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Peripheral Intravenous (PIV) Catheter Extravasation Wound Care Guidelines
Abstract Peripheral Intravenous (PIV) Catheter Extravasation Wound Care Guidelines Amy Phillips MSN, APRN-CNS, CCRN Children's Hospital and Medical Center-Omaha, Omaha, NE
Objectives: • Identify how an evidence-based practice (EBP) process was used to determine the best practice for managing peripheral intravenous (PIV) extravasation wounds in the neonate. • Describe three types of PIV extravasation wounds in the neonate and the related wound care recommendations. Practice Problem: The hospital PIV infiltration and extravasation protocol was developed in 2005 and outlined clear guidelines for treatment, assessment, and documentation requirements. The care of infiltration/extravasation wounds primarily resulting from Stage 3–4 infiltrations was identified as being inconsistent. Purpose: In the hospitalized neonatal patient with a PIV catheter extravasation, what is the best practice for managing extravasation wounds to minimize tissue damage and optimize wound healing? EBP Model/Process: An EBP project team composed of nurses representing the neonatal intensive care unit (NICU); infant medical–surgical unit; wound, ostomy and continence nurses (WOCN); and surgical services was developed. The John Hopkins Nursing Evidence-Based Practice model was used. A literature search and appraisal were completed for the past 15 years. Expert opinion evidence was provided by the WOCN team member. Summary of Literature: One neonatal clinical practice guideline addressing intravenous infiltration was found (AWHONN, 2007) representing Level I evidence. The extravasation wound care section was supported by Levels IV and V evidence. Several additional studies were reviewed with similar evidence levels. Using the Oncology Nursing Society's evidence classification schema, the body of evidence was determined to be “Interventions Recommended for Practice and/or Likely to Be Effective.” Outcomes: An algorithm was developed guiding wound care for three potential wound types. This algorithm was piloted in the NICU. Based on nurses' feedback, minute changes were made to the guideline during the pilot. Conclusion and Implications: An evidence-based standard of practice with algorithm was developed, which will be reviewed by the Clinical Practice Council for potential hospital-wide implementation. doi:10.1016/j.pedn.2011.01.264 A New Age of Pediatric Distraction in Radiology: Use of Multiple Sensory Input and A Cohesive Story Line Approach Dana Etzel-Hardman MSN, MBA, RN, CPN Children's Hospital of Pittsburgh, Pittsburgh, PA
Objectives: The learner will be able to describe two techniques used in a pediatric radiology department to reduce the need for sedation. Practice Problem and Purpose: During 2005, there was an increase in the number of requests for sedation during imaging procedures at our institution. Along with this issue came the risks of sedation, a need for additional staffing, and an increase of time spent in the hospital for families and patients. Purpose/PICO Question: To reduce sedation among pediatric patients undergoing computed tomography examinations, we used
e21 multiple distraction techniques prior to and during the examination. Based on the results from our first phase, we expanded the project to other imaging modalities. We then determined the effect of multiple sensory input distractions on the number of patient sedations and level of patient/parent satisfaction during imaging procedures. Summary of Literature: Distraction techniques are becoming widely accepted as a means by which to calm patients before various procedures and reduce the need for sedation. Evidence-Based Practice Model/Process: Our pediatric department created child-friendly room designs and employed multiple sensory input and use of a cohesive storyline approach. To evaluate the effectiveness of our advanced distraction techniques, a survey was given to families following the procedure. Outcomes: We found that distraction techniques were effective at reducing the need for sedation in pediatric patients undergoing all radiologic examinations. In addition, the decor and distraction techniques were well liked by patients and families, and they helped the patient complete the examination. Conclusion and Implications: We conclude that pediatric distraction techniques should be implemented in pediatric radiology departments to improve cooperation, reduce the need for sedation, and increase patient satisfaction. doi:10.1016/j.pedn.2011.01.265 Caring for the Chronic Pediatric Medically Ventilated Patient in a Medical Surgical Unit Maria Soto MSN, ARNP, MBA, Carmen R. Duque MSN, ARNP Miami Children's Hospital, Miami, FL
Objectives: • Participants will be able to identify two benefits of transitioning the care of the medically ventilated patient from the intensive care unit (ICU) setting to the medical– surgical setting. • Participants will be able to identify two educational components required to provide safe care to mechanically ventilated patients in a medical–surgical unit. Target Audience: Student, advanced registered nurse practitioner, nursing administrators, clinical specialist, RNs. Problem: Chronic pediatric patients that require mechanical ventilation were cared for in intensive care units. Results: Chronic pediatric patients that require mechanical ventilation have been transitioned to a medical–surgical unit. Background: Historically, pediatric patients requiring mechanical ventilation were only cared for in the intensive care unit. Our goal was to determine if these type of patients could be cared for in a medical–surgical unit. It is well known that the ICU setting is limited for the overall well-being of a patient if medically the high level of acute care is not required. Issues related to the maintenance of good health, restoration of function, improvement in quality of life, discharge planning, and transitioning the patient/family to a home care setting can be managed more effectively thru the medical–surgical unit. Method: Medically stabled chronic mechanically ventilated patients were deemed to qualify for floor care by a licensed pulmonologist. These patients were transitioned to the pediatric respiratory unit. Staff caring for these patients was formally trained by respiratory
Objectives: • Identify how an evidence-based practice (EBP) process was used to determine the best practice for managing peripheral intravenous (PIV) extravasation wounds in the neonate. • Describe three types of PIV extravasation wounds in the neonate and the related wound care recommendations. Practice Problem: The hospital PIV infiltration and extravasation protocol was developed in 2005 and outlined clear guidelines for treatment, assessment, and documentation requirements. The care of infiltration/extravasation wounds primarily resulting from Stage 3–4 infiltrations was identified as being inconsistent. Purpose: In the hospitalized neonatal patient with a PIV catheter extravasation, what is the best practice for managing extravasation wounds to minimize tissue damage and optimize wound healing? EBP Model/Process: An EBP project team composed of nurses representing the neonatal intensive care unit (NICU); infant medical–surgical unit; wound, ostomy and continence nurses (WOCN); and surgical services was developed. The John Hopkins Nursing Evidence-Based Practice model was used. A literature search and appraisal were completed for the past 15 years. Expert opinion evidence was provided by the WOCN team member. Summary of Literature: One neonatal clinical practice guideline addressing intravenous infiltration was found (AWHONN, 2007) representing Level I evidence. The extravasation wound care section was supported by Levels IV and V evidence. Several additional studies were reviewed with similar evidence levels. Using the Oncology Nursing Society's evidence classification schema, the body of evidence was determined to be “Interventions Recommended for Practice and/or Likely to Be Effective.” Outcomes: An algorithm was developed guiding wound care for three potential wound types. This algorithm was piloted in the NICU. Based on nurses' feedback, minute changes were made to the guideline during the pilot. Conclusion and Implications: An evidence-based standard of practice with algorithm was developed, which will be reviewed by the Clinical Practice Council for potential hospital-wide implementation. doi:10.1016/j.pedn.2011.01.264 A New Age of Pediatric Distraction in Radiology: Use of Multiple Sensory Input and A Cohesive Story Line Approach Dana Etzel-Hardman MSN, MBA, RN, CPN Children's Hospital of Pittsburgh, Pittsburgh, PA
Objectives: The learner will be able to describe two techniques used in a pediatric radiology department to reduce the need for sedation. Practice Problem and Purpose: During 2005, there was an increase in the number of requests for sedation during imaging procedures at our institution. Along with this issue came the risks of sedation, a need for additional staffing, and an increase of time spent in the hospital for families and patients. Purpose/PICO Question: To reduce sedation among pediatric patients undergoing computed tomography examinations, we used
e21 multiple distraction techniques prior to and during the examination. Based on the results from our first phase, we expanded the project to other imaging modalities. We then determined the effect of multiple sensory input distractions on the number of patient sedations and level of patient/parent satisfaction during imaging procedures. Summary of Literature: Distraction techniques are becoming widely accepted as a means by which to calm patients before various procedures and reduce the need for sedation. Evidence-Based Practice Model/Process: Our pediatric department created child-friendly room designs and employed multiple sensory input and use of a cohesive storyline approach. To evaluate the effectiveness of our advanced distraction techniques, a survey was given to families following the procedure. Outcomes: We found that distraction techniques were effective at reducing the need for sedation in pediatric patients undergoing all radiologic examinations. In addition, the decor and distraction techniques were well liked by patients and families, and they helped the patient complete the examination. Conclusion and Implications: We conclude that pediatric distraction techniques should be implemented in pediatric radiology departments to improve cooperation, reduce the need for sedation, and increase patient satisfaction. doi:10.1016/j.pedn.2011.01.265 Caring for the Chronic Pediatric Medically Ventilated Patient in a Medical Surgical Unit Maria Soto MSN, ARNP, MBA, Carmen R. Duque MSN, ARNP Miami Children's Hospital, Miami, FL
Objectives: • Participants will be able to identify two benefits of transitioning the care of the medically ventilated patient from the intensive care unit (ICU) setting to the medical– surgical setting. • Participants will be able to identify two educational components required to provide safe care to mechanically ventilated patients in a medical–surgical unit. Target Audience: Student, advanced registered nurse practitioner, nursing administrators, clinical specialist, RNs. Problem: Chronic pediatric patients that require mechanical ventilation were cared for in intensive care units. Results: Chronic pediatric patients that require mechanical ventilation have been transitioned to a medical–surgical unit. Background: Historically, pediatric patients requiring mechanical ventilation were only cared for in the intensive care unit. Our goal was to determine if these type of patients could be cared for in a medical–surgical unit. It is well known that the ICU setting is limited for the overall well-being of a patient if medically the high level of acute care is not required. Issues related to the maintenance of good health, restoration of function, improvement in quality of life, discharge planning, and transitioning the patient/family to a home care setting can be managed more effectively thru the medical–surgical unit. Method: Medically stabled chronic mechanically ventilated patients were deemed to qualify for floor care by a licensed pulmonologist. These patients were transitioned to the pediatric respiratory unit. Staff caring for these patients was formally trained by respiratory