Journal of infusion nursing : the official publication of the Infusion Nurses Society
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Inappropriate intravenous fluid therapy results in increased patient morbidity and mortality. By far the most common fluid and electrolyte problems that confront both chronically and critically ill patients are disturbances in sodium and water balance. Thus, it is important for the infusion therapy nurse to understand the basic pathophysiology of sodium imbalances as well as therapeutic approaches for their correction. Adding to this need is the recognition that, in hospital settings, disorders of sodium and water balance are often iatrogenic.
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Infants and children are typically undertreated for pain. Many treatment options are available to prevent and diminish the pain experienced by children during venipuncture. Infusion nurses must employ pharmacologic and nonpharmacologic treatment options to make the experience more positive for the child, the family, and the nurse. These treatment options are explored in this article.
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Sepsis is a major cause of patient morbidity and mortality. Many critically ill patients are septic, and red blood cell transfusion is often part of their treatment plan. Studies have shown that red blood cell transfusion is associated with a dose-dependent increase in patient morbidity and mortality. ⋯ In addition, there are similar effects in the pathophysiology of sepsis that may overlap with the changes that occur with storage of red blood cells. This article will discuss recent literature addressing red cell transfusion in critically ill and septic patients and discuss general guidelines for red cell transfusion in this patient population. This article will also discuss the epidemiology and pathophysiology of sepsis and relate how storage and transfusion of red cells may potentially contribute to changes observed in a septic patient.
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Ketamine is a well-described anesthetic and analgesic, unique in its ability to preserve laryngeal reflexes and airway protection, and offered to a wide range of patients, although not necessarily widely used. Because it is considered an anesthetic, widespread use by all sedation providers is often limited despite its long history as a safe sedative. ⋯ The use of ketamine in patients with epilepsy or traumatic brain injury is more controversial. This article will explore the side effects of ketamine and current research that support or discourage its use in a variety of settings.
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Randomized Controlled Trial
A randomized double-blind study comparing intradermal anesthetic tolerability, efficacy, and cost-effectiveness of lidocaine, buffered lidocaine, and bacteriostatic normal saline for peripheral intravenous insertion.
In this double-blind study, 256 surgical patients meeting eligibility criteria were randomized in a 1:1:1 ratio to 1 of the 3 intradermal injection groups prior to intravenous (IV) line insertion (Group 1=1% lidocaine, Group 2=1% buffered lidocaine, and Group 3=bacteriostatic normal saline with a benzyl alcohol preservative). The most tolerable solution, as measured by the average level of pain from an intradermal insertion, was buffered lidocaine (Group 2). The most efficacious, as measured by average level of pain at IV cannulation, were Groups 1 and 2. Group 3 was the most cost-effective.