Recuperadores sanguíneos postoperatorios / Post operatory blood recuperators. Bibliographical review

El uso de los recuperadores postoperatorios, sobre todo en cirugía ortopédica, es una práctica habitual en nuestros días. Las enfermeras tienen un especial protagonismo en su manipulación; por ello se comentan las razones para el empleo de estos dispositivos. También se exponen las diferentes evidencias científicas tras revisión bibliográfica sobre la efectividad de estos sistemas, la utilidad, la calidad del producto, el coste beneficio y la ausencia de efectos indeseables. Se concluye que existe un determinado perfil de paciente que se beneficia del empleo de este tipo de dispositivos. Tras unos años de alta implantación, se produce actualmente un ligero descenso en su uso debido, en primer lugar, al empleo prequirúrgico de agentes hematínicos y, en segundo lugar, al desarrollo de ciertas técnicas quirúrgicas menos invasivas. A pesar de ello, este procedimiento se ha demostrado como coste efectivo. El rol de las enfermeras en su manejo es importante y combinado con otras medidas (como el uso de dispositivos de análisis de la hemoglobina en cabecera del paciente) puede contribuir a una mejor gestión de los requerimientos transfusionales(AU)

The authors presented this report at the Apheresis Workshop at the Mexican Congress on Transfusions. VI Annual Congress AMMTAC in Monterrey, Nuevo León district. The use of post operatory recuperators, especially in orthopedic surgery, is a habitual practice nowadays. Nurses play a special role in their handling and use; therefore, the authors comment on the reasons why these devices should be used. The authors also state different scientific evidence, based on a bibliographical review, regarding the effectiveness of these systems, their utility, their product quality, their cost benefit, and the absence of undesirable effects. The authors conclude that there is a determined patient profile for when a patient benefits from the use of these devices. After some years of high use, at present times, there has been a reduction in using these devices due to, firstly, the pre-surgical use of hematin agents, and secondly, due to the development of certain less invasive surgical techniques. In spite of this, this procedure has proven to be cost effective. Nurses have an important role in the handling and use of these instruments which, combined with other measures such as the use of hemoglobin analysis devices at the head of a patient’s bed, can contribute to an improved management of transfusion requirements(AU)

An investigation comparing the Oxford Chair Technique with the traditional methods of glenohumeral dislocation reduction currently implemented.

UNLABELLED: This paper reports on the findings of a quantitative, retrospective service evaluation. It compared a new, conscious, sedation-free technique to reduce anterior glenohumeral dislocations with the traditional methods of reduction (TMR) currently implemented. OBJECTIVES: The first objective for this study was to examine whether a new method, used at an Emergency Department (ED) in the south of England, of glenohumeral dislocation reduction, called the Oxford Chair Technique (OCT) can reduce anterior glenohumeral dislocations and to compare the success rates of reduction with the TMR. Secondary objectives examined how the OCT compared, using four set factors, against the TMR currently used. The fundamental comparisons being analysed was in terms of time taken for treatments. METHODS: A retrospective service evaluation was performed using data collected from the Patient Administration System (PAS) software and the Picture Archiving and Communications System (PACS) on patients who presented to an ED in the South of England with an anterior glenohumeral dislocation between March 2005 and August 2006. RESULTS: Of the 61 cases in which the OCT was used over the sampling period, 38 attempts to reduce the dislocation were successful, with 23 being unsuccessful. An overall success rate of 62% was obtained with the OCT. There were no complications reported with the OCT. Statistically significant differences were found with the mean time from arrival to discharge (OCT 141 v. TMR 254 min, p<0.001); mean time between the first diagnostic X-ray and post reduction X-ray (OCT 70 v. TMR 102 min, p<0.003) and the mean time between the post reduction X-ray and discharge (OCT 51 v. TMR 119 min, p<0.001). No patients treated with the OCT required conscious sedation compared to 90% of patients treated with TMR (p<0.001). Only 38% of patients treated with the OCT had morphine administered compared to 90% of patients treated with TMR (p<0.001). CONCLUSIONS: Overall, the success rate for reduction using the OCT was good in view of this being a new treatment to the ED. While the OCT had a lower success rate of reduction compared to TMR, when reduction was successful using the OCT, there were overwhelming time-saving benefits to the patient with subsequent logistical benefits to the ED. The use of conscious sedation and morphine was also significantly less for the OCT group compared to TMR.

Recognising and treating Colles' type fractures in emergency care settings.

In this article, the author explains how to identify a Colles' type fracture, explains how to insert a haematoma block, and gives a step by step guide to reducing this type of fracture.

Soft tissue manipulation: neuromuscular and muscle energy techniques.

Muscle rigidity and spasms occur with neurological disease and may contribute to contractures and shortening of muscle fibers that can interfere with motor behaviors, such as ambulation, or activities of daily living, such as combing hair, feeding or dressing. The neuromuscular technique (NMT) and muscle energy technique (MET) are nursing interventions that can reduce pain and muscle rigidity, lengthen muscle fibers and increase range of motion necessary for normal motor behavior. Nurses can use these techniques in patients with acute neurological diseases and those recovering in rehabilitation and long-term care settings. With some neurological diseases, muscle rigidity, increased muscle tone and muscle spasms reduce the range of motion of joints and the quality of movement. These changes often lead to contractures and impairments in performing daily tasks or ambulating, and thus, to loss of independence. Soft tissue manipulation can be used to reduce muscle tension and spasms, reduce pain and enhance the range of motion of joints whose function depends on the involved muscles. Soft tissue manipulation may also improve movement during specific tasks. Although the muscle relaxation achieved with manipulation techniques is primarily short-term, long-term effects occur. This article describes two techniques of soft tissue manipulation, their mechanisms of action, assessment and implementation. A case study is used to illustrate application of the techniques and possible long-term effects.