Securing pediatric peripheral i.v. catheters--application of an evidence-based practice model.

Peripheral intravenous catheter (PIV) insertion is a traumatic experience for children and should not be repeated more frequently than necessary. Proper securement of pediatric i.v.s can preserve catheter life; however, little evidence is available to describe optimal methods. Pediatric nurses at a 246-bed, community-owned district hospital observed they were frequently attempting to rescue or restart PIVs prematurely. In the context of exemplary professional practice, an exploratory evidence-based practice project was designed to increase knowledge about the best practices in maintaining and preserving pediatric PIVs. Data collection and analysis determined that practices were inconsistent and more research is needed to determine the optimal securement practices.

Variation in care among spinal deformity surgeons: results of a survey of the Shriners hospitals for children.

STUDY DESIGN: Survey. OBJECTIVE: To understand the variation in scoliosis surgery and perioperative care among spinal deformity surgeons. SUMMARY OF BACKGROUND DATA: While variation in care has been well described in many spinal disorders, the degree of variation has not been described for spinal deformity. METHODS: Clinical histories and radiographs of 4 typical spinal deformity patients were sent to spinal deformity surgeons for review. The cases consisted of idiopathic thoracolumbar, double major, and right thoracic curves and a neuromuscular lumbar curve. The survey queried choice of surgical approach, levels fused and instrumented, type of instrumentation, preoperative testing, intraoperative neurologic monitoring, blood and antibiotic use, and postoperative care, including pain control and patient mobilization. Cost estimates for each case were obtained from the individual hospitals' pricing. RESULTS: There was wide variation in the specific fusion levels and instrumentation for the idiopathic curves. The variation was greatest for the thoracolumbar curve. The double major and right thoracic curves differed primarily in their choice of instrumenting secondary curves. The neuromuscular curve had the least variation. Costs estimates were widely disparate between centers. Perioperative care had much less disparity. CONCLUSIONS: Agreement appears common in areas with readily identifiable outcomes such as shorter length of stay and rapid postoperative mobilization. However, agreement is poor in areas where outcomes are difficult to measure and require long-term follow-up such as instrumentation fusion and levels.