American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Although nurse educators and nurse managers have disagreed about which clinical competencies are necessary for new graduates to begin working in critical care, the competencies are in need of revision and reassessment. ⋯ The agreement between nurse educators and nurse managers supports a competency list for baccalaureate nursing curricula and hospital inservice programs to integrate new graduates into critical care.
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Recently, a change in anticoagulation therapy occurred that is still partially ignored by the healthcare community. Understanding the controversy over the use of the internal normalized ratio in monitoring patients receiving warfarin therapy is important for nurses who provide care to these patients. ⋯ The international normalized ratio is the most appropriate way to evaluate the effects of warfarin therapy. All healthcare providers should use this ratio as the standard in evaluating the effects of anticoagulation therapy.
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To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. ⋯ Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.
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Comparative Study
Comparison of heparinized and nonheparinized solutions for maintaining patency of arterial and pulmonary artery catheters.
Arterial and pulmonary artery catheters are often used in the management of critically ill patients. If heparin were not necessary to maintain the patency of arterial and pulmonary artery catheters, these patients could avoid exposure to heparin. ⋯ The failure rate of pulmonary artery catheters was not affected by the use of nonheparinized solutions. Arterial catheters failed less often when they were maintained with heparinized solutions. The authors recommend that all arterial catheters be maintained with heparinized solutions, unless use of heparin is contraindicated.
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Randomized Controlled Trial Comparative Study Clinical Trial
Rewarming cardiac surgical patients: warm water vs warm air.
Hypothermia is experienced by 60% to 90% of adult patients after surgery. The detrimental physiological consequences of prolonged hypothermia are a significant risk for cardiac surgical patients. ⋯ The data suggest that rewarming with a circulating-water blanket produces normothermia more rapidly than rewarming with a warm convective-air blanket in adult patients who are hypothermic after cardiac surgery.