Critical Care Nurse

BACKGROUND: The health of critical care nurse work environments affects patient and nurse outcomes. The results of the 2018 Critical Care Nurse Work Environment Study are reported here with comparisons to previous studies and recommendations for continued improvement. OBJECTIVE: To evaluate the current state of critical care nurse work environments. METHODS: An online survey was used to collect quantitative and qualitative data for this mixed-methods study...

BACKGROUND: Rules of thumb for potassium replacement are used in intensive care units despite minimal empirical validation. OBJECTIVE: To evaluate the effectiveness and safety of rule-of-thumb potassium replacement in critically ill patients with mild and moderate hypokalemia. METHODS: A retrospective, observational study was done of patients with mild (potassium, 3-3.9 mEq/L) and moderate (potassium, 2-2.9 mEq/L) hypokalemia admitted to a medical intensive care unit who received potassium replacement...

BACKGROUND: Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect. OBJECTIVES: To determine the incidence and contributing factors of amiodarone-induced phlebitis and examine phlebitis severity. METHODS: A systematic review was conducted of articles published before February 2016 in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, MEDLINE, Embase, Web of Science, and gray databases (Bielefeld, Lenus, EUGrey, RIAN, and DART)...

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The most common invasive procedure performed in the hospital setting worldwide is the insertion of a peripheral intravenous catheter. Although use of peripheral intravenous access is common, its presence is far from benign, with a reported 35% to 50% failure rate, even in facilities with a dedicated infusion team. Significant complications related to the presence of a peripheral intravenous site include localized infection, bacteremia, phlebitis, and infiltration or extravasation. Consistent application of evidence-based standards of practice in all aspects of peripheral intravenous catheter care is essential to provide infusion therapy that delivers safe and quality care...

Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice...

The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle...

BACKGROUND: Bleeding is a serious complication of coronary artery bypass grafting that often leads to blood transfusion. Approximately 50% of patients who have the surgery receive blood products, and blood transfusions play a role in adverse outcomes after the surgery. OBJECTIVE: To examine the association between perioperative blood transfusion and postoperative adverse outcomes in patients undergoing coronary artery bypass grafting. METHODS: A systematic review of the literature, via the matrix method of quality evaluation, was conducted...

More than 250 000 cardiac surgical procedures are performed annually in the United States. Postoperative cardiac arrest rates range from 0.7% to 5.2%. This article reviews current evidence for cardiac arrest resuscitation after cardiac surgery. The evaluation included resuscitation guidelines and 22 studies identified through a MEDLINE search. Evidence-based resuscitation differs from advanced cardiovascular life support guidelines. European Resuscitation Council guidelines include correcting reversible causes of arrest, applying defibrillation/pacing before external cardiopulmonary resuscitation, resternotomy within 5 minutes if electrical therapies fail, and restricting epinephrine use to avoid rebound hypertension...

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Protein-losing enteropathy and plastic bronchitis remain challenging to treat despite recent treatment advances. Protein-losing enteropathy and plastic bronchitis have been diagnosed in patients with cardiomyopathy, constrictive pericarditis, and congestive heart failure. This article focuses on patients with protein-losing enteropathy or plastic bronchitis following the Fontan procedure. Patients with single-ventricle physiology who have undergone the Fontan procedure are at risk for these conditions. Fontan physiology predisposes patients to chronically low cardiac output, increased central venous pressure, and congestive heart failure...

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside...

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