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Archived Issues
August 2003 - VOLUME 223- NUMBER 4
What Circumstances Warrant a Chest Drain Suction Pressure Greater than -20cm H20 Q . The Atrium dry suction chest drainage system can be set to -40 cm H20 ; I have never seen suction pressures other than -20cm H20 ordered. What Circumstances Warrant a Chest Drain Suction Pressure Greater than -20cm H20 Go to Response(PDF file open in Adobe Reader) Members only
December 2002 - VOLUME 22 - NUMBER 6
Irrigation of Ventriculostomy Catheters - Scope of Practice Bedside Clinician or APN?
Q . Our physicians are asking the nurses to irrigate ventriculostomy catheters. What is the physiologic effect of irrigating these catheters? What types fo solutions and volumes are appropriate? Is this really within the scope of practice for the bedside clinician or should it only be the responsibility of the advanced practice nurses? Go to Response(PDF file open in Adobe Reader)
December 2002 - VOLUME 22 - NUMBER 6
PROTOCOLS FOR PRACTICE
Interventions to Decrease Family Anxiety
October 2002 - VOLUME 22 - NUMBER 5
PROTOCOLS FOR PRACTICE
Sedation and Neuromuscular Blockade in patients with Acute and Respiratory Failure.
April 2002 - VOLUME 22 - NUMBER 2
Suctioning ET and TT Tubes Q . How deep should I go when suctioning an endotracheal tube (ETT) or tracheostomy tube (ET)? Page 1 of PDF file Obtaining a Wedge Pressure Q . When Obtaining a wedge pressure, how will I know that the balloon is deflated if I don't withdraw the air from the balloon with the syringe? Page 3 of PDF file
Go to Response(PDF file open in Adobe Reader)
April 2002 - VOLUME 22 - NUMBER 2
PROTOCOLS FOR PRACTICE
Non Invasive Blood Pressure Monitoring
February 2002 - VOLUME 22 - NUMBER 1
Percutaneous Sheath Introducer Systems Used for Venous Access Q . Are there guidelines for use of the introducer sheath as a venous access route after the pulmonary artery catheter has been removed? This procedure appears to be common practice, yet no clear guidelines seem to exist for this use. Also, are there any special risks involved in this practice? Go to Response(PDF file open in Adobe Reader)
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December 2001 - VOLUME 21 - NUMBER 6
To Turn or Not to Turn? Patients on Mechanical Ventilation Q . Frequently in the past year, I have seen patients receiving mechanical ventilation for several days with the fraction of inspired oxygen (F102) set at 100%. I notice that many nurses do not turn these patients because the patients' arterial oxygen saturation (Sao2) may decrease to about 80% to 85% and take up to 10 minutes to return to baseline. Should we avoid turning such patients for this reason, or should we still turn patients because of all the benefits that turning provides? Usually, these patients have chronic obstructive pulmonary disease and pneumonia. Go to Response(PDF file open in Adobe Reader)
October 2001 - VOLUME 21 - NUMBER 5
How to Perform Atrial ECGs? |
Q. I would like information on the correct procedures for performing atrial electrocardiograms (ECGs) using the 5-lead bedside cable and epicardial pacing wires. I also need help interpreting the atrial ECG. Go to Response
August 2001 -VOLUME 21 - NUMBER 4
What are the Mechanisms of ACS Drugs?
Q. Please review the mechanisms of the anticoagulant and antithrombotic medications used in the treatment of acute coronary syndrome (ACS).Go to Response
June 2001 -VOLUME 21 - NUMBER 3
Instilling Medications via Chest Tubes ?
Q: I am looking for information on nurses instilling medication into chest tubes (e.g., pleurodesis with talc, antibiotics, and/or tissue-type plasminogen activator). In the past, we had a few thoracic surgeons who ordered the talc or antibiotics fairly frequently. As a result of this practice, medication instillation via chest tubes was placed in our nursing procedures manual. This is currently an infrequent procedure done by the physician. A new radiologist is insisting that this was a common practice at his previous hospital and we need to get with the program.
The procedure is still in our procedure book, but I am concerned about best practice regarding this issue. Does the American Association of Critical-Care Nurses (AACN) have any information on this procedure being done by nurses?
Go to Response
April 2001 -VOLUME 21 - NUMBER 2
Blood Sampling Techniques for Patients with Arterial or Venous Catheters ?
Q: When a patient with an arterial or central venous catheter requires a blood sample for laboratory studies, is it acceptable to stop an infusion and obtain the blood sample? How long should the infusion be stopped before a sample is obtained? Is there a difference in sampling technique between a triple-lumen central catheter, an introducer for a pulmonary artery catheter, and an introducer for a femoral artery catheter? Does the procedure differ for pediatric patients? Go to the Response
February 2001 -VOLUME 21 - NUMBER 1
Prone Positioning Guidelines re Hemodynamic Monitoring ?
Q: What are the practice guidelines for prone positioning of acutely ill patients? Specifically, what are the recommendations related to hemodynamic monitoring and tube feeding? Go to the Response (PDF file open in Adobe Reader)
August 2000- VOLUME 20 - NUMBER 4
Detecting Pulmonary Aspirations in Tube-Fed Patients
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| Q. What are the recommended standards of practice for assessment of aspiration of enteral tube feedings in patients with artificial airways such as endotracheal or tracheostomy tubes? Go to the Response |
June 2000- VOLUME 20 - NUMBER 3
Closed-System Chest Tube Suctioning
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| Q. Some of our surgeons have requested that closed-system chest tube suctioning be set to “vigorous bubbling.” Can you clarify the need for gentle versus vigorous bubbling?Go to the Response |
June 2000- VOLUME 20 - NUMBER 3
Removing Mediastinal Chest Tubes
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| Q. A surgeon is asking us to remove mediastinal chest tubes. What is the current consensus or standard of practice for nurses removing chest tubes in a postoperative setting?Go to the Response |
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April 2000- VOLUME 20 - NUMBER 2
15 - 18 Lead ECG Placement
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| Q. Our cardiologists are discussing the possibility of obtaining 15- and 18-lead ECGs on all patients with acute myocardial infarction (MI). Could you please discuss lead placement and special equipment necessary to perform these procedures? Go to the Response |
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December 1999 - VOLUME 19 - NUMBER 6
REFERENCE POINT FOR ZEROING AN ICP
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| Q. What is the recommended external reference point for zeroing an intracranial pressure monitoring system at the foramen of Monro? Go to the Response |
October 1999 - VOLUME 19 - NUMBER 5
EVALUATING WAVEFORMS. |
| Q Is there a difference in the reliability of results when evaluating the square wave of the pulmonary artery waveform as opposed to that of the arterial waveform? Go to the Response |
August 1999 - VOLUME 19 - NUMBER 4
DRY WEIGHT vs ADMISSION WEIGHT for VASOACTIVE DRUGS? |
| Q Is it appropriate to adjust body surface area and IV-administered vasoactive medication dosage against daily weight changes in the ICU? Because of these significant changes, is admission weight acceptable? Is there such a thing as "dry weight"? If so, how is it defined and measured? Go to the Response |
FEBRUARY 1999 - VOLUME 19 - NUMBER 1
ET TUBES: SWALLOWING AND ORAL CARE
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Q. Can a patient who has an endotracheal tube and is on mechanical ventilation be given ice chips? Does the swallowing movement change the pressure in the cuff of the ET tube or trachea to allow leakage into the lungs? What constitutes good, safe oral care for a patient with an artificial airway?
Go to the Response |
DECEMBER 1998 - VOLUME 18 - NUMBER 6
POSTING WAVEFORM TRACING STRIPS |
| How often should nurses place ECG and/or PA waveform tracing strips in the chart? Go to the Response |
AUGUST 1998 - VOLUME 18 - NUMBER 4
FILTER NEEDLES AND GLASS AMPULES |
| Are special filter needles required when drawing up medication from a glass ampule? Are there hidden risks to patients, i.e., sharp glass particles, if a filter needle is not used? Go to the Response |
AUGUST 1998 - VOLUME 18 - NUMBER 4
BLOOD SAMPLING FROM PULMONARY ARTERY CATHETERS
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When a patient doesn’t have an arterial or venous access, is it safe to use the distal or proximal port of the pulmonary artery catheter for blood sampling? Can this catheter be used as an additional lumen for medication/fluid administration? Go to the Response
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JUNE 1998 - VOLUME 18 - NUMBER 3
PEDIATRIC PATIENTS IN ADULT ICUs
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| How do you ensure safe and effective care of pediatric patients in adult ICUs? Go to the Response |
FEBRUARY 1998 - VOLUME 18 - NUMBER 1
PULMONARY ARTERY CATHETER PATENCY
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| What is the standard procedure for maintaining patency of a pulmonary artery (PA) catheter? In PA catheters with additional ports, is it recommended to use a continuous flush solution or can you heparin lock the ports to maintain patency? If a port becomes clogged is it recommended to use urokinase? Go to the Response |
DECEMBER 1997 - VOLUME 17 - NUMBER 6
ARTERIAL CATHETER REFERENCE LOCATION
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| In the article “Direct Arterial vs Oscillometric Monitoring of Blood Pressure: Stop Comparing and Pick One” (June 1997), Elizabeth J Bridges and Robert Middleton stated that the correct reference site for an arterial catheter is the heart, which is identified externally by the phlebostatic axis. This statement is in contrast to Marianne Chulay and Sally Holland’s recommendation (“Ask the Experts” [December 1996]) to reference the system 1 cm below the insertion site. Please clarify this issue. Go to the Response |
OCTOBER 1997 - VOLUME 17 - NUMBER 5
OBTAINING A PULMONARY ARTERY WEDGE PRESSURE
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| When obtaining a wedge pressure, what is the recommended practice regarding the gate valve after allowing the balloon to passively deflate? Should the syringe be reattached? Should the gate valve be closed or should it be left open? Go to the Response |
JUNE 1997 - VOLUME 17 - NUMBER 3
CARE OF THE INTRA-AORTIC BALLOON CATHETER INNER LUMEN
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| What is the recommendation for care of an intra-aortic balloon catheter inner lumen? Go to the Response |
APRIL 1997 - VOLUME 17 - NUMBER 2
MONITORING CONSCIOUS SEDATION
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| What is the nurse's role in monitoring a patient who is consciously sedated? How can the Joint Commission of Hospital Accreditation requirements be met on a consistent basis throughout the facility, whether it be an outpatient bronchia l unit, a GI lab, or in the recovery room? Go to the Response |
February 1997 - VOLUME 17 - NUMBER 1
Transmyocardial Laser
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| What is Transmyocardial laser revascularization? Go to the Response |
More Ask the Experts questions are on the way...
Do you have a clinical, practical, or legal question you'd like to have answered? Send it to us and we'll pass it on to our "Ask the Experts" panel. Questions may mailed to Ask the Experts, Critical Care Nurse®, 101 Columbia, Aliso Viejo, CA 92656, or sent via e-mail to ccn@aacn.org. Questions of greatest general interest will be answered in this department each issue.
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