Intravascular site care: are critical care nurses practicing according to written protocols?

Challenges of collecting data in the clinical setting

Undertaking a piece of research in the clinical setting is often far more difficult than it appears from descriptions in textbooks. This paper describes some of the challenges faced in the course of completing a non-participant observational study that examined how health promotion practice was carried out by hospital-based nurses in an acute setting. The challenges included deciding which observational role to adopt, whether to use structured or unstructured observations, which observational position to adopt, how long observation sessions should be and how to deal with ethical issues when the researcher is also a nurse. It is concluded that the answers to some dilemmas and challenges are not always found in the literature and that decisions taken often depend on the researcher's morality and pure common sense.

Implementation of a Written Protocol for Management of Central Venous Access Devices

The objectives of this study were to evaluate registered nurses' (RN) compliance with a local clinical central venous access device (CVAD) protocol after completing an educational program and to determine RNs' perception of the program. Seventy-five RNs working in hematology participated in the educational part of the program. Sixty-eight RNs were examined while changing CVAD dressings or placing a Huber needle into a port on actual patients. Sixty percent of the RNs passed the examination and reported that the program increased their knowledge. The results indicated that the educational program could be recommended for use when implementing a new clinical protocol.

Current practice in administration of parenteral nutrition: venous access

Today, there are many alternative feeding options for patients unable to eat and drink and nutrition support has become part of everyday clinical practice. Although feeding via the enteral route used to be considered optional, recent experts have re-examined the role of parenteral nutrition, and found it to be as beneficial. This article will review current practice surrounding parental nutrition, its indications and the associated complications. Successful feeding via the intravenous route relies on the selection of the appropriate intravenous access, optimum nursing care and close patient monitoring. The range of venous access options will be discussed and advantages and disadvantages identified.

Reducing infections associated with central venous catheters

The cost of infections in central venous catheters (CVCs) is high both to the NHS and to the patients and their carers. This article discusses reduction of infection in patients with CVCs. Adding to the debate on how to do this, three interlinked factors are discussed: (1) the virulence of the invading micro-organisms, (2) the environment for microbial growth, and (3) the host defence mechanisms. The article encourages healthcare workers to use interprofessional groups to write, update frequently, and discuss protocols designed to reduce infections. The discussion and updating of the protocols, based on local experience, monitoring actions and infection rates within the interprofessional group, will assist in the reduction of infection.

[The comparative costs of vancomycin treatment versus teicoplanin in osteoarticular infection caused by methicillin-resistant staphylococci]

This clinical and economical study compared two glycopeptides regimen i.e., vancomycin and teicoplanin in the treatment of osteoarticular infection involving methicillin-resistant staphylococcus. After randomization, 15 patients (group 1) received vancomycin (23 F per gram) in continuous infusion through a central venous catheter and 15 others (group 2) intramuscular teicoplanin (311-357 F a 400 mg vial). The clinical study focused on treatment tolerance in an in-patient setting as well as in a non in-patient one. The cost analysis focused on total expenses including those of antibiotics, those of medical devices for antibiotic administration and those of the complications caused by the antibiotics use. Total expenses per patient averaged 8744 F with vancomycin and 8555 F with teicoplanin (NS). The apparent money saving by using a cheap antibiotic (i.e. vancomycin) was illusionary as one took in account the expenses for medical devices e.g., central venous catheters required to administer vancomycin and the complications due to the use of these devices.

From simplicity to complexity: developing a model of practical skill performance in nursing

The purpose of this article is to present and discuss a new model of practical skill performance in nursing. The model is conceptualized as having five components: substance and sequence; accuracy; fluency; integration; and caring conduct. The model challenges the truism of 'simple' nursing procedures. It is argued that performance of practical skills in nursing is characterized by complexity on many levels. Complexity lies within and between the components of the performance model and in the interaction between the nurse and the clinical context where practical nursing actions are performed. These complexities are described. Examples that illustrate the complex and reciprocal nature of these components are drawn from an empirical study of graduate nurses' development of practical skill in surgical hospital units. Implications of the model for education, practice and research are discussed.