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The Positioning Assist Device for Stable Side Lying
THE 19TH AUSTRALlAN & NEW ZEALAND SCIENTIFIC MEETING ON INTENSIVE CARE CONFERENCE ABSTRACTS Friday 21st to Sunday 23rd October, 1994.
Poster presentation. THE POSITIONING ASSIST DEVICE FOR STABLE SIDE LYINC. Louise E Niggemeyel; Melissa J Tobin. Alfred Hospital, Melbourne, Victoria. The positioning assist device (PAD) is a triangular body length wedge of high density foam that is utilised to facilitate stable side lying for Road Trauma lntensive Care Unit patients. Developed at Alfred Hospital the device was implemented in the Trauma lntensive Care Unit to accomplish stable side lying for trauma patients over twelve months ago. The necessity for intermittent patient position change with stable side lying posed a significant challenge for the nursing of trauma patients. The constant need for the maintenance of body alignment and neutral cervical spine positioning with stability, caused the nurses of the Road Trauma lntensive Care Unit to look at inexpensive and safe alternatives to pillows. To use the PAD, the patient is log-rolled and the device placed under a foam-mattress overlay from the head to the buttocks; pillows, cervical spine stabilising foams and sandbags are located as necessary. Even intermittently agitated patients remain in a side lying posture without restraint. This device is now viewed by the nursing staff to be beneficial for trauma patients as stable side lying is not always easily provided and sustained with pillows., especially with limbs in plaster or traction as these cannot be flexed to stabilise the side lying position. While we acknowledge that this system only provides 30 to 40 degree side lying posture, the benefits in stability of position with the subsequent maintenance of body alignment make the PAD a worthwhile adjunct in the nursing considerations for our patients.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. INSTALLING A COMPLlTERISED CWNICAL INFORMATION SYSTEM Kim L Bowers Westrnead Hospital, Westmead, NSW Clinical Information System (CIS) is a term used to describe a computer system that replaces the standard paper flow sheets currently used in ICU's around the world. System 2000 CIS (the first of its kind in Australia) has been installed in to the ICU at Westmead Hospital. The installation of the CIS commenced in January 1993 and "go-live" was in November 1993 when the system was fully operational. The objective of this report is to discuss the process of implementing a CIS into an Australian ICU. To introduce the CIS to the Australian environment, hardware and software modifications had to be made at many levels. Working flow sheets and screens such as vital signs, fluid balance, neurological, respiratory, clinical assessments and notes etc, all required reconfiguration. Modificationwas also required in relation to technical aspects of designs including layout, cabling and workstation trolleys. To facilitate the training of nursing, medical and paramedical staff a complete training program was designed and implemented. Detailed consideration was given to the medico-legal requirements of the electronic signature. For the
introduction of the system, hospital policies and procedures were developed in areas including documentation, accountability, system users and passwords. System 2000 CIS facilitated real time accurate documentation. Studies are currently in progress to assess improved patient and nursing management and the ability to conduct comprehensive research and audit. Whilst providing a challenge for all involved the CIS will undoubtably become integral part of Australian ICU's.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. PERCUTANEOUS DILATATIONAL TRA CHEOSTOMY IN AN INTENSIVE CARE UNIT. Kai 0 Sun, Ying Y Lee, Ping C So Dept. of Anaesthesia, Kwong Wah Hospital, Kowloon, Hong Kong. To explore the safety of percutaneous dilatational tracheostomy, the experience of this technique using a Ciaglia percutaneous tracheostomy introducer set (Cook Critical Care Ltd.)was studied prospectively in our intensive care unit (ICU) for a 6-month period. All adult patients scheduled for elective bedside percutaneous tracheostomy in our ICU were selected. Thirty-eight patients with a mean age of 66.3SYMBOL 177 \f "Symbol"l4.0 years were studied. The mean duration of tracheal intubation before tracheostomy was 5.3SYMBOL 177 \f "SymboI"3.4 days. The procedures were performed by intensive care specialists (71.I%) or by intensive care trainees supervised by the specialists (28.9%). Tracheostomy tube placements were made at the following levels: between the cricoid and the first tracheal ring (7.9%), between the first and second ring (73.7%) and between the second and third ring (18.4%). Before puncturing the trachea, the tracheal tube was withdrawn a few cm either under laryngoscopy (31.6%) or blindly (68.4%).The tracheostomy was successful in 37 patients (97.4%). Procedure-related complications, of which most were mild and self-limiting, occurred in 47.4% of the patients. Significant wound haemorrhage occurred in 5 procedures, of which 1 was abandoned and converted to a conventional tracheostomy. Other complications included punctured tracheal tube cuff (n=9), pulmonary aspiration (n=3),stoma1 infection (n=2) and transient hypoxaemia (n=2). The grades of operators, the levels of tracheostomy tube placement and the use of laryngoscope for airway guidance have no statistical significant influence on the rates of the complications. In conclusion, bedside percutaneous dilatational tracheostomy for critically ill patients can be safely performed by trained physicians.
Poster presentation. THE POSITIONING ASSIST DEVICE FOR STABLE SIDE LYINC. Louise E Niggemeyel; Melissa J Tobin. Alfred Hospital, Melbourne, Victoria. The positioning assist device (PAD) is a triangular body length wedge of high density foam that is utilised to facilitate stable side lying for Road Trauma lntensive Care Unit patients. Developed at Alfred Hospital the device was implemented in the Trauma lntensive Care Unit to accomplish stable side lying for trauma patients over twelve months ago. The necessity for intermittent patient position change with stable side lying posed a significant challenge for the nursing of trauma patients. The constant need for the maintenance of body alignment and neutral cervical spine positioning with stability, caused the nurses of the Road Trauma lntensive Care Unit to look at inexpensive and safe alternatives to pillows. To use the PAD, the patient is log-rolled and the device placed under a foam-mattress overlay from the head to the buttocks; pillows, cervical spine stabilising foams and sandbags are located as necessary. Even intermittently agitated patients remain in a side lying posture without restraint. This device is now viewed by the nursing staff to be beneficial for trauma patients as stable side lying is not always easily provided and sustained with pillows., especially with limbs in plaster or traction as these cannot be flexed to stabilise the side lying position. While we acknowledge that this system only provides 30 to 40 degree side lying posture, the benefits in stability of position with the subsequent maintenance of body alignment make the PAD a worthwhile adjunct in the nursing considerations for our patients.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. INSTALLING A COMPLlTERISED CWNICAL INFORMATION SYSTEM Kim L Bowers Westrnead Hospital, Westmead, NSW Clinical Information System (CIS) is a term used to describe a computer system that replaces the standard paper flow sheets currently used in ICU's around the world. System 2000 CIS (the first of its kind in Australia) has been installed in to the ICU at Westmead Hospital. The installation of the CIS commenced in January 1993 and "go-live" was in November 1993 when the system was fully operational. The objective of this report is to discuss the process of implementing a CIS into an Australian ICU. To introduce the CIS to the Australian environment, hardware and software modifications had to be made at many levels. Working flow sheets and screens such as vital signs, fluid balance, neurological, respiratory, clinical assessments and notes etc, all required reconfiguration. Modificationwas also required in relation to technical aspects of designs including layout, cabling and workstation trolleys. To facilitate the training of nursing, medical and paramedical staff a complete training program was designed and implemented. Detailed consideration was given to the medico-legal requirements of the electronic signature. For the
introduction of the system, hospital policies and procedures were developed in areas including documentation, accountability, system users and passwords. System 2000 CIS facilitated real time accurate documentation. Studies are currently in progress to assess improved patient and nursing management and the ability to conduct comprehensive research and audit. Whilst providing a challenge for all involved the CIS will undoubtably become integral part of Australian ICU's.
Friday 21st to Sunday 23rd October, 1994.
Poster presentation. PERCUTANEOUS DILATATIONAL TRA CHEOSTOMY IN AN INTENSIVE CARE UNIT. Kai 0 Sun, Ying Y Lee, Ping C So Dept. of Anaesthesia, Kwong Wah Hospital, Kowloon, Hong Kong. To explore the safety of percutaneous dilatational tracheostomy, the experience of this technique using a Ciaglia percutaneous tracheostomy introducer set (Cook Critical Care Ltd.)was studied prospectively in our intensive care unit (ICU) for a 6-month period. All adult patients scheduled for elective bedside percutaneous tracheostomy in our ICU were selected. Thirty-eight patients with a mean age of 66.3SYMBOL 177 \f "Symbol"l4.0 years were studied. The mean duration of tracheal intubation before tracheostomy was 5.3SYMBOL 177 \f "SymboI"3.4 days. The procedures were performed by intensive care specialists (71.I%) or by intensive care trainees supervised by the specialists (28.9%). Tracheostomy tube placements were made at the following levels: between the cricoid and the first tracheal ring (7.9%), between the first and second ring (73.7%) and between the second and third ring (18.4%). Before puncturing the trachea, the tracheal tube was withdrawn a few cm either under laryngoscopy (31.6%) or blindly (68.4%).The tracheostomy was successful in 37 patients (97.4%). Procedure-related complications, of which most were mild and self-limiting, occurred in 47.4% of the patients. Significant wound haemorrhage occurred in 5 procedures, of which 1 was abandoned and converted to a conventional tracheostomy. Other complications included punctured tracheal tube cuff (n=9), pulmonary aspiration (n=3),stoma1 infection (n=2) and transient hypoxaemia (n=2). The grades of operators, the levels of tracheostomy tube placement and the use of laryngoscope for airway guidance have no statistical significant influence on the rates of the complications. In conclusion, bedside percutaneous dilatational tracheostomy for critically ill patients can be safely performed by trained physicians.