"Extended subcutaneous route" technique: a quick subcutaneous tunnelling technique for PICC insertion.

PURPOSE: To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the "extended subcutaneous route" technique. METHODS: The "extended subcutaneous route" technique is described step by step. RESULTS: In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed. CONCLUSIONS: Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.

[The impact of closed system and 7 days intravascular administration set replacement on catheter related infections in a general intensive care unit: a before-after study]. / Efficacia della linea chiusa e sostituzione delle linee infusionali ogni 7 giorni sulle infezioni da catetere vascolare in una terapia intensiva polivalente: studio pre-post.

INTRODUCTION: The incidence of catheter related Bloodstream infections (BSI) is high in intensive care units (ICU). AIM: To evaluate the BSI rate in a population of patients admitted to a General ICU before and after the implementation of the 2011 CDC guidelines. METHODS: Retrospective observational study on patients admitted from January 2009 to December 2013. The infusion and monitoring lines were changed every 96 hours for the first 30 months, and every 7 days for the next 30. In all patients a closed infusion line with needle-free connectors pressure was used (Microclave). The following catheters were considered in the study: central venous catheter (CVC), arterial cannula (ART) and Swan Ganz catheter (SG). RESULTS: During the period with change every 96 hours 15 BSI were observed over 13395 catheters/days (C/D), 1.12 per 1000 C/D, while when lines where changed every 7 days 11 BSI were observed over 13120 C/D, 0.83 per 1000 C/D. A statistically significant reduction of BSI was observed in SG catheters (4.17 vs. no BSI p = 0.02), while the CVCS (1.12 vs 1.45 - p = 0.37) and ART (0.35 vs 0.36 - p = 0.61) infection rates remained unchanged. CONCLUSIONS: The replacement of infusion lines every 7 days in our sample did not increase the BSI, helping to reduce the costs.

[Nursing activities score: differences in nursing workload in three intensive care units]. / Nursing activities score: differenze nei carichi di lavoro infermieristici in tre terapie intensive.

INTRODUCTION: The activities that impact on the nursing workload in an intensive care unit have not been described. AIM: To retrospectively analyze the nursing workload in the three intensive care units-ICU (general, neurosurgery and cardiac surgery) of the same department with the Nursing Activities Score (NAS) to describe the nursing interventions that mostly impact on the workload. METHODS: Retrospective observational study. Patients admitted from January 2006 to December 2012 were included in the study. The NAS was completed every 24 hours around 6 am. RESULTS: Patients included in the study were 7588; their mean NAS score was 61.7 ± 19.02%; 75.9 ± 1.44 in General ICU, 61.6 ± 2.46 Neuro ICU, 62.5 ± 3.06 in the Cardiosurgical ICU. The items that mostly impacted on the nursing workload were the need of monitoring and titration, the hygiene procedures, and the Mobilization and positioning. The three procedures were performed with different frequencies in the three ICUs. CONCLUSIONS: The results confirm that the minimum required care in ICUs is around 950 minutes/day. The differences observed in the three ICUs were determined by the different clinical severity and caring complexity of the patients.

[Level of sedation level and modifications of vital signs during hygienic care in patients admitted to an intensive care unit]. / Livello di sedazione e alterazioni dei parametri vitali durante le cure igieniche nei pazienti ricoverati in una terapia intensiva polivalente.

INTRODUCTION: Hygienic care practices may represent a source of stress for intensive care patients. AIM: To identify the hygienic care practices more involved in changes of vital signs and the association to the level of sedation. METHODS: Prospective observational study of eleven patients admitted to a general intensive care unit, observed for three consecutive hygiene care morning practices. A protocol for standardizing hygiene practices was adopted. Vital signs were recorded on an electronic database at the beginning of each of the following phase: before the start of hygiene, of mouth cleaning, of sponge bath, positioning of bedpan, first and second side rotation, change of position of endotracheal tube and replacement of tapes, and at the end of hygiene. RESULTS: 29 events of hygiene practices were observed in the 11 patients included in the study (the measurements of three events were discarded). Significant vital signs alterations were induced mainly by the rotation and change of position of the orotracheal tube. Significant correlations were observed between changes in Heart Rate and Bispectral Index (BIS) (coefficient of 0.345; P: 0.329), between BIS and systolic arterial blood pressure (0.774, P: 0.009), BIS and Tidal Volume (-0.569, P: 0.086), and BIS and Respiratory Rate (0.707, P: 0.022). CONCLUSIONS: The hygienic care in intensive care patients may negatively impact on vital signs. Some nursing manoeuvres cause variations of the vital signs also related to changes in the state of consciousness caused by possible defects or excesses of sedation. The sedation level, during hygienic care, should be constantly monitored.

[Number of nurses and adverse events: the results of a study]. / Fabbisogno assistenziale e insorgenza di eventi avversi in terapia intensiva: i risultati di un'indagine.

UNLABELLED: Number of nurses and adverse events: the results of a study. Introduction. Adverse events may be related to an higher workload and a lower nurse staffing level compared to patients needs. OBJECTIVE: To assess the association between adverse events and lower nurse staffing level compared to patients workload, measured with the Nursing Activity Score (NAS). METHOD: The daily workload of patients admitted to the Intensive Care Unit of San Gerardo Hospital (Monza) from December 15, 2009 to May 9, 2010 was measured with the NAS. The scores were correlated with the number of nurses on shift over 24 hours, the bed occupancy rate and the adverse events occurred. RESULTS: Out of a population of 240 patients for a follow-up period of 145 days, 45 adverse events were observed. In the days with events the difference between ideal and actual nurses requirement amounted to -7.68% (±8.84). On days without events, the difference was 0.44% (±7.96) (p value 0.0001). In the days with events patients received less minutes of care than needed -110.66 (±127), and on days without events an excess of minutes of care 6.40 (±115) minutes /patient. The average NAS score of patients with events was 81.88 (±10.00); 73.54 (±13.83) of those without events (p=0.001). CONCLUSIONS: In the period observed adverse events occurred mainly when the difference between patients workload according to NAS and minutes of care provided by nurses on shift was higher.