American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Controlled Clinical Trial
Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit.
Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient's bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation. ⋯ Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs.
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Randomized Controlled Trial
Arterial catheter setup for glucose control in critically ill patients: a randomized controlled trial.
Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. ⋯ Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.
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Clinical practice guidelines are intended to bridge the research-practice gap, yet little is known about how critical care nurses adopt guidelines. Feeding tube verification practices remain variable and have led to patient harm and death. ⋯ Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.
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Randomized Controlled Trial
Interface pressure at different degrees of backrest elevation with various types of pressure-redistribution surfaces.
Increased elevation of the head of the bed is linked to a higher risk for sacral pressure ulcers. A semirecumbent position of at least 30° is recommended for the prevention of ventilator-associated pneumonia in patients treated with mechanical ventilation. Therefore, prevention of pressure ulcers and prevention of pneumonia seem to demand contradictory, possibly incompatible, positioning. ⋯ Backrest elevation up to 30° might be a compromise between the seemingly incompatible demands of skin integrity and the prevention of ventilator-associated pneumonia. The reverse Trendelenburg position and a mattress system with low-air-loss technology could be additional useful tools to help prevent skin breakdown at the sacrum.
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Many therapies used in critical care cause potassium depletion. Current practice relies on potassium replacement protocols after a patient becomes hypokalemic. Potassium bolus therapy creates risk for patients, is costly, and increases nurses' workload. ⋯ Patients with normal potassium and creatinine levels at admission benefitted from a maintenance intravenous dose of potassium of 72 to 144 mmol/L per day. Compared with control patients, patients receiving this dose avoided detrimental hypokalemic events, had fewer invasive procedures and lower costs, and required less nursing care.