RESUMO
A 37-year-old man was referred for consideration of percutaneous decommissioning of a left ventricular assist device (LVAD). Following careful hemodynamic monitoring during pump turn-down and temporary outflow graft occlusion, the LVAD was permanently decommissioned by using a vascular plug to induce thrombosis of the outflow graft. (Level of Difficulty: Advanced.).
RESUMO
TOPIC: The growing use of acute mechanical circulatory support devices to provide hemodynamic support that has accompanied the increasing prevalence of heart failure and cardiogenic shock, despite significant improvement in the treatment of acute myocardial infarction. CLINICAL RELEVANCE: The critical care nurse plays a crucial role in managing patients receiving acute mechanical circulatory support devices and monitoring for potential complications. PURPOSE: To review the anatomical placement and mechanics of each type of device so that nurses can anticipate patients' hemodynamic responses and avoid complications whenever possible, thereby improving patients' clinical outcomes. CONTENT COVERED: Nursing considerations regarding the intra-aortic balloon pump, the TandemHeart, the Impella, and extracorporeal membrane oxygenation.
Assuntos
Enfermagem de Cuidados Críticos/normas , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/normas , Insuficiência Cardíaca/enfermagem , Balão Intra-Aórtico/instrumentação , Balão Intra-Aórtico/normas , Choque Cardiogênico/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Balão Intra-Aórtico/métodos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVE: The purpose of this integrative literature review is to examine the effects that nurse residency programs (NRPs) have on the retention of new graduates. BACKGROUND: The Institute of Medicine recommends implementing NRPs and evaluating their effectiveness. Nursing leaders need to understand if an investment in a residency program is beneficial to their organization. METHODS: A database search was performed for research from 2010 to 2016 reporting outcomes of new graduate NRPs relating to retention. RESULTS: In the articles reviewed, the 1-year retention was higher than the national average for new graduate nurses ranging from 74% to 100%. Higher rates were associated with national programs such as the University Hospital Consortium/American Association of Colleges of Nursing or Versant compared with organization-based programs. CONCLUSIONS: NRPs can increase 1-year retention of new graduate nurses. More controlled and comparative studies are needed to evaluate program differences. Nurse leaders need evidence to ascertain which programs are the most effective in supporting retention and return on investment.
