Der Anaesthesist
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Perioperative phases of hypotension are associated with an increase in postoperative complications and organ damage. Whereas some years ago hemodynamic stabilization was primarily carried out by volume supplementation, in recent years the use and dosing of cardiovascular-active substances has significantly increased. But like intravascular volume therapy, also substances with a cardiovascular effect have therapeutic margins, and thus, potential side effects. ⋯ Special attention is paid to the question how to administrate them: central venous catheter vs. peripheral indwelling venous cannula. The authors come to the conclusion that it is not a question of whether it is principally allowed to apply cardiovascular-active drugs via peripheral veins but more importantly, what should be taken into consideration if a peripheral venous access is used. This article provides concise recommendations.
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[Findings from 10 years of CIRS-AINS : An analysis of usepatterns and insights into new challenges].
Critical incident reporting systems (CIRS) serve to sensitize organizations and individuals to unknown events relevant to patient safety and therefore help in developing safer systems; however, the use and impact of these systems in healthcare has recently been questioned for a variety of reasons, among them unclear and imprecise reporting criteria. Some authors claim that fundamental aspects of successful CIRS have been misunderstood, misapplied or entirely missed during the adaptation to the healthcare context. The aim of this study was the analysis of all reports accumulated over 10 years in the German system CIRSmedical Anesthesiology (CIRS-AINS) as a basis for improved reporting guidelines, user training and generation of further hypotheses. ⋯ The analysis provides insights into reporting practices and can influence both reporting guidelines as well as user training. Report format, content and context are of utmost importance for further analysis: A distinction has to be made between reports that contain locally rational information and cannot be understood without further context and reports that may help inform about patient safety activities on a national level. Especially in light of the limited resources for incident analysis, the content should be critically reflected upon by the user when submitting a report to support a wise allocation of available capacities. In this respect, the increase of non-CIRS reports has to be considered in the future implementation of nationwide IRS. Also, it has to be questioned whether adequate alternative means of communication for these non-CIRS reports exist. The majority of reports were made by physicians, which is in contrast to international experiences with increased engagement of nursing staff and underlines the need for increased interprofessional collaboration with incident reporting and analysis activities in Germany. Reports containing workload complaints, while constituting important signals on a local level, usually fail to address the idea of learning from others inherent to the philosophy of national IRS.
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Criteria for the identification of suitable applicants for undergraduate and postgraduate medical education are greatly and ubiquitously discussed. Apart from the acquisition of theoretical knowledge and practical skills, certain personality traits are necessary for practicing the medical profession; however, little is known on the personality traits required for medical subspecialties. This study had two objectives: 1) identification and evaluation of personality traits which are essential for performing anesthesiology and 2) establishment of a job specification for anesthesiology. ⋯ A job specification describing important personality traits can be useful to advise both undergraduates and postgraduates on their medical career and for medical team simulation tasks. For the clinical practice in anesthesiology, for example, high social interactive and cognitive personality traits are required.
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Inadvertent fixation of a Swan-Ganz pulmonary artery catheter by a suture is a rare complication. We present a case report of a patient undergoing heart transplantation in whom the catheter was fixed by a suture at the upper venous cannulation site for the cardiopulmonary bypass. ⋯ The catheter could then be removed. The patient did not suffer from any consequential damage.