Critical Care Newsline — August 6, 2009

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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 Web sites that will keep you informed on issues affecting nurses and the nursing profession.


Aug. 6, 2009

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1. NEWS Elevated troponin levels may predict mortality in surgical intracerebral patients
2. NEWS Safety concerns spur elastometric pain relief pump (ON-Q) recommendations
3. EVIDENCE Ventilators fall short in user-friendliness
4. EVIDENCE Mechanical intervention restores quality of life for patients with hypertrophic cardiomyopathy
5. NEWS Work environment contributes to turnover of new graduates
6. EVIDENCE Acupuncture lowers incidence of postoperative nausea in cardiac surgery patients
7. RESOURCES AHRQ launches monthly health advice column in “Spanish”
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES
10. REMINDERS

1. NEWS Elevated troponin levels may predict mortality in surgical intracerebral patients
Authors of a July 2009 retrospective study advise clinicians to consider troponin levels when making management decisions about ischemic stroke and subarachnoid hemorrhage (ICH and SAH) patients. The authors looked at 100 ICH surgical patients without angina or recent myocardial infarction and found a higher incidence of death among patients admitted to the hospital with elevated cardiac troponin levels.

2. NEWS Safety concerns spur elastometric pain relief pumps (ON-Q pumps) recommendations
The Institute for Safe Medication Practices advises hospitals to review the use of elastometric pain relief pumps (ON-Q pumps) because of safety concerns including lack of staff education and one incident of premature emptying of the reservoir in a patient who subsequently died The ISMP developed a table of strategies for the pumps’ safe use

3. EVIDENCE Ventilators fall short in user-friendliness
A July 2009 study reported that physicians frequently failed to complete various tasks including identifying the mode and starting pressure support on ventilators with which they’re not familiar. The authors call for closer collaboration between manufacturers and end users to improve ergonomics of ventilators.

4. EVIDENCE Mechanical intervention restores quality of life for patients with hypertrophic cardiomyopathy
Surgical myectomy or percutaneous alcohol septal ablation restores quality of life for patients with hypertrophic cardiomyopathy (HCM) who develop heart failure because of left ventricular (LV) outflow obstruction. A July 2009 article that reviewed 50 years of controversy about the cause of symptoms and mortality in HCM concluded that this obstructive disease can be mechanically reversed.

5. NEWS Work environment contributes to turnover of new graduates
Pressures on the job including time demands, conflicts between the perception and reality of nursing and poor communication contribute to turnover of newly-licensed registered nurses, according to a study of 612 new nurses. Participants suggested solutions such as programs on effective communication with physicians.
(http://www.modernhealthcare.com/article/20090727/REG/307279954/-1)
(http://www.nursingoutlook.org/article/S0029-6554(08)00268-6/abstract)

6. EVIDENCE Acupuncture lowers incidence of postoperative nausea in cardiac surgery patients
Many patients undergoing coronary artery bypass graft and cardiac valve surgeries suffer from postoperative nausea (PON). A (2009) study of 90 patients indicated no adverse effects, a lower incidence of PON and less severe nausea among patients who received an acupuncture treatment before surgery compared to control group patients.

7. RESOURCE AHRQ launches monthly health advice column in Spanish
The Agency for Healthcare Research and Quality (AHRQ) launched “Consejos de Salud Para Tí” (“Health Advice for You”), a monthly online Spanish-language health advice column. “Consejos de Salud Para Ti” can be found on the AHRQ’s Información en Español Web site, which includes Spanish audio and video.

8. CLINICAL PRACTICE RESOURCES

EVIDENCE-BASED PRACTICE
Structured Approaches to Pain Management in the ICU
http://amedeo.com/p2.php?id=19497902&s=crc&pm=0e1f4e1a88c9736

Correlation between the Sedation-Agitation Scale and the Bispectral Index in Ventilated Patients in the Intensive Care Unit
http://www.ncbi.nlm.nih.gov/pubmed/19577705

GUIDELINES
Critical Care in Pregnancy
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=14179

PATIENT SAFETY
ADVISORY Abbott POWERSAIL coronary dilation catheters recalled
In July, Abbott and the U.S. Food and Drug Administration issued a national recall of three lots and international recall of one lot of POWERSAIL Coronary Dilatation Catheters because of complaints related to a distal shaft defect than can cause leaking of contrast material. Specific product details can be found at (http://www.fda.gov/Safety/Recalls/ucm174429.htm).

ADVISORY Nutracoastal Trading recalls Steam dietary supplement
In July, Nutracoastal Trading, LLC, and the Food and Drug Administration issued a recall of the dietary supplement marketed as Steam, telling patients to stop using the product. Steam contains an analog of sildenafil, an ingredient approved for erectile dysfunction that can cause headaches and flushing and interact with nitrates, leading to hypotension.

ADVISORY FDA approves colchicine (Colcrys), issues safety warnings
On July 30, the Food and Drug Administration (FDA) approved Colchicine (Colcrys) for the treatment of familial Mediterranean fever (FMF) and acute gout flare-ups. Because drug interactions that affect colchicine absorption and metabolism can be fatal, the FDA added safety considerations to the prescribing information (http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022351lbl.pdf). In patients with gout flares, lower doses can be as effective and cause fewer adverse effects as compared to traditional higher doses.

Patient Safety Links:

Joint Commission
Medline Plus
National Patient Safety Foundation
Institute for Safe Medication Practices Newsletter
AHRQ Patient Safety Network

9. AACN Resources
For information about AACN's many resources for acute and critical care nurses, click here.

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