Critical Care Newsline — June 3, 2010

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by our clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and websites that will keep you informed on issues affecting nurses and the nursing profession.

June 3, 2010

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1. CALL TO ACTION Submit evaluation forms for CNE and CERP credit by June 7, 8 a.m.
2. CALL TO ACTION Call for NTI 2011 abstracts extended to Monday, June 7, 11:59 p.m.
3. EVIDENCE NEJM study supports CPAP over intubation and surfactant in preterm infants
4. EVIDENCE Intraoperative NG tubes can prevent PONV in cardiac surgery patients
5. CALL TO ACTION Share your thoughts, help AACN’s quest for excellence
6. EVIDENCE Emergent ET intubations in children common, increase complications risk
7. EVIDENCE Consider extracorporeal CPR in pediatric patients, a report recommends
8. EVIDENCE Target ranges of oxygen saturation in extremely preterm infants
9. CALL TO ACTION Participate in survey of hand-offs between CRNAs and SICU nurses
10. CALL TO ACTION Premier Safety Institute launches survey of injection practices
11. GUIDELINE Managing CIEDs in end-of-life and withdrawal therapy patients
12. CLINICAL PRACTICE RESOURCES
13. AACN RESOURCES AACN Protocols for Practice price reductions


1. CALL TO ACTION Submit evaluation forms for CNE and CERP credit by June 7, 8 a.m.
If you attended this year’s National Teaching Institute & Critical Care Exposition, Washington, D.C., May 15-20, submit evaluation forms online for CNE and CERP credit by Monday, June 7, 8 a.m. Pacific Time. After that, the certificates will be available for print only. Submit your forms online.

2. CALL TO ACTION Call for NTI 2011 abstracts extended to Monday, June 7, 11:59 p.m.
AACN has extended the deadline for live education abstracts for the 2011 National Teaching Institute & Critical Care Exposition (NTI) in Chicago to Monday, June 7, 2010, 11:59 p.m. PDT. Access guidelines and get started.

3. EVIDENCE NEJM study supports CPAP over intubation and surfactant in preterm infants
A randomized, multi-center trial, reported in The New England Journal of Medicine, May 17, supports continuous positive airway pressure (CPAP) instead of intubation and surfactant to treat preterm infants. Compared to infants who received surfactant, those on CPAP required less frequent intubation or postnatal corticosteroids for bronchopulmonary dysplasia and fewer days of mechanical ventilation. They were also “more likely to be alive and free from the need for mechanical ventilation by day 7,” states “Early CPAP versus Surfactant in Extremely Preterm Infants.”

4. EVIDENCE Intraoperative NG tubes can prevent PONV in cardiac surgery patients
Using a nasogastric (NG) tube in patients undergoing cardiac surgery can reduce the incidence of postoperative nausea and vomiting (PONV), states “The Effect of Nasogastric Tube Application During Cardiac Surgery on Postoperative Nausea and Vomiting – A Randomized Trial” of 202 patients published online April 28 by the Journal of Cardiothoracic and Vascular Anesthesia.

5. CALL TO ACTION Share your thoughts, help AACN’s quest for excellence
This year’s Annual Membership Forum at the National Teaching Institute & Critical Care Exposition, Washington, D.C., May 15-20, joined attendees with board members for focused discussions about AACN that explored answers to three questions: 1) What is the most innovative practice you’ve seen recently? 2) What can we, the AACN community, do to spread the word about these best practices to let other nurses know about them? 3) As a nurse, what gives you the greatest cause for optimism in the current environment? Respond to these questions at info@aacn.org or NTI Voices Online.

6. EVIDENCE Emergent ET intubations in children commonly increase complications
“Emergent endotracheal intubations are commonly performed in children, are two times more likely to occur off-hours, and are associated with three times the risk of complications as nonemergent intubations,” states “Emergent Endotracheal Intubations in Children: Be Careful If It’s Late When You Intubate,” a retrospective cohort study in May’s Pediatric Critical Care Medicine.

7. EVIDENCE Consider extracorporeal CPR for some pediatric patients, a report recommends
Extracorporeal cardiopulmonary resuscitation (CPR) should be considered for some pediatric patients who don’t respond to conventional resuscitation techniques, states a report in May’s Pediatric Critical Care Medicine. “Outcomes Among Neonates, Infants, and Children After Extracorporeal Cardiopulmonary Resuscitation for Refractory Inhospital Pediatric Cardiac Arrest: A Report From the National Registry of Cardiopulmonary Resuscitation” says 44 percent of pediatric patients treated with extracorporeal CPR survived to hospital discharge.

8. EVIDENCE Target ranges of oxygen saturation in extremely preterm infants
A randomized trial in The New England Journal of Medicine, May 16, found “a lower target range of oxygenation (85 to 89 percent), as compared with a higher range (91 to 95 percent), did not significantly decrease the composite outcome of severe retinopathy or death.” The abstract for “Target Ranges of Oxygen Saturation in Extremely Preterm Infants” adds the lower target range “resulted in an increase in mortality and a substantial decrease in severe retinopathy among survivors” — a major concern “since a lower target range of oxygen saturation is increasingly being advocated to prevent retinopathy of prematurity.”

9. CALL TO ACTION Participate in survey of hand-offs between CRNAs and SICU nurses
Nurses in the nurse anesthesia program at Georgetown University, Washington, D.C., ask nurses with surgical intensive care unit (SICU) or combined medical and surgical ICU experience to participate in a short survey about the hand-off process between certified registered nurse anesthetists (CRNAs) and SICU nurses. The deadline is June 4.

10. CALL TO ACTION Premier Safety Institute launches survey of injection practices
A short survey from Premier Safety Institute, Washington, D.C., helps identify the practices of clinicians who prepare or administer parenteral and injectable medications. Aggregate results will be shared with the Centers for Disease Control and Prevention, Atlanta, the U.S. Food and Drug Administration, Silver Spring, Md., and professional groups to guide research, outreach and education related to reducing risks to patients. The deadline to participate is June 18.

11. GUIDELINE Managing CIEDs in end-of-life and withdrawal therapy patients
On May 14, the Heart Rhythm Society released “HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy.” Written in collaboration with the American College of Cardiology, American Geriatrics Society, American Academy of Hospice and Palliative Medicine, American Heart Association and European Heart Rhythm Association, the statement includes a decision-making algorithm for withdrawing CIED therapies.

12. CLINICAL PRACTICE RESOURCES
Patient Safety
On May 31, a U.S. Food and Drug Administration (FDA), Silver Spring, Md., public health alert warned healthcare professionals not to use certain IV bags of metronidazole, ondansetron and ciprofloxacin because of possible contamination. The alert affects bags sold under the Claris, Sagent Pharmaceuticals, Pfizer and West-Ward Pharmaceuticals labels.

On May 26, the FDA reported that Baxter International Inc., Deerfield, Ill., voluntarily recalled all lots of Hylenex recombinant (hyaluronidase human injection) because of particulate matter in some vials during routine testing.

Evidence
Preclinical studies show that induced hypothermia (IH) may save the lives of those with penetrating trauma with cardiac arrest, states “Induced Hypothermia for Trauma: Current Research and Practice,” published online May 18 by the Journal of Intensive Care Medicine. “However, its potential as a treatment in trauma is not as well defined,” notes the review article, which discusses potential benefits and complications of IH and emphasizes the “current state of knowledge and practice in various types of trauma.”

On May 7, the National Association of Nurse Practitioners in Women’s Health (NPWH) launched Estrogen Therapy I.Q. (ETIQ) — a campaign designed to provide credible information about menopause and estrogen therapy to women. ETIQ, supported by Upsher-Smith Laboratories, Inc., Maple Grove, Minn., grew out of an NPWH survey that found 78 percent of NPs thought their patients were “unaware of the variety of estrogen options available,” according to campaign information.

Resource
Access podcasts and videocasts in Spanish from the Agency for Healthcare Research and Quality, Rockville, Md., including “Escoja a Su M�dico” – Choosing a Doctor, “Comparaci�n de Medicamentos para la Presi�n” – Comparing Blood Pressure Medicines and “Mant�ngase Activo y Saludable con los Diluyentes de la Sangre” – Staying Active and Healthy: Blood Thinners.

13. AACN RESOURCES
AACN Protocol for Practice price reductions
Visit the AACN Online Bookstore to buy AACN Protocols for Practice resources at reduced prices. The list includes “Palliative Care and End-of-Life Issues in Critical Care,” “Non-Invasive Monitoring, 2nd Ed.,” “Creating Healing Environments, 2nd Ed.,” “Care of the Mechanically Ventilated Patient, 2nd Ed.” and “Monitoring Technologies in Critically Ill Neuroscience Patients.”

E-Learning
AACN offers individual nurses access to two of its most popular Web-based courses, “The Preceptor Challenge” and double-award-winning “Promoting Excellence in Palliative & End-of-Life Care.” Nurses may purchase six-month access to “The Preceptor Challenge” for $100 and “Promoting Excellence in Palliative & End-of-Life Care” for $50 at the AACN LearnCenter. “The Preceptor Challenge,” a three-module course, uses virtual tools to enable nurses to identify best practices. The groundbreaking “Promoting Excellence in Palliative & End-of-Life Care” allows nurses to apply theory-based practice without the risk of harm to patients or families.

Healthy Work Environment
Access AACN Healthy Work Environment Assessment, a free Web-based tool to help nurse managers and leaders align hospital unit performance with the AACN Standards for Establishing and Sustaining Healthy Work Environments (HWEs). Developed with VitalSmarts, a provider of corporate training and organizational performance products and services in Provo, Utah, the online tool aligns the performance of any clinical environment, from single hospital units to entire healthcare organizations, with the six HWE standards. They include skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership.

Access a recording of the webinar “Assessing the Health of Your Work Environment.” Available on the AACN Web site, the webinar — a joint venture between AACN and VitalSmarts, Provo, Utah — is of particular interest to users of the AACN Healthy Work Environment Assessment, a Web-based tool that aligns any clinical environment with the six HWE Standards. NOTE: Video portion of recording loads slowly.

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