[Measurement of intra-abdominal pressure with intravesical system Unometer Abdo-Pressure]. / Medción de la presión intraabdominal con sistema intravesical Unometer Abdo-Pressure.

The measurement of intra-abdominal pressure (IAP) has been incorporated routinely in Critical Units in order to monitor and control those clinical situations that make us suspicious of intraabdominal hypertension (IAH). There are several methods to measure IAP [1-3]: direct measurement, a catheter inserted through suprapubic aspiration, although it is a discouraged procedure by being very invasive; and indirect measurement. In this method there are mainly three different techniques: Through femoral vein puncture: a catheter into the inferior vena cava is channeled. It is a technique being deprecated invasive, associated with venous thrombosis, retroperitoneal hematoma and infection. Through a gastric tube: impractical, requires managing large amounts of water associated with leakage through the pylorus risk. Through intravesical measurement: is the most commonly used method. The bladder catheter allows monitoring the PIA and diuresis and electrolyte control. This method has potential for infection associated with catheterization risk. Although this risk, it is considered the gold standard for the measurement of IAP. Have now been introduced to the market each measuring intravesical kits guaranteeing sterility circuit without disconnections. It is necessary to know the material and the correct procedure for measuring the PIA and how to interpret the results.

Medición de la presión intraabdominal con sistema intravesical unometer(R) abdo-pressure(R) / Measurement of intra-abdominal pressure with intravesical system unometer(TM) abdo-pressure(TM)

La medición de la presión intraabdominal (PIA) se ha incorporado de manera rutinaria a las Unidades de Críticos con el objetivo de monitorizar y controlar aquellas situaciones clínicas que nos hacen sospechar de una hipertensión intraabdominal (HIA) [1]. Existen diversos métodos para medir la PIA [1-3]: medición directa, a través de un catéter insertado por punción suprapúbica, procedimiento desaconsejado por ser muy invasivo; y medición indirecta. Dentro de este método existen principalmente tres técnicas diferentes: Mediante punción por vía femoral: se canaliza un catéter hasta la vena cava inferior. Es una técnica en desuso por ser invasiva, asociada a trombosis venosa, hematoma retroperitoneal e infección. A través de una sonda gástrica: poco práctica, requiere administrar gran cantidad de agua, con riesgo asociado a fuga a través del píloro. A través de medición intravesical: es el método más utilizado. El sondaje vesical permite la monitorización de la PIA y la diuresis, así como el control hidroelectrolítico. Este método presenta riesgo potencial de infección asociada a sondaje vesical. A pesar de este riesgo, está considerado actualmente como el gold standard para la medición de la PIA. Actualmente se han introducido en el mercado unos kits de medición intravesical que garantizan la esterilidad del circuito sin necesidad de desconexiones. Es necesario conocer el material y el correcto procedimiento de la medición de la PIA, así como saber interpretar los resultados obtenidos (AU)

The measurement of intra-abdominal pressure (IAP) has been incorporated routinely in Critical Units in order to monitor and control those clinical situations that make us suspicious of intra-abdominal hypertension (IAH ) .There are several methods to measure IAP [1-3]: direct measurement, a catheter inserted through suprapubic aspiration, although it is a discouraged procedure by being very invasive; and indirect measurement. In this method there are mainly three different techniques: Through femoral vein puncture: a catheter into the inferior vena cava is channeled. It is a technique being deprecated invasive, associated with venous thrombosis, retroperitoneal hematoma and infection. · Through a gastric tube: impractical, requires managing large amounts of water associated with leakage through the pylorus risk. · Through intravesical measurement: is the most commonly used method. The bladder catheter allows monitoring the PIA and diuresis and electrolyte control. This method has potential for infection associated with catheterization risk. Although this risk, it is considered the gold standard for the measurement of IAP. Have now been introduced to the market each measuring intravesical kits guaranteeing sterility circuit without disconnections. It is necessary to know the material and the correct procedure for measuring the PIA and how to interpret the results (AU)

[Cell saver]. / Recuperador cellular.

The blood retrievers are instruments increasingly used in operating rooms. They are especially useful in operations where there is a high risk of bleeding and transfusion requirements are high. In paediatrics is of great importance in complex interventions in order to avoid allogeneic transfusion (blood collected from donors). The implementation of the recovery of blood in the surgical field is very simple and easy to use. This is a suction tube that collects the blood that is free, transferring it to a centrifuge where it is filtered and washed, stored in a blood collection bag for subsequent infusion. The blood is of high quality and contains a high hematocrit blood from the bank.

Recuperador celular / No disponible

Los recuperadores de sangre son unos instrumentos usados cada vez más en los quirófanos. Resultan especialmente útiles en las intervenciones donde existe mucho riesgo de sangrado y las necesidades transfusionales son elevadas. En pediatría tienen una gran importancia en intervenciones complicadas con la finalidad de evitar transfusiones alogénicas (sangre obtenida de donantes). La aplicación del recuperador de sangre en el campo quirúrgico es muy simple y de fácil utilización. Se trata de una cánula de aspiración que recoge la sangre que queda libre, trasladándola a una centrifugadora donde se filtra y lava, almacenándola en una bolsa de recogida para su posterior infusión. La sangre es de gran calidad y contiene un hematocrito más elevado que la procedente de banco (AU)

The blood retrievers are instruments increasingly used in operating rooms. They are especially useful in operations where there is a high risk of bleeding and transfusion requirements are high. In paediatrics is of great importance in complex interventions in order to avoid allogeneic transfusion (blood collected from donors). The implementation of the recovery of blood in the surgical field is very simple and easy to use. This is a suction tube that collects the blood that is free, transferring it to a centrifuge where it is filtered and washed, stored in a blood collection bag for subsequent infusion. The blood is of high quality and contains a high hematocrit blood from the bank (AU)

[Care levels in an intensive care unit. Analysis of therapeutic requirements and severity scales]. / Niveles asistenciales en un Servicio de Medicina Intensiva. Análisis de escalas de esfuerzo terapéutico y nivel de gravedad.

The APACHE II and TISS scales usually are used in intensive medicine services to assess patient's severity and therapeutic requirements, respectively. Both scales serve to classify ICU patient's into three care levels, each of which has its own well-defined surveillance and care requirements. Nursing personnel have used the TISS scale to determine work loads and plan nurse-patient ratios. However, this scale is complex and its application is time-consuming, thus impeding its routine use. In recent years, the NEMS (Nine Equivalents of Nursing Manpower) scale has been validated for this purpose. This scale uses just nine variables to objectively quantify nursing requirements. In order to determine if the NEMS scale could be used to evaluate the severity and nursing requirements of patient's admitted to our ICU and to establish care levels, we designed a descriptive study of a sample of 78 patients. The results showed that the APACHE II, TISS and NEMS scales has a good correlation and that the NEMS scale could be used to determine patient care requirements in our service. Based on the TISS and NEMS correlation, we determined discriminative numerical NEMS values for assigning patient's to different care levels.

[Venous catheters with peripheral access]. / Catéteres venosos de acceso periférico.

Using different catheters to inject or infuse drugs into patients veins, as well as drawing blood samples, are part of the daily hospital routine for nursing personnel. There are many documented accounts written about these instruments, most by professional experts and therefore usually very technical in nature. This technical aspect presents a stumbling block for nursing personnel who are studying or just starting their practice. The purpose of this article is to present a practical, simple description of the different types of peripheral access catheters, their use and maintenance.