Should capnography be used in postoperative, unventilated patients?

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There isn’t a consensus on whether capnography should be used in postoperative patients.

Eichhorn, John H. “Review article: practical current issues in perioperative patient safety.” Canadian journal of anesthesia 60.2 (2013):111-118.
The first paragraph of page 116 discusses the lack of consensus on how best to monitor postoperative patients for hypoventilation from postoperative pain medication.

Jarzyna, Donna, et al. “American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression.” Pain management nursing 12.3 (2011):118-145.e10.
Article states, “there is a paucity of information and no consensus about the benefits of technology supported monitoring, such as…capnography.”

Hutchison, Rob, and LesRodriguez. “Capnography and respiratory depression.” American journal of nursing 108.2 (2008):35-39.
This randomized prospective study of 54 postoperative orthopedic patients found a significantly higher rate of respiratory depression in the capnography group, concluding that “capnography may be more appropriate for use with postsurgical high-risk patients taking opioids” and “may have the added advantage of indicating those patients who may be at risk for obstructive sleep apnea.”

What medications are associated with high fall rates?

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Among the medications discussed as contributing to higher rates of falls include psychotropics, analgesics, diuretics, and antihypertensives.

See <a href="” target=”_blank”>Falls > Possible Risk Factors > Medication effects.  In:  DynaMed.  References studies documenting medications associated with falls.

Click here to access collection of articles discussing medications and fall rates.

Characteristics of kidney stones in women

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Wilcox: Therapy in Nephrology & Hypertension, 3rd ed.
Copyright © 2008 Saunders, An Imprint of Elsevier
PART V – Nephrolithiasis
Chapter 35 – Evaluation and Management of Kidney Stone Disease
Eric N. Taylor, Gary C. Curhan
Symptomatic nephrolithiasis classically presents with sudden unilateral flank pain. The pain is caused by the passage of a kidney stone from the renal pelvis to the ureter and is due to ureteral spasm. The pain is often severe and can cause nausea and vomiting. The location of the pain depends on the location of the stone; a stone in the upper ureter may cause pain to radiate anteriorly to the abdomen, and a stone in the lower ureter can cause pain to radiate to the ipsilateral testicle in men or to the ipsilateral labium in women.

Cunningham et al.: Williams Obstetrics, 24th ed.
Copyright © 2014  The McGraw-Hill Companies, Inc.
Chapter 53. Renal and Urinary Tract Disorders
“There is some evidence that pregnant women may have fewer symptoms with stone passage because of urinary tract dilatation (Hendricks, 1991; Tan, 2013). That said, more than 90 percent of pregnant women with nephrolithiasis present with pain. Gross hematuria is less common than in nonpregnant women and was reported to be a presenting symptom in 23 percent of women described by Butler and associates (2000). In another study, however, Lewis and coworkers (2003) found that only 2 percent had hematuria.”

Reviewed and updated 4/24/2014 ldt

What is the recent evidence on whether closed catheter systems prevent catheter-associated bloodstream infections (CLABSIs)?

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Ishizuka, Mitsuru, et al. “Needleless closed system does not reduce central venous catheter-related bloodstream infection: a retrospective study.” International surgery 98.1 (2013):88-93.

Newman, Nitza, et al. “Central venous catheter-associated bloodstream infections.” Pediatric blood & cancer 59.2 (2012):410-414.

Ellger, B, et al. “Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions.” Journal of hospital infection 78.1 (2011):31-35.

Graves, Nicholas, Adrian GBarnett, and Victor DRosenthal. “Open versus closed IV infusion systems: a state based model to predict risk of catheter associated blood stream infections.” BMJ open 1.2 (2011):e000188-e000188.

Maki, Dennis G, et al. “Impact of switching from an open to a closed infusion system on rates of central line-associated bloodstream infection: a meta-analysis of time-sequence cohort studies in 4 countries.” Infection control and hospital epidemiology 32.1 (2011):50-58.

McAfee, Nancy, et al. “A continuous quality improvement project to decrease hemodialysis catheter infections in pediatric patients: use of a closed luer-lock access cap.” Nephrology Nursing Journal 37.5 (2010):541-4.

Jarvis, William R, et al. “Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.” Clinical infectious diseases 49.12 (2009):1821-1827.

Ishizuka, Mitsuru, et al. “Valve system does not reduce the catheter-related bloodstream infection.” Journal of investigative surgery 22.6 (2009):430-434.

Vilins, Margarete, et al. “Rate and time to develop first central line-associated bloodstream infections when comparing open and closed infusion containers in a Brazilian Hospital.” The Brazilian journal of infectious diseases 13.5 (2009):335-340.

Ivy, D D, et al. “Closed-hub systems with protected connections and the reduction of risk of catheter-related bloodstream infection in pediatric patients receiving intravenous prostanoid therapy for pulmonary hypertension.” Infection control and hospital epidemiology 30.9 (2009):823-829.

Franzetti, F, et al. “Impact on rates and time to first central vascular-associated bloodstream infection when switching from open to closed intravenous infusion containers in a hospital setting.” Epidemiology and Infection 137.7 (2009):1041-1048.

Blake, Molly. “Update: Catheter-related bloodstream infection rates in relation to clinical practice and needleless device type.” The Canadian journal of infection control 23.3 (2008):156-60, 162.

How should closed catheter systems be maintained?

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Rupp, Mark E, et al. “Adequate disinfection of a split-septum needleless intravascular connector with a 5-second alcohol scrub.” Infection control and hospital epidemiology 33.7 (2012):661-665.
This is a prospective observational clinical survey and laboratory assessment of disinfection procedures.

Aly, Hany, et al. “Is bloodstream infection preventable among premature infants? A tale of two cities.” Pediatrics 115.6 (2005):1513-1518.
Described the protocol for maintaining a closed medication system.

Should needleless caps be changed before drawing blood samples?

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Mathew, Alice, et al. “Central catheter blood sampling: the impact of changing the needleless caps prior to collection.” Journal of infusion nursing 32.4 (2009):212-218.
This study of 91 patients compared 3 methods of blood draws (old cap (existing cap), new cap (replacing old cap with a sterile one), and peripheral methods).  Nine false positive cases of bacteremia were identified using the old cap. Researchers recommending changing the cap before drawing culture samples.

 

Does changing needleless caps reduce the rate of infections?

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Conflicting evidence exists on whether changing needleless caps reduces the rate of infections.

Do, A N, et al. “Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting.” The Journal of infectious diseases 179.2 (1999):442-448.
Cohort study found that rate of bloodstream infections (BSIs) rate “decreased as the frequency of changing the needleless device end cap increased from once weekly up to every 2 days, suggesting that the mechanism for BSI may involve contamination from the end cap.”

McDonald, L C, S N NBanerjee, and W R RJarvis. “Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy.” Infection control and hospital epidemiology 19.10 (1998):772-777.
Bloodstream infection (BSI) rates increased in patients receiving “intermittent (vs continuous) intravenous therapy through one or more lumens. The IVAC device valvecomponent was replaced every 6 days, and the endcap used to cover the valve (when connected to an unused lumen) was replaced every 24 hours or after each access. The BSI rate returned to baseline after institution of a policy to replace the entire IVAC device, valve, and endcap every 24 hours.”

Danzig, L E, et al. “Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy.” JAMA: the Journal of the American Medical Association 273.23 (1995):1862-1864.
Researchers conducted case-control and retrospective cohort studies. Data found that needleless device used for total parenteral nutrition and intralipid therapy (TPN/IL) “was associated with increased risk of BSI when injection caps were changed every 7 days.”