American Journal of Critical Care. 2008;17: 13
Copyright © 2008 by the American Association of Critical-Care Nurses.
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
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Gender and Acute Coronary Syndromes
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DeVon and colleagues and Noureddine and colleagues describe and add validation for gender differences in symptoms for acute coronary syndromes (ACS). The American Heart Association (AHA) notes that clinicians and patients often attribute chest pain in women to noncardiac causes, leading to misinterpretation of their condition.
But both women and men may present with "classic" chest pain, whereas women may have a greater tendency for atypical chest pain, complain about abdominal pain, and experience difficulty breathing (dyspnea), nausea, and unexplained fatigue. Other gender differences related to ACS have been reported by AHA and others:
- Women delay seeking medical care and have heart attacks later in life than men do.
- An exercise stress test, or stress ECG, may be less accurate for women.
- Women may experience different symptoms during ACS.
- Women may present with more back pain, dyspnea, indigestion, nausea/vomiting, and weakness compared to men.
- Men are more likely to present with chest pain. However, DeVon and colleagues report the following:
- No differences between women and men in back pain, dyspnea, nausea/vomiting, or weakness.
- No gender differences in the classic symptoms of chest pain, diaphoresis, and shortness of breath.
- More jaw and neck pain in women than in men, but whereas chest pain was the most frequently reported symptom, 21% of women and 10% of men experienced no chest pain.
See Article, pp 14–25; 26–35
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Preventing Central Venous Catheter Infections
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How well do you know the recommendations for care of a central venous catheter (CVC)? Labeau and colleagues describe the development of a questionnaire to assess nurses’ knowledge of this evidence-based guideline. The guidelines recommend:
- Replace CVCs only when indicated.
- Replace pressure transducers and tubing every 4 days.
- Change the site dressing when indicated and at least weekly.
- Disinfect the site with 2% aqueous chlorhexidine.
- Do not use an antibiotic ointment.
- Replace the lipid emulsion administration set within 24 hours.
- Change the administration set every 96 hours if neither lipids nor blood products are administered.
See Article, pp 65–72
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Effectiveness of Clinical Alarms
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Because of the dangers inherent in critical care and use and misuse of alarm systems, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) set 6 national patient safety goals for 2003, one of which was to improve the overall effectiveness of clinical alarms. After 2004, due to high compliance rates, this goal was retired and became part of the JCAHO accreditation requirements, but misuse of alarms remains a problem. What is clinical alarm compliance like in your unit?
Korniewicz and colleagues present the results of a national survey on the efficacy of clinical alarms. Among their findings are that clinicians should work to minimize nuisance alarms though proper use of equipment.
- One approach is to select limit settings for heart rate that provide sufficient protection for the patient but do not allow clinically unimportant rate changes to set off nuisance alarms.
- All clinicians should take an active role in learning how to use equipment safely over its full range of capabilities.
- Effective alarm management also depends on equipment designs that promote appropriate use as well as hospitals that recognize the complexities of managing alarms and devote the necessary resources to develop effective management schemes.
See Article, pp 36–43
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Delivery of Enteral Nutrition to Patients on Mechanical Ventilation
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O’Meara and colleagues describe the enteral feeding process and reasons for feeding interruption and inability to meet feeding goals. Malnutrition has negative effects on the critically ill. National guidelines for nutrition recommend the following:
- Initiate enteral nutrition within 24 to 48 hours after ICU admission.
- If possible, use postpyloric nutrition based on a trend toward reducing infectious complications.
- Elevate the head of the patient’s bed to 45° during enteral feeding, or, if contraindicated, elevate as high as possible.
See Article, pp 53–61
Clinical Pearls is designed to help implement evidence-based care at the bedside by summarizing some of the most clinically useful material from select articles in each issue. Readers are encouraged to photocopy this ready-to-post page and share it with colleagues. Please be advised, however, that any substantive change in patient care protocols should be carefully reviewed and approved by the policy-setting authorities at your institution.
Related articles in AJCC:
- Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men
- Holli A. DeVon, Catherine J. Ryan, Amy L. Ochs, and Moshe Shapiro
AJCC 2008 17: 14-24.
[Abstract]
[Full Text]
- Response to Signs and Symptoms of Acute Coronary Syndrome: Differences Between Lebanese Men and Women
- Samar Noureddine, Mary Arevian, Marina Adra, and Houry Puzantian
AJCC 2008 17: 26-35.
[Abstract]
[Full Text]
- A National Online Survey on the Effectiveness of Clinical Alarms
- Denise M. Korniewicz, Tobey Clark, and Yadin David
AJCC 2008 17: 36-41.
[Abstract]
[Full Text]
- Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation
- Debra O’Meara, Eduardo Mireles-Cabodevila, Fran Frame, A. Christine Hummell, Jeffrey Hammel, Raed A. Dweik, and Alejandro C. Arroliga
AJCC 2008 17: 53-61.
[Abstract]
[Full Text]
- Critical Care Nurses’ Knowledge of Evidence-Based Guidelines for Preventing Infections Associated With Central Venous Catheters: An Evaluation Questionnaire
- S. Labeau, A. Vereecke, D.M. Vandijck, B. Claes, S.I. Blot, and on behalf of the executive board of the Flemish Society for Critical Care Nurses
AJCC 2008 17: 65-71.
[Abstract]
[Full Text]
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