Reviewed by John Nemeth 4/14
What are the best practices for peritoneal dialysis general care and exit site care?
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Monthly Archives: January 2014
What are the best practices for assisting with paracentesis?
What are the best practices on measuring blood pressure (BP)?
A search of Joanna Briggs Institute identified the following articles:
Vital Signs. [Recommended Practices], AN: JBI2005, Updated: 02 Dec 2013.
Reviewed by John Nemeth 4/14
Is there evidence-based research to support using ice packs for postoperative pain management?
Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cyrotherapy following total knee rcplacement. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007911
Bottom Line: In regard to postoperative pain following total knee replacement,this Cochrane Systematic Review had 11 randomized controlled trials and one controlled trial with a total of 809 participants which met its inclusive criteria. The author found that potential benefits of cryotherapy on blood loss, postoperative pain and range of motion was too small to justify its use and the quality of evidence was low or very low for all main outcomes. Additionally another Cochrane Systemic Review, Bala, MM, Riemsma, RP, Woff, R, Kleijnen J. Cryotherapy for liver metastases. Cochrane Database for Syst. Rev. 2013 June 5;6 , stated there is insufficient evidence that cyotherapy benefited patients with liver metastases from various primary sites in terms of survival or recurrence compared with conventional surgery.
The databases searched were PubMed, CINAHL and Joanna Briggs. My search stratedy was the following: (ice packs OR cyrotherapy) AND postoperative pain limited from 2000-present and human and English language.
Eight randomized controlled trials results saw benefits from cold therapy relieving postoperative pain from different parts of the body. Lastly another randomized controlled trial, Modabber A, Rana M, Ghassemi A, Gerressen M, Gellrich NC, Holzle F, Rana M. Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized observer-blind prospective study. Trials. 2013 Jul 29;14:238, found that hilotherapy was a more efficient cooling method than conventional cooling in relieving postoperative pain and swelling.
Reviewed by John Nemeth 4/14
For patients on ventilator receiving neuromuscular blockade, how frequently should patient’s response to dose be monitored with peripheral nerve stimulation?
Bottom line: No published evidence compares monitoring frequency (eg, q4, q8, etc.) to determine what is safest and most effective for monitoring dosage of neuromuscular blocking agents. Professional recommendations advocate every 2-12 hours.
Summary: ASA. Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration. Anesthesiology. 2009; 110(2): 218-230.
Page 221 begins review of recommendations and evidence for effectiveness of methods for detecting respiratory depression, and on p. 222, recommendation by expert consensus for monitoring after single injection and continuous infusion depend on class of drugs (neuraxial lipophilic opioids v. neuraxial hydrophilic opioids), clinical condition of patient and concurrent medications.
AACN Procedure Manual for Critical Care, 6th ed. [In print at EUH]
Recommends train of four (TOF) testing every 4-8 hours during infusion after patient is stable and after optimal dose for neuromuscular blockade is achieved (p. 310.) References guidelines (see below.)
Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med. 2002;30:142-156.
In the monitoring section, the guidelines recommend monitoring but do not provide specifics. They do however, cite a study (Kleinpell) that surveys ICUs about their practices, as well as one prospective study (Strange) that compares TOF to clinical assessment and one retrospective study (Frankel) about implementing standards for monitoring in a surgical unit.
(“Monitoring, Physiologic”[MAJR]) AND “Neuromuscular Blockade”[MAJR] AND (train-of-four OR electric stimulation) AND (prospective study OR observational study OR cohort study OR comparison study)
Here is a PubMed search for comparison and cohort studies evaluating train-of-four. Some are evaluating specific devices or stimulation methods. Baumann (2004) and Strange (1997) address the use of the TOF itself.
There is also an RCT by Rudis (1997) that compares clinical assessment to TOF for reduction in dose of neuromuscular nondepolarizing agent to maintain paralysis .
Reviewed by John Nemeth 4/14
Evidence Matters 