What is the evidence behind recommended syringe size in pushing medications through IVs?

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No relevant references were identified in searches of Joanna Briggs, PubMed and CINAHL for combinations of these terms:
Iv push, Infusion, Catheter
Complications, adverse effects, adverse events, rupture
Syringe
Size, diameter

A search on Google revealed a discussion board on your topic.
http://allnurses.com/infusion-nursing-intravenous/question-about-piccs-241871-page3.html

There was a reference in the discussion board to this article:
Catheter Connection Column. Journal of Vascular Access Devices. Volume 3 No 3,  Fall 1998

A cited reference search on this reference in CINAHL identified two papers that cite the it:
Douglas L, et al.  Central venous access devices: review of practice.  Paediatric Nursing, 2009 Jun; 21 (5): 19-22.

Dougherty L.  Central venous access devices.  Nursing Standard, 2000 Jul 12-18; 14 (43): 45-50, 53-4.

jkn March 2014

Is use of a secondary IV, or piggyback system, reduce the rate of central line-associated bloodstream infections?

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A search of Joanna Briggs for the term piggyback identified several evidence summaries and recommendations.  Each of them cited the 2002 CDC guidelines as evidence in discussing piggyback systems.

MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
O’Grady NP, et al.  Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

On p. 11, the guidelines state that “modified piggyback systems have the potential to prevent contamination…” and cite this single study:

JPEN J Parenter Enteral Nutr. 1992 Nov-Dec;16(6):581-5.
Inoue Y, et al.  Prevention of catheter-related sepsis during parenteral nutrition: effect of a new connection device.

A search of PubMed was conducted using the following terms:
(piggyback OR secondary iv OR (secondary AND infusion)) AND infections AND prevention AND central venous catheters

The results include the Inoue study.  No other studies focus on prevention of catheter-associated bloodstream infections, but may report data on infection rates, which may also be useful.  However, the populations for most of the other studies were neonates.

jkn 3/14

What is the standard of care for the post-operative patient who received spinal anesthesia?

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Searches of PubMed, The Joanna Briggs Institute EBP Database, and the National Guideline Clearinghouse yielded the following practice guideline.

Whitaker Chair, D K, et al. “Immediate post-anaesthesia recovery 2013: Association of Anaesthetists of Great Britain and Ireland.” Anaesthesia 68.3 (2013):288-297.

The abstract states, “The standard of nursing and medical care should be equal to that in the hospital’s critical care units.”

Reviewed 4/8/2014 ldt

What patient education interventions are used in the preoperative care of patients?

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A search of Joanna Briggs Institute and PubMed identified the following references.
The PubMed search included terms for these concepts: preoperative period, pain, psychology, adults, patient education.

From Joanna Briggs:

Cabilan C, et al.  Prehabilitation for surgical patients: a systematic review protocol. 2013.
This is protocol for a systematic review, but in the background information, it references several papers on presurgical interventions specifically concerning the outcome of pain.

Stern C.  Knowledge retention from preoperative patient information.  2005 (updated 2010).
This systematic review references several studies investigating usefulness of preoperative education on outcomes such as pain.

From PubMed:
(“Preoperative care”[mesh] OR “preoperative period”[mesh]) AND pain AND (psychology OR anxiety OR fear) AND adults AND patient education

This search may include references cited in the Joanna Briggs reviews.  It also includes a systematic review on outcomes of preoperative patient education in surgical setting:
Ronco M, et al.  Patient education outcomes in surgery: a systematic review from 2004 to 2010.  Int J Evid Based Healthc. 2012 Dec;10(4):309-23.

Are there studies on training programs for clinical care coordinators/patient technicians in communication skills?

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Searches of PubMed and CINAHL for your concepts of nurses aides, communication, and education found the following articles.

Fukaya, Yasuko, et al. “Education to promote verbal communication by caregivers in geriatric care facilities.” Japan journal of nursing science 6.2 (2009):91-103.

McGilton, Katherine S, et al. “A systematic review of the effectiveness of communication interventions for health care providers caring for patients in residential care settings.” Worldviews on evidence-based nursing 6.3 (2009):149-159.

Levy Storms, Lené. “Therapeutic communication training in long-term care institutions: recommendations for future research.” Patient education and counseling 73.1 (2008):8-21.

Williams, Kristine N, Teresa BIlten, and HelenBower. “Meeting communication needs: topics of talk in the nursing home.” Journal of psychosocial nursing and mental health services 43.7 (2005):38-45.

Cunningham, Adrian. “Developing a communications course for health care assistants.” Nursing times 100.47 (2004):36-38.

Williams, Kristine Enhancing communication with older adults: overcoming elderspeak. Journal of Gerontological Nursing 2004 vol:30 iss:10 pg:17 -25

Stevens Roseman, Ellen S, and PatrickLeung. “Enhancing attitudes, knowledge and skills of paraprofessional service providers in elder care settings.” Gerontology & geriatrics education 25.1 (2004):73-88.

Counsell, Colleen M, and RoseRivers. “Inspiring support staff employees.” The Journal of nursing administration 32.3 (2002):120-121.

Burgio, L D, et al. “Come talk with me: improving communication between nursing assistants and nursing home residents during care routines.” Gerontologist, The 41.4 (2001):449-460.

McCallion, P, et al. “Educating nursing assistants to communicate more effectively with nursing home residents with dementia.” Gerontologist, The 39.5 (1999):546-558.

Thomas, L H. “A comparison of the verbal interactions of qualified nurses and nursing auxiliaries in primary, team and functional nursing wards.” International journal of nursing studies 31.3 (1994):231-244.

Is there benefit to routinely screening for urinary tract infection (bacteruria) in hospitalized patients without urinary catheters?

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The information below pertains to asymptomatic bacteruria because the assumption is if the patient were symptomatic, diagnostic testing would be administered as standard care for the patient.

Here are guidelines for diagnosing and managing asymptomatic bacteruria.

  • Infectious Diseases Society of America (IDSA) guideline on diagnosis and treatment of asymptomatic bacteriuria in adults.  Clin Infect Dis 2005 Mar 1;40(5):643.
    • Based on evidence from at least 1 quality RCT in each case, IDSA recommends AGAINST screening premenopausal, nonpregnant women, women with diabetes, elderly institutionalized persons, older persons living in community, patients with spinal cord injury, patients with indwelling urethral catheter.  Also recommends screening pregnant women.
    • IDSA does recommend screening prior to transurethral resection of prostate (based on at least 1 RCT) and before other urologic procedures (based on descriptive studies and expert opinion)
    • IDSA does not make any recommendation about screening renal or other solid organ transplant recipients
  • United States Preventive Services Task Force (USPSTF) recommendation on screening for asymptomatic bacteriuria in adults.  National Guideline Clearinghouse 2008 Aug 4:12619 or Ann Intern Med 2008 Jul 1;149(1):43.
    • Only recommends routine screening for pregnant women.

Guidelines suggest further research is needed to address management of asymptomatic bacteruria in these populations:  chronic kidney disease, indwelling urinary devices other than catheters (eg, urinary stents, nephrostomy tubes), selected immunocompromised patients (eg, neutropenia, transplant recipients), and patients undergoing prosthetic implantation (orthopedic or vascular procedures).

Evidence from the guidelines includes hospitalized and non-hospitalized patients.  Details of the evidence are provided in the guidelines.

Searches of Medline and CINAHL using combinations of these terms did not identify any papers on routine testing of hospitalized patients.

Urine analysis
Routine, screening
Hospitalized, inpatients
Transplant, immunocompromised

Nursing care for a patient with externalized shunt

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Hill, Michelle A multidisciplinary approach to end external ventricular drain infections in the neurocritical care unit. Journal of Neuroscience Nursing, 2012 Aug; 44 (4): 188-93.

Henman, Lita Checklists and Bundles-Not Just for Central Lines Anymore: Using a Standardized Insertion and Maintenance Approach to Eliminate External Ventricular Drain Infections. American Journal of Infection Control, 2011 Jun; 39 (5): E195.

Orsi GB Hospital-acquired infection surveillance in a neurosurgical intensive care unit. Journal of Hospital Infection, 2006 Sep; 64 (1): 23-9.

Cummings R Understanding external ventricular drainage. Journal of Neuroscience Nursing (J NEUROSCI NURS), 1992 Apr; 24 (2): 84-7.

Lwin, Sein, et al. “External ventricular drain infections: successful implementation of strategies to reduce infection rate.” Singapore medical journal 53.4 (2012):255-259.

Littlejohns, Linda R, and BrettTrimble. “Our policy on external ventricular drainage systems includes the procedure for priming the system. Does it really have to be primed?.” Critical care nurse 25.3 (2005):57-59.

Criddle, Laura M. “Is it an expected practice for critical care nurses to irrigate an external ventriculostomy drainage (EVD) system with tissue plasminogen activator (tPA) to break up blood clots in the tubing to facilitate drainage, thereby preventing increased intracranial pressure?.” Critical care nurse 27.3 (2007):78-78, 81.

Searched PubMed & CINAHL. Keywords: external shunt, externalized shunt, (nursing or nurse)