Without Aspiration and Applying Manual Pressure Before Vaccination on Pain and Crying Time in Infants.

AIM: To compare effects of rapid injection without aspiration and 10-second manual pressure before injection on pain severity and crying time in 4- to 6-month-old infants given the vaccine DTaP/IPV/Hib. METHODS: This is a randomized double-blind controlled study. The study population included all the infants presenting for DTaP/IPV/Hib to two family health centers between April and August in 2015. The study sample included 128 infants based on confidence interval of 95% and statistical power of 80%. The sample was divided into four groups: manual pressure, rapid injection without aspiration, manual pressure combined with rapid injection without aspiration, and control groups. There were 32 infants in each group. Gender was adjusted in all groups. Stratified and block randomizations were used. RESULTS: Pain severity scores and crying time during and after the injections were significantly lower in the three intervention groups than in the control group (p = .001). The lowest increase in the mean heart rate during and after the injections occurred in the rapid injection without aspiration group (p < .05). In addition, the mean oxygen saturation before, during and after the injections was significantly lower in this group than in the other groups (p < .05). However, two infants in the rapid injection without aspiration group had low oxygen saturation levels starting before the injections. In fact, mean oxygen saturations did not change across time. This suggests that lower oxygen saturation in the rapid injection without aspiration group cannot be due to vaccines or the techniques used. LINKING EVIDENCE TO ACTION: Manual pressure and rapid injection without aspiration are effective and useful in relief of pain and reduction of crying time due to vaccine injections in 4- to 6-month-old infants.

Management of non-ovarian cancer malignant ascites through indwelling catheter drainage.

BACKGROUNDS: Intra-abdominal placement of the Central Venous Catheter (CVC) was conducted to manage the ascites-related symptoms of non-ovarian cancer patients. The aim of this study is to document the efficacy of symptom relief and conduct survival analysis of non-ovarian cancer patients with malignant ascites who received paracentesis and indwelling catheter drainage. METHODS: Seventy eight patients received paracentesis and drainage. All patients who met the inclusion criteria were included in this study. The overall survival (OS) was defined as the interval between initial diagnosis and death. Since-paracentesis survival (SP-Survival) was defined as the interval between initial paracentesis and death. RESULTS: Hepatic cancer was the most frequent original cancer in this study. Peritoneal catheters remained in situ for a median of 13 days. No immediate complications, such as perforation of a viscus or excessive bleeding, were encountered during placement. All ascites-related symptoms improved after drainage compared with the baseline. There was a statistically significant improvement in the mean score for abdominal swelling (p < 0.001), anorexia (p = 0.023) and constipation (p = 0.045). Cancer type was shown to be an independent prognostic factor for overall survival length (p = 0.001). Serum albumin was an independent prognostic factor for SP-survival (p = 0.02). CONCLUSIONS: Paracentesis and indwelling catheter drainage through CVC set is a useful method for improving painful symptom. Further research is needed to validate the findings.

Patient experience of non-malignant ascites and its treatment: a qualitative study.

BACKGROUND: Ascites is an accumulation of serous fluid in the abdominal cavity. It can be caused by both malignant and non-malignant conditions and produces distressing symptoms. There have been no qualitative studies looking at the experiences of patients with non-malignant ascites. AIMS: To explore the experiences of patients living with non-malignant ascites and its management. Also, to explore the views of these patients about services available to them. METHOD: Phenomenological qualitative research study using digitally recorded semi-structured interviews. SETTING AND PARTICIPANTS: Six adult patients with non-malignant ascites who were receiving paracentesis to manage their symptoms in an acute hospital day unit. RESULTS: Participants experienced a wide variety of physical symptoms. They discussed how the ascites impacted on their social lives. They had views on diuretics, low sodium diet and paracentesis as methods of symptom management. Participants' confidence in staff performing paracentesis was a common finding, particularly as ultrasound was rarely used. While only some were suitable for liver transplant, all discussed their future care needs. CONCLUSION: Participants' experiences of non-malignant ascites are that it has a considerable effect on their quality of life. Patients like the system of day case admission for drainage, but question whether this is sustainable. Advanced practitioners can successfully provide a paracentesis service for these patients in hospitals and potentially this is transferable to hospices. Patients seemed happy to consider the option of semi-permanent drains and pumps as methods of managing ascites.

Papel de la enfermera durante el proceso de realización de una paracentesis / The role of nurses during the paracentesis procedure

OBJETIVOS: conocer el papel del profesional de la Enfermería en el proceso de realización de una la paracentesis, basado en la evidencia científica, a fin de diseñar posteriormente una guía clínica y mejorar la calidad de los cuidados a los pacientes. MÉTODO: revisión narrativa en la que se lleva a cabo una búsqueda bibliográfica en las bases de datos de Medline, Cinahl, Cochrane Library y UpToDate, así como en bases de datos de Guías clínicas: Guidelines International Networks, Practice Guideline, National Guideline Clearinghouse, New Zealand Clinical Guidelines Group, Primary Care Clinical Practice Guidelines y Scottish Interncollegiate Guidelines Network. Se consultaron igualmente las bases de datos de guías clínicas del Hospital General Universitario Gregorio Marañón de Madrid, del Complexo Hospitalario Universitario de Vigo y del Club Internacional de la Ascitis. RESULTADOS Y CONCLUSIONES: se seleccionaron 15 artículos y tras el análisis de los hallazgos obtenidos se establecieron tres categorías en las que se describe el papel que la enfermera desempeña en la paracentesis: cuidados que proporciona la enfermera antes, durante y después del procedimiento. Además de cada una de las intervenciones enfermeras en cada fase del mismo, se observa como muy importante la presencia de un profesional enfermero que valorará al paciente de manera holística. En un futuro inmediato se implantará una guía clínica que se diseñará con base en los resultados obtenidos y se revisarán en un año todos los aspectos que se han considerado para esta guía, así como la literatura científica que se haya podido publicar valorando los puntos a mejorar. Entre las limitaciones de este trabajo cabe señalar la baja calidad metodológica de los artículos seleccionados y la poca bibliografía referente al tema, por lo que convendría realizar estudios con diseños metodológicos más rigurosos y de mayor calidad para poder tener más impacto en la práctica clínica

OBJECTIVES: to learn about the role of the Nursing Professional during the paracentesis procedure, based on scientific evidence, with the aim of designing clinical guidelines, and improving the quality of patient care. METHOD: a narrative review, where a bibliographic search was conducted in the Medline, Cinahl, Cochrane Library and UpToDate databases, as well as in Clinical Guidelines Databases: Guidelines International Networks, Practice Guideline, National Guideline Clearinghouse, New Zealand Clinical Guidelines Group, Primary Care Clinical Practice Guidelines and Scottish Intercollegiate Guidelines Network. The Clinical Guidelines Databases from the Hospital General Universitario Gregorio Marañón in Madrid, the Complexo Hospitalario Universitario de Vigo and the International Ascites Club were also consulted. RESULTS AND CONCLUSIONS: fifteen articles were selected, and after the analysis of the findings obtained, three categories were established, describing the role played by nurses during paracentesis: the care provided by nurses before, during and after the procedure. Apart from each of the nursing interventions at each stage of said procedure, the presence of a nursing professional to assess the patient in a holistic way was considered very important. In the near future, clinical guidelines will be implemented, that will have been designed based on the results obtained, and all aspects considered for these guidelines will be reviewed at one year, as well as the scientific literature which may have been published, assessing those items to be improved. Among the limitations of this study, we must point out the low methodological quality of the articles selected, and the little bibliography available about this matter; therefore, it would be convenient to conduct studies under stricter methodological designs, with higher quality, in order to have a higher impact on clinical practice

Outpatient interventions for hepatology patients with fluid retention: a review and synthesis of the literature.

Cirrhosis of the liver was the 12th leading cause of death in the United States, according to the 2010 Vital Statistics Report. Cirrhosis is responsible for more than 150,000 hospitalizations each year. Similar to heart failure, severe fluid retention in cirrhotic patients leads to hospitalizations and increase in resource utilization. Outpatient interventions can be used to decrease preventable hospitalizations. The existing literature was explored to determine what interventions can be implemented in an outpatient setting that may reduce or prevent hospital admissions for cirrhotic patients with fluid retention. Seventeen articles were included in the review of the literature. There were 9 randomized controlled trials that yielded a total of 1,694 patients. One meta-analysis yielded 5 randomized controlled trials with 330 patients. Three cohort studies yielded 86 patients. One systematic review yielded 2,115 articles and 2 literature reviews yielded 110 articles. One report from an expert committee was included in the review. Findings from the studies identified 6 main interventions that can be used for outpatient management of cirrhotic patients with fluid retention and may prevent related hospitalizations. These include dietary sodium restriction, diuretics, daily weights, albumin infusions and paracentesis, placement of a transjugular intrahepatic portosystemic shunt, and telephone management.

Arthrocentesis: the latest on joint pain relief.

Arthrocentesis is a procedure in the diagnostic workup and treatment of joint pain that has few complications. Analysis of joint fluid yields important treatment data. Corticosteroid and local anesthetic injections provide longer pain relief.

Centesis studies in critical care.

Critical care nurses have a vital role in caring for patients undergoing centesis studies. Any centesis procedure involves puncturing a body cavity, joint, organ, or space with a hollow needle to withdraw fluid. All centesis studies are invasive procedures, typically performed for either therapeutic or diagnostic purposes. Because there are a variety of centesis procedures that the critical care nurse might encounter, the following centesis procedures are discussed in depth: amniocentesis, arthrocentesis, lumbar puncture, paracentesis, pericardiocentesis, and thoracentesis. By becoming more familiar with each of these procedures, the critical care nurse gains confidence in caring for clients when these procedures are indicated.

Unidad de atención continuada y hospital de día como alternativa a la hospitalización convencional: experiencia de 10 años en un hospital comarcal / Continuing care unit and day hospital as an alternative to conventional hospitalization: 10 years’ experience in a district hospital

La unidad de atención continuada y hospital de día permite el manejo ambulatorio de los pacientes con una enfermedad digestiva. Objetivo: Disminuir los ingresos hospitalarios y el número de pacientes con una enfermedad digestiva que acude a urgencias. Material y métodos: Los pacientes se atienden según dos niveles asistenciales: a) atención continuada, en que se visitan de forma urgente los pacientes con una descompensación aguda de su enfermedad digestiva, y b) atención programada, en que se realizan procedimientos que por su complejidad requieren personal de enfermería, sin ser necesario el ingreso hospitalario. Resultados: En el período comprendido entre 1995 y 2005 se ha pasado de realizar 118 visitas en atención continuada en 1995 a 784 en 2005. En atención programada las paracentesis han aumentado de 237 en 1995 a 687 en 2006 y las infusiones de hierro intravenoso de 111 en 2004 a 519 en 2006. El número de ingresos hospitalarios pasó inicialmente de 605 en 1995 a 430 en 2000, para posteriormente aumentar. El número de pacientes con una enfermedad digestiva que acudió a urgencias disminuyó un 75% estos años. Conclusiones: La unidad de atención continuada y hospital de día permite una disminución inicial del número de ingresos en el área de hospitalización convencional y en el porcentaje de pacientes con patología digestiva que acuden a urgencias

The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. Aim: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. Material and methods: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. Results: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. Conclusions: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department