Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2017
Intravascular catheters-an ultrasound imaging based observational study of position and function.
Peripheral intravenous and intra-arterial catheters often block with movement of the limb in which they are inserted. Although the cause of this blockage is commonly attributed to a valve or other structure within the vein, evidence for this is lacking. We used ultrasound to assess the cause of blockage on movement, and degree of tip movement, of 62 venous and 21 radial arterial catheters. ⋯ Mean potential tip movement was 12.3 mm and 5.7 mm in hand and forearm venous catheters respectively and 9.5 mm in radial artery catheters. There was a significantly lower rate of blockage for forearm (20%) compared to dorsal hand venous catheters (83%, P <0.001) and 52% of radial artery catheters showed damping and blockage on wrist flexion. This study emphasises the advantages of placement of venous catheters in the straight veins of the forearm.
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Anaesth Intensive Care · Jul 2017
Awareness during general anaesthesia in the first 4,000 incidents reported to webAIRS.
The aim of this study was to analyse the incidents related to awareness during general anaesthesia in the first 4,000 cases reported to webAIRS-an anaesthetic incident reporting system established in Australia and New Zealand in 2009. Included incidents were those in which the reporter selected "neurological" as the main category and "awareness/dreaming/nightmares" as a subcategory, those where the narrative report included the word "awareness" and those identified by the authors as possibly relevant to awareness. ⋯ Memory of intraoperative events caused significant ongoing distress for five of the 16 awareness patients. Patients continue to be put at risk of awareness by a range of well-described errors (such as syringe swaps) but also by some new errors related to recently introduced anaesthetic equipment, such as electronic anaesthesia workstations.
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Anaesth Intensive Care · Jul 2017
Primary prevention in the intensive care unit: a prospective single-centre study of the risk factors for invasive pneumococcal disease.
Invasive pneumococcal disease is a significant health burden in Australia, with immunisation recommended for children and at-risk adults. Health benefits of immunisation are clear, but less effective when immunisation rates are low, as in Western Australia. We hypothesised that patients admitted unplanned to the intensive care unit (ICU) would have high eligibility for pneumococcal immunisation, but low rates of recorded vaccine administration. ⋯ Fifty-four of 119 admitted patients (45%) were assessed as eligible for immunisation after ICU discharge. ICU survivors represent a high-risk population for which intervention against modifiable targets, such as invasive pneumococcal disease, may reduce both their chronic health burden and future health expenditure. Future efforts should concentrate on assessing the feasibility of a screening program for modifiable factors in ICU survivors, and the logistics of delivering these interventions in a timely manner during their hospital stay.
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Anaesth Intensive Care · Jul 2017
Fluid resuscitation in critically ill patients-timing and dose matters.
Fluid management is a complex subject in healthcare, particularly when pertaining to critically ill patients. Following a literature search on international recommendations regarding fluid administration for shocked patients, an audit was undertaken at Rotorua Public Hospital, New Zealand, to assess how the local fluid resuscitation strategy could be improved. The first part of the audit looked at the fluid resuscitation approach used to treat shocked patients admitted to the ICU of Rotorua Hospital in 2014 and changes required to achieve best practice recommendations. ⋯ Data was extracted from patient files, fluid charts and electronic records to assess fluid administration and de-escalation measures. The collated information was analysed and compared to recommendations found in the literature. The complete audit cycle revealed not only a significant improvement in adherence to best practice guidelines, but also an association with better patient outcomes.