American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Comparative Study
Echocardiographic determination of valid zero reference levels in supine and lateral positions.
The phlebostatic axis--the junction of the fourth intercostal space and the midpoint of the anterior-posterior diameter--has been accepted as a reliable external reference point for the mid-right and mid-left atrium. Acceptance of this reference point is based upon research conducted in 1945 that measured venous pressures in the hands of subjects positioned with the head of the bed raised to different levels. The validity of this reference point for intracardiac pressure measurements in supine or laterally positioned patients has not been established. ⋯ We analyzed the data of 25 normal, healthy subjects. The study findings show that the phlebostatic axis is a valid reference point for the right atrium, and the phlebostatic axis and midanterior-posterior diameter are valid reference points for the left atrium in the supine position. However, neither is a valid external reference point in the lateral positions. Pressure measurements obtained when patients are in the lateral positions are not accurate. There remains a need to develop valid methods of accurate pressure measurements in various body positions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Accuracy of drawing coagulation samples from heparinized arterial lines.
To determine the accuracy of activated partial thromboplastin time and prothrombin time studies when samples are drawn through heparinized arterial lines. ⋯ Results indicated that the minimal amount of discard volume for accurate activated partial thromboplastin time values in this population of percutaneous transluminal coronary angioplasty patients was the catheter deadspace volume plus 2 mL (total 3.6 mL).
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Comparative Study
Clinical safety and cost of heparin titration using bedside activated clotting time.
To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time. ⋯ These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.
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Adult respiratory distress syndrome, presenting as rapid respiratory decompensation in the setting of preeclampsia at 36 weeks of gestation, was managed by early hemodynamic monitoring with pulmonary artery catheterization. With confirmation of the diagnosis of preeclampsia the patient was delivered promptly; improvement of her respiratory failure was observed within 48 hours. Consideration of adult respiratory distress syndrome in the setting of preeclampsia is discussed, with emphasis on early confirmation of the diagnosis and determination of the precise mechanisms of pulmonary edema.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Evaluation of the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines: the AACN Thunder Project. By the American Association of Critical-Care Nurses.
To evaluate the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines. ⋯ Chances for patency are greatest in men with long femoral lines who receive other anticoagulants or thrombolytics and heparinized flush solutions. Risks of nonpatency are greatest in women with short nonfemoral lines who do not receive other anticoagulants or thrombolytics and have nonheparinized flush solutions.