Anaesthesia
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Multicenter Study
A survey of the use of ultrasound guidance in internal jugular venous cannulation.
It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 2002, promoting the use of ultrasound in placement of internal jugular venous cannulae, utilisation of ultrasound has increased throughout the United Kingdom. ⋯ There was no significant difference in practice between those working within a sub specialty in anaesthesia. There continues to be discrepancies between the application of the guideline and how senior anaesthetists both site and teach the placement of internal jugular vein central venous cannulae.
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Unplanned extubation in a paediatric intensive care unit: impact of a quality improvement programme.
Unplanned tracheal extubation is an important quality issue in current medical practice as it is a common occurrence in paediatric intensive care units. We have assessed the effectiveness of a continuous quality improvement programme in reducing the incidence of unplanned extubation over a 5-year period. After a 2-year baseline period, we developed action plans to address the issues identified. ⋯ This reduction was the result of a decrease in unplanned extubation in children younger than 2 years of age. Although mortality was similar to that of children who did not experience an unplanned extubation, those with an unplanned extubation had a significantly longer duration of mechanical ventilation, longer stay in the intensive care unit, and longer hospital stay. We found that the implementation of a continuous quality improvement programme is effective in reducing the overall incidence of unplanned extubations.
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The threshold for the identification of changes in heart rate and the accuracy in estimating heart rate were compared between 20 anaesthetists and 20 non-anaesthetists in a simulated operating theatre, both with and without distraction tasks. Typical operating theatre distractions were simulated by requiring anaesthetists and non-anaesthetists to perform secondary tasks. There were no differences found between the groups in identification of heart rate changes. ⋯ An upward heart rate change was more easily detected than a reduction. Anaesthetists were found to be marginally better at estimating the heart rate change from an auditory tone alone. However, the study did not confirm that anaesthetists have a superior ability to detect changes in heart rate than non-anaesthetists.
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We reviewed all patient safety incidents reported to the UK National Patient Safety Agency between August 2006 and February 2007 from intensive care or high dependency units. Incidents involving equipment were then categorised. A total of 12 084 incidents were submitted from 151 organisations (median (range) 40 (1-634) per organisation). ⋯ Twenty-nine incidents were associated with more than temporary harm to patients. Failure or faulty equipment was described in 537 incidents (26% with some harm) and incorrect setting or use was described in 358 incidents; these were more likely to be associated with harm (39%; p = 0.001). We suggest changes to improve the reporting of incidents and to improve equipment safety.
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We present three patients with respiratory failure in whom conventional mechanical lung ventilation resulted in unacceptably high levels of carbon dioxide, severe acidosis and high vasopressor requirements. A pumpless arteriovenous extracorporeal carbon dioxide removal device (Novalung) was inserted. ⋯ There were no complications associated with use of the device. We conclude that use of extracorporeal carbon dioxide removal devices should be considered at an early stage in the management of respiratory failure refractory to conventional ventilatory techniques.