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Carbon Dioxide Angiography for Endovascular Procedures
PAGE 72
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
JUNE 2014
2014 SVN National Conference Poster Abstracts Poster #1 Validity, Reliability and Accuracy of Oscillometric Devices in Ankle-Brachial Index Determination: An Integrative Review Vanessa Ferreira Amorim de Melo, RN, Maria Aparecida de Medeiros, and Rita de Cassia Gengo e Silva, RN, MSc, PhD, Heart Institute, Medical School, University of Sao Paulo, Brazil Ankle-Brachial Index (ABI) is a non-invasive clinical exam to determine the gradual loss of pressure along the arterial tree. It is one of the most effective methods for screening obstructive peripheral arterial disease, and lower values have been associated with cardiovascular morbidity and mortality. However, a vascular Doppler and professional training are needed to perform the traditional technique and authors have reported that these are barriers for disseminating this kind of screening, especially in developing countries. Taking that into account, researchers have investigated Doppler replacement by other devices. The aim of this study was to evaluate the validity, reliability and accuracy of ABI measurements performed with oscillometric devices compared with vascular Doppler. It was an integrative review of the literature. The PICO strategy was used for the research question construction, and evidence search in PubMed, Scopus and Isi Web of Science databases. The research question was ‘‘Are the blood pressure values obtained by using oscillometric devices (comparison) effective and reliable (outcome) when compared to the values obtained by gold standard (Doppler) (intervention) in patients with poad (Patient)?’’. For the search strategy, controlled terms were used or not according to database characteristics. Studies were included in this review if they met the following inclusion criteria: primary study on ABI measurement comparing Doppler with oscillometric device, published between 2008 and 2013 in Portuguese, English or Spanish, with access to full version. Studies on toe-brachial index, and those that used arteriography or other methods as gold standards were excluded. For data extraction, it was used a validated instrument. Data analysis was descriptive. The search resulted in 127 citations and four remained in the study. All of them were published between 2008 and 2010 in international journals, whose impact factor varied between 0.427 and 1.531. Studies were heterogeneous regarding the sample and the methodological approaches used to check the systolic pressure of the extremities. It was observed that results about sensibility, specificity, and positive and negaCopyright Ó 2014 by the Society for Vascular Nursing, Inc. 1062-0303/$36.00 http://dx.doi.org/10.1016/j.jvn.2014.05.005
tive predictive values varied widely, as well as in relation to reliability. In conclusion, studies were conflicting and did not allow any statement on validity, reliability and accuracy of vascular Doppler replacement by oscillometric devices for ABI.
Poster #2 Carbon Dioxide Angiography for Endovascular Procedures Miriam Brainard, BSN, RN, CNOR, University of Texas Southwestern Medical Center, St. Paul University Hospital, Dallas, TX Contrast enhanced imaging studies are required in patients undergoing endovascular procedures; however the use of iodine contrast may not be suitable in patients with renal dysfunction or severe contrast allergies. The use of CO2 gas as a contrast media was first used in the 1950’s. CO2 is used to guide various vascular interventions including angioplasties, stent placements and endovascular abdominal aortic aneurysm repairs. Currently we use the hand held syringe with the plastic bag method. The use of CO2 as a contrast media gives good vascular images. They are slightly less than those obtained with contrast. The use of CO2 is not associated the nephrotoxicity or allergic reactions. Unlimited amounts of CO2 may be given during a case because the gas is effectively eliminated from the body by respiration. CO2 angiography is particularly useful for patients undergoing complex vascular procedures with compromised renal function.
Poster #3 Improving Adherence to Venous Thromboembolism Prophylaxis Administration Kerry Carnevale, MS, RN, Linda Denekamp, MS, RN, and Kim Sulmonte, MSN, RN, Beth Israel Deaconess Medical Center, Boston, MA Problem: Pulmonary Emboli leads to 300,000 deaths annually and is the most common cause of preventable hospital death (Heit 2005). The Joint Commission (TJC) Venous Thromboembolism (VTE) Core Measure set includes reducing incidence of potentially preventable VTE. Patient events at our institution led us to evaluate current nursing practice regarding venous thromboembolism prophylaxis and identify areas for improvement. We found that the risk of VTE was underestimated by nursing staff and prescribed DVT prophylaxis was being held without nurses notifying the licensed prescriber. Aim: To improve nurses’ knowledge regarding risk for venous thromboembolism in the hospitalized patient and to increase
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
JUNE 2014
2014 SVN National Conference Poster Abstracts Poster #1 Validity, Reliability and Accuracy of Oscillometric Devices in Ankle-Brachial Index Determination: An Integrative Review Vanessa Ferreira Amorim de Melo, RN, Maria Aparecida de Medeiros, and Rita de Cassia Gengo e Silva, RN, MSc, PhD, Heart Institute, Medical School, University of Sao Paulo, Brazil Ankle-Brachial Index (ABI) is a non-invasive clinical exam to determine the gradual loss of pressure along the arterial tree. It is one of the most effective methods for screening obstructive peripheral arterial disease, and lower values have been associated with cardiovascular morbidity and mortality. However, a vascular Doppler and professional training are needed to perform the traditional technique and authors have reported that these are barriers for disseminating this kind of screening, especially in developing countries. Taking that into account, researchers have investigated Doppler replacement by other devices. The aim of this study was to evaluate the validity, reliability and accuracy of ABI measurements performed with oscillometric devices compared with vascular Doppler. It was an integrative review of the literature. The PICO strategy was used for the research question construction, and evidence search in PubMed, Scopus and Isi Web of Science databases. The research question was ‘‘Are the blood pressure values obtained by using oscillometric devices (comparison) effective and reliable (outcome) when compared to the values obtained by gold standard (Doppler) (intervention) in patients with poad (Patient)?’’. For the search strategy, controlled terms were used or not according to database characteristics. Studies were included in this review if they met the following inclusion criteria: primary study on ABI measurement comparing Doppler with oscillometric device, published between 2008 and 2013 in Portuguese, English or Spanish, with access to full version. Studies on toe-brachial index, and those that used arteriography or other methods as gold standards were excluded. For data extraction, it was used a validated instrument. Data analysis was descriptive. The search resulted in 127 citations and four remained in the study. All of them were published between 2008 and 2010 in international journals, whose impact factor varied between 0.427 and 1.531. Studies were heterogeneous regarding the sample and the methodological approaches used to check the systolic pressure of the extremities. It was observed that results about sensibility, specificity, and positive and negaCopyright Ó 2014 by the Society for Vascular Nursing, Inc. 1062-0303/$36.00 http://dx.doi.org/10.1016/j.jvn.2014.05.005
tive predictive values varied widely, as well as in relation to reliability. In conclusion, studies were conflicting and did not allow any statement on validity, reliability and accuracy of vascular Doppler replacement by oscillometric devices for ABI.
Poster #2 Carbon Dioxide Angiography for Endovascular Procedures Miriam Brainard, BSN, RN, CNOR, University of Texas Southwestern Medical Center, St. Paul University Hospital, Dallas, TX Contrast enhanced imaging studies are required in patients undergoing endovascular procedures; however the use of iodine contrast may not be suitable in patients with renal dysfunction or severe contrast allergies. The use of CO2 gas as a contrast media was first used in the 1950’s. CO2 is used to guide various vascular interventions including angioplasties, stent placements and endovascular abdominal aortic aneurysm repairs. Currently we use the hand held syringe with the plastic bag method. The use of CO2 as a contrast media gives good vascular images. They are slightly less than those obtained with contrast. The use of CO2 is not associated the nephrotoxicity or allergic reactions. Unlimited amounts of CO2 may be given during a case because the gas is effectively eliminated from the body by respiration. CO2 angiography is particularly useful for patients undergoing complex vascular procedures with compromised renal function.
Poster #3 Improving Adherence to Venous Thromboembolism Prophylaxis Administration Kerry Carnevale, MS, RN, Linda Denekamp, MS, RN, and Kim Sulmonte, MSN, RN, Beth Israel Deaconess Medical Center, Boston, MA Problem: Pulmonary Emboli leads to 300,000 deaths annually and is the most common cause of preventable hospital death (Heit 2005). The Joint Commission (TJC) Venous Thromboembolism (VTE) Core Measure set includes reducing incidence of potentially preventable VTE. Patient events at our institution led us to evaluate current nursing practice regarding venous thromboembolism prophylaxis and identify areas for improvement. We found that the risk of VTE was underestimated by nursing staff and prescribed DVT prophylaxis was being held without nurses notifying the licensed prescriber. Aim: To improve nurses’ knowledge regarding risk for venous thromboembolism in the hospitalized patient and to increase