American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. ⋯ Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.
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Multicenter Study
Factors Associated With Home Visits in a 5-Year Study of Acute Respiratory Distress Syndrome Survivors.
Participant retention is vital for longitudinal studies. Home visits may increase retention, but little is known about the subset of patients they benefit. ⋯ Home visits were important for retaining older and more physically impaired study participants, helping reduce selection bias caused by excluding them.
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Hospital-acquired pressure injuries disproportionately affect critical care patients. Although risk factors such as moisture, illness severity, and inadequate perfusion have been recognized, nursing skin assessment data remain unexamined in relation to the risk for hospital-acquired pressure injuries. ⋯ The strongest predictor was irritated skin, a potentially modifiable risk factor. Irritated skin should be treated and closely monitored, and the cause should be eliminated to allow the skin to heal.
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Bedside methods to verify placement of a feeding tube are not accurate for detecting placement within the gastrointestinal tract, increasing risk of pulmonary aspiration. Current guidelines recommend verifying placement every 4 hours, yet the rationale for this recommendation is unknown. ⋯ No tubes migrated retrograde into the stomach or esophagus, challenging the practice of verifying placement every 4 hours. Verification every 24 hours may be adequate if migration is not suspected. Also, lack of visible anatomical structures on insertion tracings from an electromagnetic placement device make subtle changes in postpyloric placement difficult to identify accurately.
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Removal of urinary catheters depends on accurate noninvasive measurements of bladder volume. Patients with acute kidney injury often have low bladder volumes/ascites, possibly causing measurement inaccuracy. ⋯ Bladder volume can be measured accurately with bladder scanning or US, but abdominal fluid remains a confounding factor limiting accuracy of bladder scanning.