Critical Care Newsline — October 8, 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.

Oct. 8, 2009

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1. NEWS Surgical masks protect as well as N95 respirators against influenza in routine settings
2. REVIEW TeleICUs may reduce mortality and costs
3. PATIENT SAFETY Change in heparin reference standard to reduce potency
4. PATIENT SAFETY FDA warns of potential dosing errors with Tamiflu oral suspension
5. RECALL Penumbra recalls original version of a Neuron Delivery Catheter
6. RESEARCH Increasing chest compression time may improve survival rates for patients with pre-hospital cardiac arrest
7. RESEARCH Early enteral nutrition may reduce mortality in critically ill patients
8. CLINICAL PRACTICE RESOURCES
9. AACN RESOURCES
10. REMINDER

1. NEWS Surgical masks protect as well as N95 respirators against influenza in routine settings
Standard surgical masks protect healthcare workers as well as fit-tested N95 respirators against influenza according to randomized trial results of 446 nurses in Oct. 1’s JAMA. Authors say their findings “should not be generalized to settings where there is a high risk for aerosolization, such as intubation or bronchoscopy, where use of an N95 respirator would be prudent.” Learn more.

2. REVIEW TeleICUs may reduce mortality and costs
TeleICUs may reduce overall mortality and costs according to a practice review published Sept. 13 online by the Journal of Intensive Care Medicine. Noting significant variations in programs, study authors say “tele-ICU is thought to have great promise to support critically ill patients.” They add that improvements were “not universal and many of the studies have yet to be published in peer-reviewed journals.” Read more.

3. PATIENT SAFETY Change in heparin reference standard to reduce potency
On Oct. 1, the U.S. Food and Drug Administration announced a new reference standard for heparin that reduces its potency by about 10 percent. Availability of heparin manufactured to both standards will continue. Companies plan to identify the new United States Pharmacopeial Convention unit potency with an “N” next to the lot number. Read more here.

4. PATIENT SAFETY FDA warns of potential dosing errors with Tamiflu oral suspension
The U.S. Food and Drug Administration issued an alert to healthcare providers about potential dosing errors associated with oseltamivir (Tamiflu) for oral suspension. The liquid drug, dosed in milligrams rather than milliliters, can cause confusion among providers. See the dosage table.

5. RECALL Penumbra recalls original version of a Neuron Delivery Catheter
On Sept. 29, Penumbra, based in Alameda, Calif., recalled the original version of the Neuron 6F 070 Delivery Catheter shown to kink or ovalize. This makes advancing the catheter or other devices through the guide catheter difficult to perform. See product catalog and lot numbers.

6. RESEARCH Increasing chest compression time may improve survival rates for patients with pre-hospital cardiac arrest
Increasing chest compression fractions (the proportion of time spent on cardiac compressions) improves survival rates outside the hospital for patients with ventricular fibrillation/tachycardia cardiac arrest according to a study published Sept. 29 in Circulation. The prospective observational cohort study included 506 adult patients from the Resuscitation Outcomes Consortium Cardiac Arrest Epistry.

7. RESEARCH Early enteral nutrition may reduce mortality in critically ill patients
Enteral nutrition started within 24 hours of injury or ICU admission significantly reduces pneumonia and mortality according to a meta analysis of six randomized controlled trials of 234 critically ill patients. Study authors call for a large multicenter trial to confirm the findings. Read more.

8. CLINICAL PRACTICE RESOURCES
EVIDENCE
You can access evidence-based guideline resources for preventing hospital-acquired conditions.

RESEARCH
Pediatric critical care teams with special training report fewer unplanned events, such as airway problems, and fewer deaths compared to transport teams without special training states a study in July’s Pediatrics. Read more.

PATIENT SAFETY
McNeil Consumer Healthcare, Fort Washington, Pa., issued a voluntary, precautionary recall of children’s and infants’ oral suspension Tylenol products distributed March through May 2008 because of potential manufacturing problems. The company issued the recall Sept. 24 and reports no illnesses to date. See a list of product lot numbers here.

September’s Anaesthesia and Intensive Care analyzes the communication breakdown that pertained to an ICU patient given three times the intended dose of intravenous human immunoglobulin. Learn more.

GUIDELINES
Sept. 22’s Intensive Care Medicine proposes an algorithm for diagnosing pediatric delirium. It includes evaluation of sedation-agitation level, psychometric assessment of behavior and the opinion of caregivers. Read more.

9. AACN RESOURCES AACN will offer 15 scholarships for the Nurse in Washington Internship (NIWI) program scheduled Sunday, March 14 through Tuesday, March 16, 2010 in Washington, D.C. Visit Capitol Hill and make your voice heard at NIWI, the preeminent program for nurses who want to learn to work with legislators to advance policies and agendas. Apply here. Deadline is Nov. 1.

10. REMINDER
AACN members can access free continuing education activities.


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