Are there guidelines for use of high frequency oscillatory ventilation in patients with acute lung injury?

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DynaMed, a good source for locating the most current guidelines.

Mechanical ventilation: The guidelines seem to be about when to wean, or how to prevent ventilator-associated pneumonia
ARDS:  the only one I saw specifically addressing oxygen therapy was from American Association of Respiratory Care (2001).

Professional organization websites:

Society for Critical Care Medicine
http://www.learnicu.org/pages/guidelines.aspx
Did not locate any guidelines on respiratory failure that mention HFOV

American Association for Respiratory Care
A paper (2007) on the site – http://www.rcjournal.com/contents/09.07/09.07.1224.pdf – indicates that at that time the technique was not included in any AARC guidelines.
Did not locate any other guidelines on the site that address use of HFOV.

AACN Procedure Manual for Critical Care (in EUH Branch Library), 2011.  Indicates that there has not been enough evidence to show superiority of HFOV over conventional modes of ventilation in patients with ARDS (p. 278).

Also see:  What is the latest evidence and nursing implications on the use of high frequency ocsillatory ventilation?

What is the latest evidence and nursing implications on the use of high frequency ocsillatory ventilation?

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Mechanical Ventilation.  In:  DynaMed. 
See a summary of current evidence in the “Ventilator Settings (Evidence)” section>High Frequency Oscillatory Ventilation (HFOV).

A systematic review ( Cochrane Database Syst Rev 2013 Feb 28;(2):CD004085) of studies (N=419) with methodological limitations concluded that may reduce mortality and treatment failure.  However it did not include results of two recent RCTs:

1.  HFOV does not reduce mortality compared to conventional ventilation (N Engl J Med 2013 Feb 28;368(9):806)  RCT (N=795 adults with ARDS).  RESULTS:  All-cause mortality rate 41.7% for HFOV group v. 41.1% for conventional ventilation group (not significant).

2. HFOV may increase risk of mortality compared to conventional ventilation protocol.  RCT (N=548 adults with moderate to severe ARDS).  RESULTS:   12% of patients in control group received HFOV for refractory hypoxemia.  In-hospital mortality 47% for HFOV group vs. 35% for control group.

What is the risk for transmitting infection by healthcare providers using a stethoscope as he or she moves from patient to patient?

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Bottom line:  Stethoscopes, mostly the earpieces, are a reservoir for bacteria, but there is no evidence directly addressing any association between use of stethoscopes on multiple patients and transmission of the bacteria found on the stethoscope

Halcomb E, et al. Role of MRSA reservoirs in the acute care setting. JBI Library of Systematic Reviews. 2008; 6(16): 633-685.
Identified one observational study of the eartips of stethoscopes dedicated to patients on contact precaution for MRSA.  13 of 78 (17%) eartips examined had potentially pathogenic bacteria on them, but none of the bacteria were the same as the infectious agents in the patients.

Other similar studies were identifed in a PubMed search.   Only the Brook (1997) paper below describes an actual infection (in a nurse) traced to an earpiece of a stethoscope.  The other studies show that most common organisms identified on stethoscopes (mostly earpieces) is S. aureas.

Gopinath KG, et al. Pagers and stethoscopes as vehicles of potential nosocomial pathogens in a tertiary care hospital in a developing country.  Trop Doct. 2011 Jan;41(1):43-5.  PMID: 21109607

Youngster I, et al. The stethoscope as a vector of infectious diseases in the paediatric division.  Acta Paediatr. 2008 Sep;97(9):1253-5.   PMID:18554272

Bernard L, et al.  Bacterial contamination of hospital physicians’ stethoscopes.  Infect Control Hosp Epidemiol. 1999 Sep;20(9):626-8.  PMID:10501265

Brook I.  Bacterial flora of stethoscopes’ earpieces and otitis externa.  Ann Otol Rhinol Laryngol. 1997 Sep;106(9):751-2.  PMID:9302906

Smith MA, et al.  Contaminated stethoscopes revisited.  Arch Intern Med. 1996 Jan 8;156(1):82-4.  PMID:8526701

Wright IM, et al.  Stethoscope contamination in the neonatal intensive care unit.  J Hosp Infect. 1995 Jan;29(1):65-8.  PMID:7738341

Search strategy:
Consulted and evidence summary source:  Searched Joanna Briggs Institute for “stethoscope and infection” – Identified a systematic review, which cited a paper on stethoscopes dedicated to MRSA-infected patients as as reservoirs.
Looked up that reference in PubMed and identified terms for a focused PubMed search:
(“Stethoscopes/microbiology”[MAJR] OR “Equipment contamination”[MAJR]) AND (nosocomial OR “hospital-acquired infection”)

Used QUOSA to identify articles from this set that discuss stethoscopes.

What information is available on patients with central venous catheters ambulating off the nursing unit/ward floor?

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Standardizing central venous catheter care: hospital to home. The Nebraska Medical Center. Standardizing central venous catheter care: hospital to home. Omaha (NE): The Nebraska Medical Center; 2012. 8 p.

Chopra, Vineet, et al. “Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: A Michigan survey.” Journal of hospital medicine (2013)

Zhao, Vivian M, et al. “Characterization of post-hospital infections in adults requiring home parenteral nutrition.” Nutrition 29.1 (2013):52-59.

Ouanes, Islem, et al. “A model to predict short-term death or readmission after intensive care unit discharge.” Journal of critical care 27.4 (2012):422.e1-422.e9.

Jaffer, Amir K. “Update in hospital medicine: studies likely to affect inpatient practice in 2011.” Cleveland Clinic journal of medicine 78.7 (2011):430-434.

Simcock, L. “Central venous catheters: some common clinical questions.” Nursing times 97.19 (2001):34-36.

What are the effects of medroxyprogesterone on breastfeeding?

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Forinash, Alicia B, et al. “The use of galactogogues in the breastfeeding mother.” The Annals of pharmacotherapy 46.10 (2012):1392-1404.

Roy, Geneviève. “Injectable contraception.” Seminars in reproductive medicine 28.2 (2010):126-132.

Zuppa, Antonio A, et al. “Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production.” Journal of pharmacy & pharmaceutical sciences 13.2 (2010):162-174.
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Curtis, Kathryn M, Camaryn EChrisman, and Herbert BPeterson. “Contraception for women in selected circumstances.” Obstetrics and gynecology 99.6 (2002):1100-1112.

Kelsey, J J. “Hormonal contraception and lactation.” Journal of human lactation 12.4 (1996):315-318.

World Health Organization

CDC

Search CINAHL and PubMed on concepts of breastfeeding, medroxyprogesterone and Depo Provera. Also, searched WHO and CDC websites.

What are the costs associated with nursing turnover in acute care environments?

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Jones, Cheryl B. “The costs of nurse turnover: part 1: an economic perspective.” The Journal of nursing administration 34.12 (2004):562-570.

Jones, Cheryl B. “The costs of nurse turnover, part 2: application of the Nursing Turnover Cost Calculation Methodology.” The Journal of nursing administration 35.1 (2005):41-49.

Jones, Cheryl B. “Revisiting nurse turnover costs: adjusting for inflation.” The Journal of nursing administration 38.1 (2008):11-18.

Halfer, Diana. “A magnetic strategy for new graduate nurses.” Nursing economic$ 25.1 (2007):6-11, 3.

PubMed search keywords: nursing turnover, cost, acute care

Click here to run a CINAHL search on costs associated with nursing turnover in acute care environments

What is recommended practice for administering dopamine? What studies are available on dopamine and extravasation?

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Administration. To access DynaMed information on Dopamine Administration
Dopamine

Select “Dosage and Administration” from left menu.

Dynamed also has information about extravasation available by clicking “Warnings” on left menu.

A search of PubMed with keywords dopamine and extravasation produced these results.

Bhosale, Guruprasad P, and Veena RShah. “Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene.” Journal of Anaesthesiology-Clinical Pharmacology 28.4 (2012):534-535.

Phillips, Reid A, et al. “Deep dopamine extravasation injury: a case report.” Journal of plastic, reconstructive & aesthetic surgery 62.7 (2009):e222-e224.

Chen, J L, and MO’Shea. “Extravasation injury associated with low-dose dopamine.” The Annals of pharmacotherapy 32.5 (1998):545-548.

Bey, D, et al. “The use of phentolamine in the prevention of dopamine-induced tissue extravasation.” Journal of critical care 13.1 (1998):13-20.

Dugger, B. “Peripheral dopamine infusions: are they worth the risk of infiltration?.” Journal of intravenous nursing 20.2 (1997):95-99.