Critical Care Newsline — November 19, 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.

Nov. 19, 2009

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1. NEWS FDA issues letter to healthcare professionals about H1N1 vaccine
2. AACN RESOURCES Comprehensive H1N1 information available on AACN Web site
3. NEWS FDA extends H1N1 vaccine approval to infants and children
4. CALL TO ACTION CDC invites comments to proposed guideline revisions
5. EVIDENCE Off-pump CABG patients worse at one-year follow-up
6. CALL TO ACTION Distinguished Research Lectureship nominations now open
7. EVIDENCE Sildenafil improves hemodynamics in patients with pulmonary hypertension
8. EVIDENCE Increase in wait time to see ED doctor asserts Archives of Internal Medicine
9. EVIDENCE CE article examines infection control, dressings for central venous insertion sites
10. CLINICAL PRACTICE RESOURCES

1. NEWS FDA issues letter to healthcare professionals about H1N1 vaccine
Letter from the Commissioner to Nation’s Healthcare Professionals on H1N1 Vaccine” provides information that can be “helpful as you talk to patients about the 2009 H1N1 influenza vaccines.” The letter includes an update on 2009 efforts to make the H1N1 vaccine and monitor its safety.

2. AACN RESOURCES Comprehensive H1N1 information available on AACN Web site
Keep up-to-date on flu and infection control efforts and earn free CNE by visiting AACN’s comprehensive H1N1 Influenza Resource Center.

3. NEWS FDA extends H1N1 vaccine approval to infants and children
On Nov. 12, the FDA approved an H1N1 vaccine manufactured by CSL Ltd., a biopharmaceutical company based in Melbourne, Australia, for children 6 months and older. The FDA previously approved this drug for patients age 18 years and older. Read more.

4. CALL TO ACTION CDC invites comments to proposed guideline revisions
The Centers for Disease Control and Prevention, Atlanta, invites public comment to proposed revisions to guidelines to prevent intravascular catheter-related infections. Comment on the proposed guidelines

5. EVIDENCE One-year outcomes worse with off-pump coronary-artery bypass surgery
Patients undergoing coronary-artery bypass grafting (CABG) without cardiopulmonary bypass (off-pump) showed worse outcomes and poorer graft patency at the one-year follow-up than the on-pump group, according to a randomized study of 2,203 patients in the Nov. 5 New England Journal of Medicine. No significant difference between off- and on-pump CABG could be found at the 30-day outcome, states the study.

6. CALL TO ACTION Distinguished Research Lectureship nominations open
Nominations for the 2011 AACN Distinguished Research Lectureship awards can be found here. Nomination deadline is Dec. 1.

7. EVIDENCE Sildenafil improves hemodynamics in patients with pulmonary hypertension
Sildenafil decreased mean pulmonary artery pressure at rest and during exercise in a randomized, dose comparison of 20 patients with pulmonary hypertension caused by chronic obstructive pulmonary disease, according to a report published online Oct. 29 by the American Journal of Respiratory and Critical Care Medicine.

8. EVIDENCE Increase in wait time to see ED doctor asserts Archives of Internal Medicine
A Nov. 9 article in the Archives of Internal Medicine indicates an increase in wait time to see a physician in U.S. emergency departments (ED). The article notes a steady decline in the percentage of patients seen by ED physicians within established triage times described to be “at its lowest point in at least 10 years.” ReadPercentage of US Emergency Department Patients Seen Within the Recommended Triage Time.”

9. EVIDENCE CE article examines infection control, dressings for central venous insertion sites
A CE article in the American Journal of Critical Care evaluates evidence-based practices for care of central venous catheter insertion sites in pediatric intensive care units of urban tertiary care centers. It also looks at two regimens for dressing changes on the rate of catheter-related bloodstream infections and costs. According to “Evaluating Central Venous Catheter Care in a Pediatric Intensive Care Unit,” infection control efforts should focus on “processes rather than on products,” and few differences exist between a transparent dressing and a dressing impregnated with chlorhexidine used with a transparent dressing. Read the article.

10. CLINICAL PRACTICE RESOURCES
PATIENT SAFETY
On Nov. 13, the FDA issued an alert about serious complications associated with negative pressure wound therapy (NPWT) systems. The alert, which includes ways to reduce NPWT risks, cites six deaths and 77 injuries related to this procedure over the past two years. Read more.

On Oct. 29, Edwards Lifesciences, a cardiovascular product company, Midvale, Utah, issued a recall letter for the EC1001 and EC65 CardioVations EndoClamp aortic catheters because of potential spontaneous balloon ruptures. In a Nov. 9 alert, the FDA categorized the recall as class 1 and stated “a reasonable probability” the product will cause serious injury or death. The catheters monitor aortic pressure during cardiopulmonary bypass surgery. Learn more.

On Nov. 6, Hospira, a pharmaceutical and medication delivery company, Lake Forest, Ill., announced a voluntary recall of 85 lots of Liposyn, an intravenous fat emulsion, and 73 lots of Propofol Injectable Emulsion, a sedative-hypnotic agent, because of possible particulate matter contamination in the containers. Read more.

Citing 35 reports of patients with chondrolysis, the FDA issued a Nov. 13 reminder to healthcare professionals that local anesthetics shouldn’t be delivered via continuous intra-articular infusion or elastomeric infusion devices.

Since 2006, the FDA has received 14 reports about ineffective 200 J biphasic defibrillators, mostly related to cardioversion for atrial fibrillation. A 360 J defibrillator brought immediate results, reports the FDA, which requested no practice changes. Clinicians should report defibrillator problems through MedWatch, advises the FDA. Read the report, issued Nov. 5.

EVIDENCE
AccuChek provides acceptable glucose measurements for ICU patients compared to blood samples from arterial catheters, states a study in October’s Critical Care Medicine. AccuChek proves 1 percent less accurate than required by the International Organization for Standardization, it adds.

RESOURCE
Download an article on trauma in pregnancy from November’s American Journal of Nursing.

REVIEW
Pediatric Research published a review of neonatal ICU analgesic and sedative use on Nov. 4.

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