Journal of infusion nursing : the official publication of the Infusion Nurses Society
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In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, specialty nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. This research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power-injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital's rehabilitation facility. Of the 422 catheters removed, none exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection.
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Fluid management is a vital component in the resuscitative care of the injured child. The goal of fluid resuscitation is to restore tissue perfusion without compromising the body's natural compensatory mechanism. Recent literature has questioned the timing, type, and amount of fluid administration during the resuscitative phase. ⋯ Fluid resuscitation in the early phase of care, whether in the field, emergency department, or operating room, should be targeted toward perfusing critical organs, such as the brain and heart. Once obvious bleeding is controlled, the overall goal for fluid management centers on maintaining oxygen delivery to perfuse vital structures with enough oxygen and energy substrates to maintain cellular function, thus avoiding tissue ischemia. However, specific issues around timing and type of fluid administration, once thought to be straightforward, have triggered increasing investigation of current beliefs.
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Cardiac (pericardial) tamponade occurs when the pressure of the fluid within the pericardial sac is high enough to impair the venous return to the heart. Cardiac tamponade can occur during central venous catheter placements. ⋯ A methodical approach to this potentially fatal condition can greatly increase patient safety. This article reviews this condition, its clinical presentation and diagnosis, and strategies for avoiding central vascular access-associated tamponade.