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Current strategies employed by nurses used to manage the symptom of thirst in chronic heart failure
Abstract
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213 Current strategies employed by nurses used to manage the symptom of thirst in chronic heart failure S. Allida 1,∗ , S. Inglis 1 , P. Davidson 1,2,3 , P. Newton 1 , C. Hayward 2,4,5 1 Centre
for Cardiovascular and Chronic Care, University of Technology, Sydney, Ultimo, Australia 2 St Vincent’s Hospital, Darlinghurst, Australia 3 Johns Hopkins University, Baltimore, USA 4 Victor Chang Cardiac Research Institute, Darlinghurst, Australia 5 University of New South Wales, Randwick, Australia Thirst is a burdensome symptom of chronic heart failure and a contributor to poor adherence to fluid restriction. Excess fluid intake may contribute to fluid overload leading to hospitalisations. Despite the prevalence of thirst, there are no standard clinical practice strategies. Our aim was to identify the current strategies used by health professionals to help alleviate thirst in chronic heart failure patients and their perceived efficacy and usefulness of these strategies, specifically chewing gum in relieving thirst. A paper survey was distributed to attendees of the Australasian Cardiovascular Nursing College Conference in 2014. There were 42/70 (60%) respondents to the survey. The majority (33/40; 82%) had employed a number of strategies to alleviate thirst. Ice chips was the most used strategy (36/38; 95%). Over half of respondents had used chewing gum 20/33 (60%). Overall, the respondents reported ‘some use’ in all of the strategies. Chewing gum was found to have ‘some use’ (12/20; 60%) in relieving thirst. Health professionals use various strategies to help their patient’s relieve thirst. In the absence of evidence for these approaches further research is crucial in investigating the efficacy of these methods in relieving thirst in chronic heart failure. http://dx.doi.org/10.1016/j.hlc.2015.06.214 214 Dental-associated viridans streptococci bloodstream infection in patients with continuous-flow ventricular assist devices C. Dowling 1,∗ , C. Lim 2 , N. Kerr 1 , S. Rao 1 , D. Robson 1 , P. Macdonald 1 , E. Kotlyar 1 , A. Jabbour 1 , C. Hayward 1 , A. Keogh 1 1 St
Vincent’s Hospital, Sydney, Australia 2 National Heart Centre Singapore, Singapore Background: Ventricular assist device (VAD)-related infection leads to significant morbidity and mortality. Viridans streptococci have not been reported as a major cause of VADrelated blood stream infection (BSI). Methods: From January to December 2014, we prospectively obtained data on BSI from 35 patients with HeartWare
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continuous-flow ventricular assist devices (HeartWare Inc, Framingham, MA). Results: Over a period of 21.7 patient-years there were 10 cases of VAD-related BSI, including 6 cases of viridans streptococci BSI. Within these 6 cases, 3 patients had biventricular assist devices and 3 patients had left ventricular assist devices. Causative organisms were Streptococcus sanguinis (2 patients), Streptococcus mitis (2 patients), Streptococcus parasanguinis (1 patient) and Streptococcus salivarius (1 patient). Recent dental associations were dental scaling (2 patients, one of whom received antibiotic prophylaxis), dental restoration (1 patient) and dental abscess (1 patient). Two patients did not have any identifiable dental associations. Duration of intravenous antibiotic treatment varied from 2 weeks (1 patient) to 6 weeks (5 patients). Chronic suppressive oral antibiotic treatment was given to 4 patients. Viridans streptococci BSI did not recur in any patient. Two patients underwent cardiac transplantation and explanted VAD cultures did not grow viridans streptococci. Conclusion: Dental-associated viridans streptococci BSI was common in our VAD cohort. This group of patients are at high risk for BSI and antibiotic prophylaxis should be considered. http://dx.doi.org/10.1016/j.hlc.2015.06.215 215 Derivation of left atrial pressure from flow analysis in continuous-flow left ventricular assist devices D. Vickers ∗ , S. Shehab, N. Jain, S. Rao, A. Jabbour, P. Jansz, C. Hayward St Vincent’s Hospital, Sydney, Australia Purpose: Pulmonary capillary wedge pressure (PCWP) measurement requires invasive right heart catheterisation (RHC). This study investigated whether PCWP could be derived from HeartWare HVAD flow waveform analysis.
Method: LVAD speed (2,200-3,200RPM), heart rate (60120BPM), and haematocrit (26.5-45%) were systematically varied in a dual circulation mock circulatory loop (MCL). Multiple left atrial pressures (5-30mmHg) and mean aortic pressures (70-100mmHg) were achieved for each variation. Pump parameters and haemodynamic values were recorded simultaneously (sample rate 50Hz). A novel marker of preload (ndQdt) was derived from flow waveform analysis based on the slope of the early diastolic flow waveform. In vivo validation studies were performed in HVAD patients undergoing RHC under normal and exercising states.
S202
213 Current strategies employed by nurses used to manage the symptom of thirst in chronic heart failure S. Allida 1,∗ , S. Inglis 1 , P. Davidson 1,2,3 , P. Newton 1 , C. Hayward 2,4,5 1 Centre
for Cardiovascular and Chronic Care, University of Technology, Sydney, Ultimo, Australia 2 St Vincent’s Hospital, Darlinghurst, Australia 3 Johns Hopkins University, Baltimore, USA 4 Victor Chang Cardiac Research Institute, Darlinghurst, Australia 5 University of New South Wales, Randwick, Australia Thirst is a burdensome symptom of chronic heart failure and a contributor to poor adherence to fluid restriction. Excess fluid intake may contribute to fluid overload leading to hospitalisations. Despite the prevalence of thirst, there are no standard clinical practice strategies. Our aim was to identify the current strategies used by health professionals to help alleviate thirst in chronic heart failure patients and their perceived efficacy and usefulness of these strategies, specifically chewing gum in relieving thirst. A paper survey was distributed to attendees of the Australasian Cardiovascular Nursing College Conference in 2014. There were 42/70 (60%) respondents to the survey. The majority (33/40; 82%) had employed a number of strategies to alleviate thirst. Ice chips was the most used strategy (36/38; 95%). Over half of respondents had used chewing gum 20/33 (60%). Overall, the respondents reported ‘some use’ in all of the strategies. Chewing gum was found to have ‘some use’ (12/20; 60%) in relieving thirst. Health professionals use various strategies to help their patient’s relieve thirst. In the absence of evidence for these approaches further research is crucial in investigating the efficacy of these methods in relieving thirst in chronic heart failure. http://dx.doi.org/10.1016/j.hlc.2015.06.214 214 Dental-associated viridans streptococci bloodstream infection in patients with continuous-flow ventricular assist devices C. Dowling 1,∗ , C. Lim 2 , N. Kerr 1 , S. Rao 1 , D. Robson 1 , P. Macdonald 1 , E. Kotlyar 1 , A. Jabbour 1 , C. Hayward 1 , A. Keogh 1 1 St
Vincent’s Hospital, Sydney, Australia 2 National Heart Centre Singapore, Singapore Background: Ventricular assist device (VAD)-related infection leads to significant morbidity and mortality. Viridans streptococci have not been reported as a major cause of VADrelated blood stream infection (BSI). Methods: From January to December 2014, we prospectively obtained data on BSI from 35 patients with HeartWare
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
continuous-flow ventricular assist devices (HeartWare Inc, Framingham, MA). Results: Over a period of 21.7 patient-years there were 10 cases of VAD-related BSI, including 6 cases of viridans streptococci BSI. Within these 6 cases, 3 patients had biventricular assist devices and 3 patients had left ventricular assist devices. Causative organisms were Streptococcus sanguinis (2 patients), Streptococcus mitis (2 patients), Streptococcus parasanguinis (1 patient) and Streptococcus salivarius (1 patient). Recent dental associations were dental scaling (2 patients, one of whom received antibiotic prophylaxis), dental restoration (1 patient) and dental abscess (1 patient). Two patients did not have any identifiable dental associations. Duration of intravenous antibiotic treatment varied from 2 weeks (1 patient) to 6 weeks (5 patients). Chronic suppressive oral antibiotic treatment was given to 4 patients. Viridans streptococci BSI did not recur in any patient. Two patients underwent cardiac transplantation and explanted VAD cultures did not grow viridans streptococci. Conclusion: Dental-associated viridans streptococci BSI was common in our VAD cohort. This group of patients are at high risk for BSI and antibiotic prophylaxis should be considered. http://dx.doi.org/10.1016/j.hlc.2015.06.215 215 Derivation of left atrial pressure from flow analysis in continuous-flow left ventricular assist devices D. Vickers ∗ , S. Shehab, N. Jain, S. Rao, A. Jabbour, P. Jansz, C. Hayward St Vincent’s Hospital, Sydney, Australia Purpose: Pulmonary capillary wedge pressure (PCWP) measurement requires invasive right heart catheterisation (RHC). This study investigated whether PCWP could be derived from HeartWare HVAD flow waveform analysis.
Method: LVAD speed (2,200-3,200RPM), heart rate (60120BPM), and haematocrit (26.5-45%) were systematically varied in a dual circulation mock circulatory loop (MCL). Multiple left atrial pressures (5-30mmHg) and mean aortic pressures (70-100mmHg) were achieved for each variation. Pump parameters and haemodynamic values were recorded simultaneously (sample rate 50Hz). A novel marker of preload (ndQdt) was derived from flow waveform analysis based on the slope of the early diastolic flow waveform. In vivo validation studies were performed in HVAD patients undergoing RHC under normal and exercising states.