Category Archives: Patient Safety

What are current guidelines on moving a patient from heparin drip to oral coumadin?

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Outpatient management of uncomplicated deep venous thrombosis. Michigan Quality Improvement Consortium. Outpatient management of uncomplicated deep venous thrombosis. Southfield (MI): Michigan Quality Improvement Consortium; 2011 Sep. 1 p.

Venous thromboembolism (VTE). University of Michigan Health System. Venous thromboembolism (VTE). Ann Arbor (MI): University of Michigan Health System; 2009 Feb. 13 p.

A. Maddali S, Morton C, Biring T, Bluhm J, Hanson M, Kopecky S, Krueger K, Larson T, Mikelson M, Miley T, Pruthi R, Schullo-Feulner Antithrombotic therapy supplement. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 May. 87 p.

Bozzato, Silvia Thromboprophylaxis in surgical and medical patients. Seminars in respiratory and critical care medicine 2012 vol:33 iss:2 pg:163 -175

Eisenstein, Diana Anticoagulation management in the ambulatory surgical setting. AORN journal 2012 vol:95 iss:4 pg:510 -21 examination 522

Pellegrini, Vincent DVT prophylaxis: better living through chemistry: affirms. Orthopedics 2010 vol:33 iss:9 pg:642 -642

Reviewed JKN 4/14

What are some guidelines or criteria for thermoregulation of neonates?

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Knobel, Robin Thermoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely low-birthweight infants. Journal of obstetric, gynecologic, and neonatal nursing 2007 vol:36 iss:3 pg:280 -287

Bissinger, Robin Thermoregulation in very low-birth-weight infants during the golden hour: results and implications. Advances in neonatal care 2010 vol:10 iss:5 pg:230 -238

McCall, E M Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane database of systematic reviews 2008 iss:1 pg:CD004210 -CD004210

Knobel, Robin Heat loss prevention for preterm infants in the delivery room. Journal of perinatology 2005 vol:25 iss:5 pg:304 -308

Watkinson, Michael Temperature control of premature infants in the delivery room. Clinics in perinatology 2006 vol:33 iss:1 pg:43 -53, vi

Assessment and care of the late preterm infant. Evidence-based clinical practice guideline. Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). Assessment and care of the late preterm infant. Evidence-based clinical practice guideline. Washington (DC): Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN); 2010. 57 p.

Dr Rasika Jayasekara RN, BA, BScN(Hons), PGDipEdu, MNSc, PhD Hypothermia: Management The Joanna Briggs Institute 19/10/2011

What is the evidence for caring for post radial catheterization/angiplasty patients?

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Search of CINAHL and Joanna Briggs on concept of concepts of post radial catheterization/angioplasty care

Carrington C ; Mann R ; El-Jack S An accelerated hemostasis protocol following transradial cardiac catheterization is safe and may shorten hospital stay: a single-center experience. Journal of Interventional Cardiology, 2009 Dec; 22(6): 571-5

Cosman, Tammy L ; Arthur, Heather M ; Natarajan, Madhu K Prevalence of bruising at the vascular access site one week after elective cardiac catheterisation or percutaneous coronary intervention. Journal of Clinical Nursing, 2011 May; 20(9/10): 1349-56

Kilonzo, Brid ; O’Connell, Rhona Secondary prevention and learning needs post percutaneous coronary intervention (PCI): perspectives of both patients and nurses. Journal of Clinical Nursing, 2011 Apr; 20(7/8): 1160-7

Mills, Cally ; Wright, Christine ; Newell, Caroline Care of the post percutaneous coronary intervention patient. Australian Nursing Journal, 2012 Feb; 19(7): 26-7

Theophilus Maloreh-Nyamekye, B.A (Nursing); PgCert (Research Methods); PgDip; MBA; MSc; MCIPS, PhD Candidate Post-Coronary Angiogram/PTCA: Patient Mobility 18/09/2011

Is a transradial band effective and safe for achieving hemostasis after transradial catheterization?

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Search in PubMed for catheterization AND band AND radial artery identified:

  • Catheter Cardiovasc Interv. 2010 Nov 1;76(5):660-7. RCT; 790 patients randomized to TR band or Radistop hemostatic compression device after catheterization; compared patient tolerance of device, local vascular complications, and time to achieve hemostasis
  • Catheter Cardiovasc Interv. 2012 Jan 1;79(1):78-81. doi: 10.1002/ccd.22963. Comparative study; 200 patients received TR band for 6 hours after procedure and 200 patients received TR band for 2 hours after procedure. Compared rates of 24 hour and 30 day radial artery occlusion and bleeding events.
  • J Interv Cardiol. 2009 Dec;22(6):571-5. Before and after study; 100 patients undergoing transradial catherization received TR band for 60 minutes and were compared to outcomes of 25 patients who had received band for 2 hours. Evaluated complications.
  • J Invasive Cardiol. 2009 Mar;21(3):101-4. Comparative study; 250 consecutive patients received HemoBand and 250 consecutive patients received TR band. Compared rates of radial artery occlusion at various time intervals.

Does trimming peripherally inserted central catheters (PICC) increase the incidence of thrombosis?

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Bottom line: There is not much published evidence addressing this question.

Summary:
Joanna Briggs: Peripherally Inserted Central Catheters: Occlusion
Reviews evidence associated with risk associated with misplacement or movement of the catheter tip and location of insertion site.  I checked the references cited, but did not find any discussion of modifying or trimming the catheter.

PubMed:
peripherally inserted catheter AND thrombosis AND (trimmed OR trimming OR modif* OR cutting)

Evidence that specifically discusses trimming includes
Parvez. Thrombosis Research (2004) 113, 175—177:  A comparison of changes in surface of catheter at site of trimming.  Authors hypothesize that roughness introduced by trimming line can contribute to thrombosis.

EMBASE:
To view search click on the EMBASE link and then copy this search statement into the search box:

‘peripherally inserted central catheter’ AND thrombosis  AND (trimming OR trimmed OR modif*)

Additional evidence that specifically discusses trimming includes:

Trimming of peripherally inserted central catheters: The end result
Pettit J.  JAVA – Journal of the Association for Vascular Access 2006 11:4 (209-214)
This paper references a study showing how trimming affects the catheter tip.  Possibly this reference is to the Parvez article from the PubMed results above.  We do not have access to this Pettit paper, but you can request through interlibrary loan link in the Find It @ Emory menu for this article

Other papers in both the PubMed and EMBASE searches seem to mention trimming or cutting the catheter, but only as part of the procedures and not as a risk factor.

SEARCH METHODS
Resources searched:
Evidence summary resources:  Joanna Briggs JBI+Connect
Large literature databases: PubMed, EMBASE

Search included combinations of these terms:
Peripherally inserted central catheter, catheter
trimming, trimmed, modif* (for modify, modified, modification, etc.)
thrombosis

How do postsurgical outcomes compare for general v. local anesthesia for implantation and testing of implantable cardioverter defibrillators (ICD)?

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A search of PubMed for “Defibrillators, Implantable”[MAJR] AND (local anesthesia OR sedation) AND (outcome OR complications OR safety OR satisfaction) identified several studies.

Studies comparing local anesthesia/sedation v. general anesthesia

Can we implant cardioverter defibrillator under minimal sedation?
Marquié C, Duchemin A, Klug D, Lamblin N, Mizon F, Cordova H, Boulo M, Lacroix D, Pol A, Kacet S.
Europace. 2007 Jul;9(7):545-50.
Measured patient-reported level of pain.

Electrophysiologist-implanted transvenous cardioverter defibrillators using local versus general anesthesia.
Manolis AS, Maounis T, Vassilikos V, Chiladakis J, Cokkinos DV.
Pacing Clin Electrophysiol. 2000 Jan;23(1):96-105.
Measured rate of post-surgical complications

Local anaesthesia versus general anaesthesia for cardioverter-defibrillator implantation.
Stix G, Anvari A, Podesser B, Pernerstorfer T, Mayer C, Laufer G, Schmidinger H.
Wien Klin Wochenschr. 1999 May 21;111(10):406-9.
Measured rate of post-surgical complications

Intravenous sedation for placement of automatic implantable cardioverter-defibrillators.
Pinosky ML, Reeves ST, Fishman RL, Alpert CC, Dorman BH, Kratz JM.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):764-6.
Measured length of stay and rate of post-surgical complications

Studies describing outcomes for procedures performed under locatl anesthetic/sedation

Safety and acceptability of implantation of internal cardioverter-defibrillators under local anesthetic and conscious sedation.
Fox DJ, Davidson NC, Royle M, Bennett DH, Clarke B, Garratt CJ, Hall MC, Zaidi AM, Patterson K, Fitzpatrick AP.
Pacing Clin Electrophysiol. 2007 Aug;30(8):992-7. Erratum in: Pacing Clin Electrophysiol. 2007 Nov;30(11):1423

Additional descriptive studies

Reviewed JKN 4/14

How do acuity-based nurse staffing models affect patient safety and overall nurse staffing?

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Searching CINAHL, PubMed and Joanna Briggs, for the concepts of nurse, staffing, (acuity OR “patient classification”), safety, and outcomes, identifies the following resources:

General information on acuity systems:

Choi J, et al. Power up your staffing model with patient acuity. Nurs Manage. 2011 Sep;42(9):40-3.

Acuity systems dialogue and patient classification system essentials. Nursing administration quarterly 2007 vol:31 iss:4 pg:284

On patient safety and quality

PubMed:  “Nursing Staff, Hospital”[majr] AND (acuity OR “patient classification”) AND (safety OR mortality) which includes references such as

  • Kiekkas P, et al.   Association between nursing workload and mortality of intensive care unit patients.  J Nurs Scholarsh. 2008;40(4):385-90.
  • Massey D, et al. What factors influence suboptimal ward care in the acutely ill ward patient? Aust Crit Care. 2008 Aug;21(3):127-40.

CINAHL:   nurse staffing AND (acuity OR “patient classification”) AND (safety OR mortality OR quality OR outcome)    which includes references such as:

  • Butler M, et al.  Hospital nurse staffing models and patient and staff-related outcomes.  Cochrane Database of Systematic Reviews, 2011 (7).

Revision of post from Dec 13, 2011. JKN