American Journal of Critical Care. 2009;18: 12 doi:10.4037/ajcc2009865
Copyright © 2009 by the American Association of Critical-Care Nurses.
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
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Feeding Protocol for Neonates With Heart Disease
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Growth failure and malnutrition are common in neonates with congenital heart disease, and inadequate caloric intake is a major factor. In this issue, Schwalbe-Terilli et al describe their feeding protocol and evaluate caloric intake in these infants. Children with heart defects may need as much as 50% more calories than normal children to achieve normal growth.
The feeding protocol dictates the following:
- Infants with ductal-dependent lesions on prostaglandin, and/or with umbilical arterial lines, are not fed.
- Total parenteral nutrition is typically initiated on the 2nd postoperative day and discontinued once enteral feeding of 100 mL/kg per day is achieved.
The authors also found the following:
- A caloric intake of 100 kcal/kg was achieved in 48% of feeding days, and 120 kcal/kg was achieved in 20% of feeding days.
- Enteral feedings were temporarily discontinued on 21% of feeding days.
- Inadequate caloric intake in the postoperative period was common.
See Article, pp 52–57
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Patient Bath Basins as a Source of Health Care–Acquired Infection
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Can bath basins harbor microorganisms that are potential sources for health care–acquired infection, even after removal of the possibly contaminated water? In this issue, Johnson et al attempt to answer this question. They note the following:
- The evidence demonstrates a link between waterborne pathogens in the health care setting and the development of biofilm (multiple colonies of microorganisms attached to a surface).
- Most nurses disposed of used bath water in hand-washing sinks, which could then contaminate the sink and surrounding areas.
- Mechanical friction releases skin flora into bath water, whereas the bath basin can become contaminated with gram-negative bacteria from the environment and serve as a source of bacterial exposure during future baths.
- Storing basins upright allows for remaining droplets of water to pool at the bottom, allowing biofilms to form.
See Article, pp 31–40
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Pressure Dressings vs Film or Transparent Dressings
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Is use of the standard pressure dressing after sheath removal with percutaneous transluminal coronary angioplasty (PTCA) procedures necessary? McIe et al reviewed the evidence and made a practice change that resulted in greater patient comfort and improved assessments. They noted:
- Patients complained of skin irritation, pain, pulling, rash, blisters, and skin burns after the pressure dressing was removed.
- There was reduced ability to assess for early bleeding complications with a pressure dressing.
- The literature indicated that routine use of pressure dressings may be unnecessary.
In testing transparent or adhesive dressings in their setting, the authors found
- no increased risk of bleeding complications
- increased patient satisfaction and reduced skin irritation
- increased ability to assess for early bleeding
See Article, pp 14–20
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Glucose Control in the ICU
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Are glucose measurements from fingersticks the same as from a central venous catheter (CVC)? Are they the same as laboratory results? Cook et al investigated these questions and found the following:
- No differences were found in glucose values using fingerstick vs blood from CVCs.
- There was a significant difference between point of care (POC) and laboratory glucose values.
- Twenty percent of fingerstick and 15% of 6 CVC, POC blood samples had
20 mg/dL differences from laboratory values.
- Differences between POC and lab glucose values were greater in those with lower hematocrit levels.
- Finger edema did not explain differences between the POC and laboratory glucose values.
See Article, pp 65–72
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:
- Transparent Film Dressing vs Pressure Dressing After Percutaneous Transluminal Coronary Angiography
- Stacie McIe, Trisha Petitte, Lori Pride, Donna Leeper, and C. Lynne Ostrow
AJCC 2009 18: 14-20.
[Abstract]
[Full Text]
- Patients’ Bath Basins as Potential Sources of Infection: A Multicenter Sampling Study
- Debra Johnson, Lauri Lineweaver, and Lenora M. Maze
AJCC 2009 18: 31-40.
[Abstract]
[Full Text]
- Enteral Feeding and Caloric Intake in Neonates After Cardiac Surgery
- Courtney R. Schwalbe-Terilli, Diane H. Hartman, Monica L. Nagle, Paul R. Gallagher, Richard F. Ittenbach, Nancy B. Burnham, J. William Gaynor, and Chitra Ravishankar
AJCC 2009 18: 52-57.
[Abstract]
[Full Text]
- Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients
- Anjannette Cook, Delyla Laughlin, Margery Moore, Doreen North, Kathleen Wilkins, Gay Wong, Allyson Wallace-Scroggs, and Lisa Halvorsen
AJCC 2009 18: 65-72.
[Abstract]
[Full Text]
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Feeding Protocol for Neonates...
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