The purpose of this study was to examine the effect that the patient's level of consciousness and the degree of nasogastric tube flexibility would have on the ease of insertion of the tube in patients with an endotracheal tube in place. The statistical hypotheses tested were: 1. The Degree of nasogastric tube flexibility will not influence the ease with which the tube is inserted. 2. The level of consciousness of the patient will not influence the ease with which the nasogastric tube is inserted. 3. There will be no interaction between the degree of flexibility of the nasogastric tube to be inserted and the level of consciousness of the patient in whom the tube is placed. The sample from whom data was collected for the study consisted of 121 patients admitted to the respiratory intensive care unit of a large teaching hospital who required endotrachea intubation and subsequent placement of a nasogastric tube. The number of attempts per patient for successful placement of each tube were recorded over a four month period and the data analysed using a 2 X 3 factorial design. The two independent variables were degree of nasogastric tube flexibility with two levels: flexible and rigid, and level of consciousness with three levels: conscious, obtunded and unconscious. The data collected from the study indicate that the degree of nasogastric tube flexibility significantly affects the ease with which a tube can be inserted in an intubated patient (α=.05) the rigid tube requiring a statistically fewer number of attempts than the flexible tube. The difference among levels of patient consciousness were not found to be statistically significant in this investigation but the interaction between the degree of tube flexibility and level of patient consciousness revealed statistical significance. / Applied Science, Faculty of / Nursing, School of / Graduate

Overcrowding in emergency departments is a worldwide problem. The non-urgent utilization of the emergency service is considered a serious threat to the quality of care delivered. Patients in stable condition admitted for nasogastric tube dislodgement is one of the typical examples observed in Hong Kong. According to the triage protocol, the waiting time for consultation is estimated to be at least 120 minutes for patients triaged into non-urgent categories, with the total length of stay possibly prolonged in cases of resuscitation. Consequently, these patients are at risks of feeding regime disturbance and altered nutrition. Nasogastric tube insertion is a basic nursing procedure in most clinical settings in Hong Kong. However, under current practice, nurses in the emergency department are not allowed to initiate the procedure unless a medical consultation has been performed, not even for patients in stable condition. In order to reduce the length of stay of these patients and minimize possible complications resulted from the delayed treatment, it is suggested to switch the practice from physician-led to nurse-led. This translational nursing research project was i) to explore and evaluate the effectiveness of nurse-led care for stable patients in various healthcare settings through a systematic literature review, ii) to develop an evidence-based protocol of nurse-initiated nasogastric tube replacement, iii) to assess its feasibility and applicability in a local emergency department, as well as iv) to develop strategies for the implementation and evaluation of the new practice. A systematic literature review was undertaken using four electronic databases, namely MEDLINE, CINAHL, Cochrane Library and British Nursing Index. Search terms “nurse-led”, “nurse-initiated”, “training”, “effect$” were used. A total of 1,994 relevant citations were retrieved. Ten randomized controlled trials met the inclusion criteria and were finally selected. Extracted data and methodological qualities of the included studies were assessed using a structured appraisal instrument. All studies generated high level of evidence on the effectiveness of nurse-initiated interventions provided to stable patients in various healthcare settings, which included the improvement of patients’ health outcomes, reduction of waiting time for consultations, increased level of patient satisfaction. The quality of nurse-led practice was of the same standard as the usual practice led by doctors. The nurse- initiated intervention was further enhanced by the provision of training and collaboration with medical staff. Six evidence-based recommendations were devised for the nurse-initiated nasogastric tube replacement protocol. It included i) provision of training, ii) development of patient assessment form for the protocol, iii) initiation of baseline assessment for eligible patients and iv) radiographic verification by nurses, v) collaboration with medical staff, and vi) ongoing evaluation of the implementation. The nurse-initiated nasogastric tube replacement for stable patients is an effective solution to the problem of overcrowding in emergency department. Further development of non-urgent treatments and services led by emergency nurses should be considered. / published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

A dissertation to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine (in the branch of Anaesthesia). Johannesburg 1994. / Unrecognized oesophageal intubation leads to death or severe disability. Even careful, well trained anaesthetists may be unable to differentiate tracheal from oesophageal intubation by the commonly employed methods. End-tidal carbon dioxide measurement has been found to be a reliable test of tracheal intubation. The availability of a small disposable end-tidal carbon dioxide detector, the Easy cap makes this facility universally available. The oesophageal detector device is a small mechanical device used to recognize oesophageal intubation. By combining two reliable devices working on completely different principles the risk of false negative or false positive results are virtually eliminated. The potential defects of each device are covered by the other. The purpose of this study was to evaluate the combined use of the oesophageal detector device and the Easy cap by a blinded observer to differentiate the endotracheal tube from an oesophageal tube in sixty patients. These two tests were found to be very reliable, easy, rapid and cheap - ideal for use in theatre, casualty departments and in the field. The advantages and disadvantages of these devices are discussed and the relevant literature is reviewed.

Theses (M Med.(Anaesthesiology))--University of Limpopo, 2007. / Comparison of Alfentanil and Lignocaine in blunting the pressor response during endotracheal intubation. Laryngoscopy and tracheal intubation produce marked increases in heart rate and blood pressure, which is potentially dangerous in certain patients. Various pharmacological agents have been used before laryngoscopy and tracheal intubation in an attempt to attenuate the adrenergic response, but with varying degree of success. OBJECTIVE To compare the efficacy of lignocaine to alfentanil in blunting the pressor response to endotracheal intubation. DESIGN An open label comparative study. POPULATION Seventy eight ASA I and II adult patients between the ages of 18 and 65 years booked for elective surgery which requires endotracheal intubation. SETTING Dr George Mukhari Hospital, a tertiary level training hospital in Gauteng, South Africa. 2 METHOD After obtaining ethical clearance the study was conducted on 78 ASA class I & II patients. The patients were randomly allocated to three groups according to their treatment regime. All patients were premedicated with diazepam 10mg 2 hours pre operatively. Anaesthesia was induced with Thiopentone 5mg/kg followed by Vecuronium 0,1mg/kg and maintained with Isoflurane in nitrous oxide and oxygen mixture. Group A patients received lignocaine 1.5mg/kg iv 3 minutes before intubation. Group B – alfentanil 15ug/kg iv 1 minute before intubation and group C patients did not receive any treatment before intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the following intervals: pre- induction, pre- intubation 1, 2 and 3 minutes post intubation. STATISTICS Statistical analysis was done by Chi Square test followed by the normal approximation of the binomial distribution. Increase in blood pressure and heart rate in the three treatment groups were compared by analysis of variance, followed by pairwise comparisons. A p- value <_ 0,05 was considered significant. 3 MAIN RESULT The three treatment groups did not differ in relation of Gender ratio, Mean weight and Mean age. ALFENTANIL GROUP There was a non significant increase in heart rate 1 minute post intubation (P= 0,7625), and there was no increase 2 and 3 minutes post intubation. A decrease in SBP, DBP and MAP was observed at 1, 2 and 3 minutes post intubation. LIGNOCAINE GROUP There was an increase in all parameters 1 minute post intubation which was comparable to the control group. A decrease in all parameters which differed from that of the control group except for heart rate, was observed at 2 and 3 minutes post intubation. CONTROL GROUP There was an increase in all parameters 1 minute post intubation. A decrease in all parameters 2 and 3 minutes post intubation remained above the baseline. CONCLUSION Alfentanil is superior to lignocaine in blunting the pressor response to endotracheal intubation.

Endotracheal suctioning is a procedure performed on a daily basis in hospitals, and is mostly take place in intensive care units (ICUs). (Annapoorna, 2005; Day et al, 2009). It helps removing sputum or secretion out from patients’ trachea. For patients who are under mechanical ventilation, this procedure is vital to maintain their airway patency when they are intubated with endotracheal tube or tracheostomized (Finucane & Santora, 2003). However, the procedure has its own risk and complications such as hypoxaemia, atelectasis, cardiovascular instability and more (Thomson, 2000). There are in general two types of endotracheal suctioning: open and closed system. As disconnection of mechanical ventilation from patients is needed for open endotracheal suctioning (OES), it has a higher risk of complications. However, the cost for OES is much cheaper compared to the closed system. Although OES is widely used in Hong Kong, there is no evidence-based guideline for nurses to follow. The guideline developed by American Association of Respiratory Care (2010) is lack of specificity on the target population and its recommendations were based on mixed literatures targeting on adult and infant patients. Therefore, the aim of this dissertation is to develop an evidence-based guideline for OES in adult patients under mechanical ventilation in ICU. To develop a guideline for OES, search was performed in multiple electronic databases (British Nursing Index, CINAHL, Cochrane Library, Ovid MEDLINE, and PubMed) with keywords related to OES and its complications. A total of 457 studies fulfilled the inclusion criteria and 11 of them were selected. The selected studies were evaluated by quality appraisal checklists, which are developed by Scottish Intercollegiate Guidelines Network (SIGN). Data were extracted for developing the guideline. Evidence have shown that the incidence of post-OES hypoxemia can be reduced by performing hyperoxygenation with 100% oxygen for 4-6 breaths prior and after each open endotracheal suction, accompanying with hyperinflation with 150% of patient’s tidal volume at most 8 breaths/40 seconds delivered by ventilator and prohibiting normal saline instillation into trachea for diluting the sputum. The grades of the recommendations in the guideline were rated with using of the SIGN grading system. The implementation potential was analyzed by the patients’ characteristics, transferability of the findings, feasibility of implementation and cost-benefit ratio. A 12-month implementation program was developed including communication with stakeholders, 4-week pilot testing, and training of ICU staffs, and implementation of OES guideline. The effectiveness of the guideline will be evaluated based on the primary outcome (i.e. oxygen level in blood) for detecting the incidence of hypoxemia. Also, the acceptability of the guideline, compliance of the guideline, financial cost reduction and better quality of service will be used as other evaluation indicators. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 28-29).

Thesis (M.S.)--University of Wisconsin--Madison, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 101-103).

Thesis (M.S.)--University of Wisconsin, School of Nursing. / eContent provider-neutral record in process. Description based on print version record.