Guided imagery: replication study using coronary artery bypass graft patients

Replication of a guided imagery study, based on the work of D. Tusek and colleagues, was initiated for coronary artery bypass graft patients, using the Center for Advanced Nursing Practice's Evidence-Based Practice Model. Through the leadership of clinical nurse specialists and the support of perioperative and postoperative bedside clinicians, this initiative offered benefits to patients and served as a template for program expansion to other patient populations.

Collaborative research: a community approach

Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a positive outcome. The purpose of the demonstration project was to describe a collaborative process in one community, culminating in a research utilization study and development of nursing standards pertaining to an aggregate population of patients.

Comparison of two endotracheal tube securement techniques on unplanned extubation, oral mucosa, and facial skin integrity

OBJECTIVE

To determine the effect of 2 standard methods (i.e., twill tape versus adhesive tape) of securement on unplanned extubation, oral mucosa, and facial skin integrity of the orally intubated patient.

DESIGN

A prospective, quasi-experimental design was used for the pilot study.

SETTING

The setting for the pilot study included critical care units of 3 community hospitals and 1 veterans' hospital in a midwestern city.

SUBJECTS

A total of 52 orally intubated adult subjects were enrolled in the study from the 4 clinical sites over a 6-month period of time. The participants in the study consisted of 30 men and 22 women. The subjects ranged in age from 22 to 85 years, with a mean age of 62.3 years. The mean length of intubation was 89.6 hours.

OUTCOME MEASURES

The outcome measures of the study were (1) unplanned extubation, (2) oral mucosa status, and (3) facial skin integrity.

INTERVENTIONS

Endotracheal tube securement with either the twill tape or the adhesive tape securement method.

RESULTS

With use of multiple analysis of variances (MANOVA) and repeated analyses of variances (ANOVAs), there were no significant differences by time or type of endotracheal tube securement method on oral mucosa or facial skin integrity. A chi-square analysis demonstrated no significant association between the 2 types of endotracheal tube securement when comparing their efficacy in preventing unplanned extubation.

CONCLUSION

The findings of this pilot study demonstrated both methods of endotracheal tube securement to be comparable in preventing unplanned extubation and in maintaining oral mucosa status and facial skin integrity.

Effect of oxygen insufflation during endotracheal suctioning on arterial pressure and oxygenation in coronary artery bypass graft patients

BACKGROUND Numerous studies have demonstrated the need for increased inspired oxygen with endotracheal suctioning to prevent hypoxemia; however, increased arterial pressure has been reported as a consequence of lung hyperinflation/inflation used to deliver hyperoxygenation. OBJECTIVES To compare insufflation during endotracheal suctioning with a standard procedure of hyperoxygenation using a ventilator on arterial pressure, pulmonary artery pressure, heart rate, arterial oxygen saturation, and blood gases in intubated, mechanically ventilated coronary artery bypass graft patients. METHODS A within-subjects, repeated-measures design was used to measure arterial pressure (systolic, diastolic, and mean), pulmonary artery pressure (systolic, diastolic, and mean), airway pressure, heart rate and rhythm, arterial oxygen tension, arterial carbon dioxide tension, pH, and arterial oxygen saturation during an oxygen insufflation protocol and a hyperoxygenation protocol via the ventilator. RESULTS Using analysis of variance for repeated measures, statistically significant time effects were found for all variables. Statistically significant differences between protocols over time were found for arterial pressure, arterial oxygen tension, and arterial oxygen saturation. CONCLUSIONS Oxygen insufflation resulted in less increase in arterial pressure than did the hyperoxygenation protocol. The hyperoxygenation protocol resulted in hyperoxia. Based on this study, oxygen insufflation is a safe alternative for providing oxygen during endotracheal suctioning.

Effect of oxygen insufflation during endotracheal suctioning on arterial pressure and oxygenation in coronary artery bypass graft patients

BACKGROUND Numerous studies have demonstrated the need for increased inspired oxygen with endotracheal suctioning to prevent hypoxemia; however, increased arterial pressure has been reported as a consequence of lung hyperinflation/inflation used to deliver hyperoxygenation. OBJECTIVES To compare insufflation during endotracheal suctioning with a standard procedure of hyperoxygenation using a ventilator on arterial pressure, pulmonary artery pressure, heart rate, arterial oxygen saturation, and blood gases in intubated, mechanically ventilated coronary artery bypass graft patients. METHODS A within-subjects, repeated-measures design was used to measure arterial pressure (systolic, diastolic, and mean), pulmonary artery pressure (systolic, diastolic, and mean), airway pressure, heart rate and rhythm, arterial oxygen tension, arterial carbon dioxide tension, pH, and arterial oxygen saturation during an oxygen insufflation protocol and a hyperoxygenation protocol via the ventilator. RESULTS Using analysis of variance for repeated measures, statistically significant time effects were found for all variables. Statistically significant differences between protocols over time were found for arterial pressure, arterial oxygen tension, and arterial oxygen saturation. CONCLUSIONS Oxygen insufflation resulted in less increase in arterial pressure than did the hyperoxygenation protocol. The hyperoxygenation protocol resulted in hyperoxia. Based on this study, oxygen insufflation is a safe alternative for providing oxygen during endotracheal suctioning.