Abstract

Medication errors occur frequently in hospital settings, creating harmful consequences for patients and families, as well as tremendous financial losses. “Smart pump” technology is one means by which these errors can be reduced. The study reported here is a part of a three phase study and focused on the perceptions of nurses (n=512) in a tertiary care hospital regarding the impact of the implementation of “smart pump” technology and its impact on nursing care provided, medication errors, and job satisfaction. Sociotechnical System Theory and the Life Patterns Model were used to frame the study. The Infusion System Perception Scale was used to assess demographic information, and perceptions of nurses on a 30-item five-point Likert scale. Results indicate that nurses perceived the “pump” increased safe medication administration, did not decrease the perception of the punitive nature of reporting medication errors and did not increase the nurse's workload, but did make routines easier. The “pump” was perceived to increase self-confidence but had no effect on use of the pharmacy staff. Findings suggest that the “pump” could be implemented in a variety of settings, regardless of the age, gender, and educational background of the nurses. The “pump” offers an effective approach to the reduction of intravenous medication errors.

Abstract

Background: Vitamin E has antiplatelet, fibrinolytic and endotoxin properties that may help avoid the problems of occlusion or inability to withdraw blood from port VADs.

Purpose: Disseminate information about the non-traditional therapeutic use of vitamin E associated with care of Venous Access Devices (VAD) in patients with cancer.

Methodology: In-person focus groups. Sample of 22 cancer patients who had port Venous Access Devices (VAD).

Findings: Fourteen percent (N = 3) of patients felt that taking vitamin E, 400 -800 IU per day orally, in capsule form, avoided the problems of occlusion or inability to withdraw blood from their current VAD.

Practice Implications: The effects of vitamin E on occlusion and inability to withdraw blood in caring for patients who have port VADs, requires further investigation.

Abstract

Background: The incidence of end stage renal disease (ESRD) has increased in recent years. Elderly patients constitute the most rapidly growing group who need renal replacement therapy. In 2003, persons over 65 comprised 35% of all hemodialysed patients in Poland, and by the end of 2005 more than 44%.

Methods: From January 1984 through July 2004, patients 65 or older (n=133) starting hemodialysis (HD), were considered. The study group consisted of 80 men and 53 women (mean age 71.8±4.9years). Patients' survival probability, primary, primary-assisted, and secondary patency of the vascular access (VA) were calculated using Kaplan-Mayer curves and log-rank analysis. Cox's proportional-hazards model was used to assess the influence of risk factors on VA patency.

Results: A total of 196 VAs were created. Of the 108 native arteriovenous fistulas (AVF) created, 24 were radiocephalic (RCAVF), 15 were brachiobasilic (BBAVF), and 64 were brachiocephalic (BCAVF). Arteriovenous grafts (AVG) were used in 35 patients and permanent tunneled cuffed catheters (PTCC) in 53. Secondary patency at 1-year was: 49% for native AVF, 62% for AVG, and 19% for PTCC. The survival rate of the 133 elderly patients was 63% at 1-year, 50% at 2 years, and 26% at 5 years.

Conclusion: People 65 and older are a predominant population in whom HD can preserve life. In elderly patients AVG had the best secondary patency. When limited life expectancy was taken into consideration AVGs were a good alternative for vascular access in hemodialysis.

Abstract

Introduction: Peripherally Inserted Central Catheters (PICCs) are a proven and cost effective alternative to traditional short term central venous catheters inserted via subclavian or jugular vein routes. It has been theorized that persons with cervical spinal cord injury (SCI) are more prone to upper extremity deep venous thrombosis (DVT) post PICC insertion. Purpose: This study was conducted to determine if there is a statistically significant increase in the incidence of PICC-related upper extremity thrombosis in persons with quadriplegia as compared to other patient populations. Methods: A retrospective chart review of 56 PICC insertions, performed on 44 patients, was conducted to identify risk factors associated with symptomatic upper extremity DVTs. Results: The overall incidence of symptomatic DVTs was 7.1% per PICC line insertion (95% CI 2.8% - 17.0%) and 9.1% per patient (95% CI 3.6% - 21.2%) and the number of DVTs per 1,000 catheter days was 3.14. DVT diagnosis was not significantly associated with any of the patient or PICC-related characteristics examined. The incidence of symptomatic DVTs per PICC line insertion was not significantly different than the lowest incidence of thrombosis reported in the scientific literature among all patients receiving PICCs. Conclusions: Results from this study do not suggest that persons with cervical spinal cord injuries are at increased risk for developing upper-extremity DVTs related to PICC insertion. Due to the retrospective nature of the present study and small sample size, prospective studies are recommended to further examine DVTs in patients' with spinal cord injuries. Estimates from the present study can be used in planning prospective studies.