published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Intravenous cannulation of pediatric patients is a common procedure in emergency departments. It is a useful tool to facilitate medical investigations and drug administration. However, the pain induced by the procedure can lead to patient distress and bother the nursing and medical procedures afterwards. There are many kinds of topical anesthesia but no relevant evidence-based guideline for their use is available for the emergency departments. This dissertation synthesizes the available evidence in the literature to establish an evidence-based guideline for the use of topical anesthesia to reduce pain caused by pediatric intravenous cannulation in an emergency department. The communication, implementation and evaluation plan are also developed. A systematic literature review was conducted from 30th August to 2nd September, 2011. A number of electronic databases, including PubMed, CINAHL Plus and Embase were searched. Thirteen eligible randomized controlled trials were identified. They were integrated into a table of evidence and were critically appraised by the SIGN Methodology Checklist. After synthesis of evidence, it is suggested that needleless anesthesia with apparatus assistance significantly reduced pain as early as in five minutes. Patients should however be observed for two hours after the administration of anesthesia for signs of adverse effects. The implementation potential, in terms of the transferability, feasibility and cost-benefit ratio, was examined. Among the anesthesia devices, the Jet lidocaine device has satisfactory transferability, feasibility and cost-benefit ratio. The evidence is then translated into a practice guideline with the recommendations scored based on the “SIGN 50: A guideline developer’s handbook”. A fourteen-month implementation plan,including a communication plan, a pilot study and an evaluation plan is developed. The communication phase lasts for three months and the stakeholders including the Chief of Service, Department Operation Manager, Advanced Practice Nurses, frontline healthcare professionals and the pharmacy department are identified. The pilot plan lasts for ten weeks, which includes a two-week training period, a three-week observational period for baseline measurement, a three-week intervention period and an eight-week amendment period. The pilot study collects data regarding the pain level at baseline and identifies unanticipated problems in the guideline. Amendments would be made accordingly and the revised guideline would be sent for ethical approval before the implementation phase. In the evaluation plan, the primary outcome for the innovation is the level of pain. The secondary outcomes are the admission rate and length of hospital stay. Other outcomes are the satisfaction of healthcare professionals, utilization rate and cost. It is expected that the cannulation pain, admission rate and length of hospital stay would be lower with the application of topical anesthesia. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1459945. ProQuest document ID: 1622198801. Includes bibliographical references (p. 41-43)

published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1438486. ProQuest document ID: 1192191231. Includes bibliographical references (p. 49-52)

Intravenous line placement is one of the most common procedures performed on children presenting to the Emergency Department. Anxiety about needles is widespread, and many children experience high levels of fear and/or pain with their IV line placements. Hypnosis is a behavioral intervention that shows significant promise for alleviating procedure-related pain and anxiety in children. Twenty-five developmentally normal, English-speaking children between the ages of five and fifteen who required IV line placement in the Pediatric Emergency Department at Yale-New Haven Childrens Hospital were randomized to receive either the standard of care or standard of care plus a brief hypnotic intervention. The groups were similar with regard to baseline demographic and socioeconomic status, previous experience with medical care, and presence or absence of chronic medical conditions. Childrens pre-procedural anxiety ratings on a 10cm visual analog scale (VAS) and expected procedural pain ratings by 10-point oucher and 10cm VAS were not significantly different between the groups. Children randomized to the hypnosis group reported less anxiety during the procedure (mean 5.0 vs 3.1, median 7.2 vs 2.2, p = 0.28) than children randomized to the standard of care group. Cases also had a decrease in anxiety from expected to actual of 1.6 on a 10cm scale, while those randomized to the control group had an increase from expected to actual anxiety of 1.1 (p=0.01). A smaller trend towards decreased pain in the hypnosis group was also present. As measured by VAS, cases had lower mean pain scores (3.4 vs 4.3) than controls. In a comparison of anticipated and actual pain scores between groups, the hypnosis group had a mean decrease of 0.8 on a 10cm VAS , while the control group had a mean increase of 0.5 (p=0.14). Recruitment of subjects is ongoing, but preliminary results suggest that hypnosis is effective for alleviating needle-related anxiety in children undergoing IV line placement and may be helpful for alleviating the pain of IV line placement as well.

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

A quantitative research design for a descriptive and contextual study to determine the critical care nurses knowledge and data preferences regarding the central venous and pulmonary artery catheters management and decision making after coronary arte.y bypass graft operations and the utmzation period of the pulmonary artery catheter after coronary artery bypass graft operations. The data was collected through a questionnaire completed by critical care nurses and retrospective analysis of patient records through a structured checklist. Data analysis indicated the following: critical care nurses have a knowledge deficit in the management of the central venous and pulmonary artery catheters and felt more competent and confident in the central venous measurements. The utilization period of the pulmonary artery catheter was 48% compared to the 100% of the central venous catheter. / Advanced Nursing Science / M.A. (Advanced Nursing Science)

O Cateter Central de Inserção Periférica (PICC) constitui-se de dispositivo intravenoso, instalado através de uma veia periférica, que avança até a veia cava adquirindo características de cateter central. Neste sentido, o presente estudo teve como objetivo geral: identificar as condições de viabilidade para a definição de padrões e protocolos que possibilitem a utilização do PICC em pacientes adultos e pediátricos. E como objetivos específicos: analisar o desempenho da primeira e terceira geração de PICC em pacientes da oncohematologia comparando com a literatura internacional; detectar pontos sensíveis no contexto do uso do PICC para a proposição de protocolo; propor instrumento para a coleta e investigação de relevância de dados e variáveis; e propor protocolo de utilização do PICC para pacientes pediátricos e adultos. Trata-se de estudo descritivo exploratório observacional prospectivo longitudinal com abordagem quantitativa. A pesquisa foi desenvolvida na Unidade de Hemoterapia, Hematologia e Oncologia (UHHO) nos setores: Serviço de Transplante de Medula Óssea (STMO), Quimioterapia de Alto Risco (QTAR) e seus ambulatórios, Unidade de Terapia Intensiva (UTI) cardíaca, clínica médica e pediátrica, num hospital de ensino da região do sul do país. A amostra foi não-probabilística, por conveniência constituída de dois grupos, (Grupo 1) pacientes que utilizaram a primeira geração do PICC e (Grupo 2) pacientes que utilizaram a terceira geração do dispositivo. Os dados foram coletados no período de janeiro de 2015 a agosto de 2016 através de instrumento elaborado para este estudo, contendo 22 variáveis sócio-demográficas e 35 variáveis clínicas. 40 PICCs primeira geração foram inseridos em 36 pacientes por técnicas “às cegas”, totalizando 830 dias de cateter, média de 20,71 dias, tendo alcance mínimo de dois e máximo de 141 dias. Quanto à terceira geração do cateter, dez PICCs foram inseridos em dez pacientes por Técnica de Seldinger Modificada (TSM) guiados pelo Ultrassom (US), totalizando 397 dias de cateter, média de 39,7 dias com alcance mínimo de dez e máximo de 86 dias. Realizou-se análise descritiva por meio da distribuição de frequência absoluta, média e desvio padrão. Posteriormente, todas as variáveis foram analisadas pelo ‘Software R’, identificou-se 11 componentes principais que fortemente se relacionaram e constituíram a base do Modelo de Equações Estruturais (MEE). Estas variáveis expressam-se de maneira relevante para o desenvolvimento de investigações futuras. Em suma, o PICC pode ser utilizado com sucesso na maioria dos pacientes internados na oncohematologia e em outros setores no ambiente hospitalar, assim como em crianças. Pode ser inserido por enfermeiros, desonerando o ambiente cirúrgico, processo anestésico e o médico especialista, conferindo-lhes autonomia. / The Peripherally Inserted Central Catheter (PICC) consists of an intravenous device, installed through a peripheral vein, wich advanced to the vena cava acquiring central catheter characteristics. In this sense, the present study had as general objective: to identify the feasibility conditions for the definition of standards and protocols that allow the use of PICC in adult and pediatric patients. And as specific objectives: to analyze the performance of the first and third generation of PICC in oncohematology patients comparing with the international literature; to detect sensitive points in the context of the use of the PICC for the protocol proposal; propose an instrument for the collection and relevant investigation of data and variables; and to propose protocol of use of PICC for pediatric and adult patients. This is a descriptive prospective longitudinal observational exploratory study with a quantitative approach. The research was developed in the Hematology, Oncology and Hematology Unit (UHHO) in the following sectors: Bone Marrow Transplantation Service (STMO), High Risk Chemotherapy (QTAR) and its outpatient clinics, Intensive Care Unit (ICU), cardiac, medical clinic and pediatric in a teaching hospital in the southern region of the country. The sample was non-probabilistic, for convenience consisted of two groups, (Group 1) patients who used the first generation of PICC and (Group 2) patients who used the third generation of the device. Data were collected from January 2015 to August 2016 through an instrument developed for this study, containing 22 socio-demographic variables and 35 clinical variables. 40 firstgeneration PICCs were inserted in 36 patients by "blind" techniques, totaling 830 days of catheter, average of 20.71 days, with a minimum range of two and a maximum of 141 days. Regarding the third generation of the catheter, ten PICCs were inserted in ten patients by Ultrasound-guided Modified Seldinger Technique (TSM), totaling 397 days of catheter, mean of 39.7 days with a minimum range of ten and a maximum of 86 Days. A descriptive analysis was performed by means of the absolute frequency distribution, mean and standard deviation. Afterwards, all variables were analyzed by 'Software R', we identified 11 main components that were strongly related and formed the basis of the Structural Equations Model (MEE). These variables express themselves in a relevant way for the development of future investigations. In summary, PICC can be used successfully in most patients admitted to oncohematology and other sectors in the hospital setting, as well as in children. It can be inserted by nurses, discharging the surgical environment, anesthetic process and the specialist doctor, granting them autonomy.