[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.

[Tracheostomy cannulas]. / Cánulas de traqueostomia.

Tracheostomic clyster pipes are mechanisms which allow one to artificially maintain the permeability of the air passageway under those circumstances when it is not possible to breathe by the conventional way. Nowadays, there is a wide variety of clyster pipes available to medical professionals. Each of these has its own traits and precise applications. This article describes those clyster pipes most frequently used in hospitals and outpatient clinics; furthermore, their use, care and therapeutic applications are mentioned.

[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.