An Open label, Randomised Controlled trial on the effectiveness of the Orve+ Wrap® versus Forced Air Warming in restoring normothermia in the Post Anaesthetic Care Unit

AIMS AND OBJECTIVES: This study aims to determine the clinical effectiveness and safety of the Orve+Wrap® thermal blanket. BACKGROUND: Inadvertent peri-operative hypothermia is a common problem in Post Anaesthetic Care Units and can have significant effects on patients' post-operative morbidity. Despite its commercial availability there is no clinical evidence on the effectiveness of Orve+Wrap®. DESIGN: A single centre prospective, open label, non-inferiority randomized controlled trial. METHODS: Post-operative hypothermic (35.0°C - 35.9°C) patients who had undergone elective surgery were randomised to receive either Orve+Wrap® or Forced Air Warming for the during their PACU stay. Patient temperatures we recorded every 10 minutes using Zero Heat Flux Thermometry. This study is reported using CONSORT Extension checklist for non-inferiority and equivalence trials. RESULTS: Between December 2016 and October 2018, 129 patients were randomised to receive either Orve+wrap® blanket, (n=65, 50.3%) or Forced Air Warming, (n= 64, 49.7%). The mean 60-minute post-operative temperature of patients receiving Orve+wrap® blanket was 36.2°C and 36.3°C for the patients receiving Forced Air Warming. The predefined non-inferiority margin of a mean difference in temperature of 0.3°C, was not reached between the groups at 60 minutes. Additionally, there were no statistical differences between adverse event rates across these groups. CONCLUSIONS: In the context of this study warming patients with the Orve+wrap® was non-inferior to Forced Air Warming. There were comparable rates of associated post-operative consequences of warming (shivering, hypotension, arrhythmias or surgical site infections), between the groups. RELEVANCE TO CLINICAL PRACTICE: The Orve+wrap® potentially provides an alternative warming method to Forced Air Warming for patients requiring short term post-operative warming. However, there are still a number of unknowns regarding the Orve+wrap® performance and further exploration is required

The continuing question of how fever duration is associated with patient outcome

Although fever magnitude and etiology have been associated with outcomes of critically ill patients, possible associations between fever duration and mortality remain inconclusive. Since long-lasting fever is generally attributed to severe pathologic conditions, it is expected to be an indicator of adverse outcome. It also seems plausible that persistent fever in specific patient groups, mainly those with cerebral damage or limited cardiorespiratory reserve, could lead to worsened outcomes. Existing studies on these associations have been considerably limited because of methodological flaws, which may account for controversial findings that have been reported. Well-designed, large-sample studies using diverse measures of fever duration need to be conducted. © 2012 BioMed Central Ltd

Changes in nursing practice: Associations with responses to and coping with errors

Aims and objective. To investigate emotional responses of nurses and perceived senior staff responses to errors, error-coping strategies used by nurses and how these are associated with constructive or defensive changes in nursing practice. Background. Healthcare professionals have generally reported distressing emotional responses to errors and fear concerns about their consequences. However, errors can also be part of a developmental process, by offering opportunities for learning and leading to constructive changes in clinical practice. Design. Prospective, correlational, multicentre study. Methods. Five hundred and thirty-six structured questionnaires completed from nurses employed in various hospital departments were considered eligible for data extraction. The revised questionnaire used was evaluated for content validity. Results. Data analysis indicated that positive perceived senior staff responses (p=0·030), accepting error responsibility (p=0·031) and seeking social support (p=0·019) predicted constructive changes in nursing practice, while negative perceived senior staff responses (p=0·040) and error escape-avoidance (p=0·041) predicted defensive changes. Conclusions. Errors promote constructive changes in clinical practice when nurses are encouraged to use adaptive error-coping strategies within a supportive, non-blaming culture. Relevance to clinical practice. These findings highlight the role of senior staff in the establishment of a supportive, trustful ward climate, so that nurses can learn from errors, prevent their recurrence and improve patient safety. © 2011 Blackwell Publishing Ltd

Psychological distress and delusional memories after critical care: A literature review

Background: A considerable number of intensive care unit (ICU) survivors report delusional memories, which refer to dreams, nightmares, paranoid delusions and hallucinations experienced in the ICU. These memories often have a strong vividness, long duration and high emotional impact. Aim: The aim of this review was to investigate and synthesize published literature about psychological distress associated with delusional memories of adult ICU survivors. Methods: Using key terms, a search was conducted in major health care electronic databases [Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science and PsycInfo] focusing on articles published between 1990 and 2009 in English-language journals. Findings: Ten articles met the inclusion criteria. Recall of delusional memories at various intervals after ICU discharge was associated with post-traumatic stress disorder (PTSD)-related symptoms in many studies, while associations with other aspects of psychological distress, mainly feelings of fear, anxiety and depression, were also reported. Recent studies did not seem to confirm the protective role of factual memories. Conclusions: The findings support the association between delusional memories and PTSD-related symptoms, but further research is needed to confirm their association with other psychological disorders. Development of a safety sense in the ICU can protect patients against the emotional impact of both delusional and stressful factual ICU memories. Appropriate follow-up of high-risk patients could improve their long-term psychological recovery. © 2010 The Authors International Nursing Review © 2010 International Council of Nurses

Implementation of tunneled versus not tunneled peripherally inserted central catheters

Tunneled peripherally inserted central catheters (PICCs) offer several advantages such as an exit site at the green zone no matter where the puncture point is and a long subcutaneous route, which is considered a shield against infections and provides comfort to the patient. Clinicians could choose the proper exact exit site so as to avoid blood leakage from the exit point. The aim of the study was to assess the value of the tunneled PICCs versus normal PICCs with no long subcutaneous route. Sixty patients were randomly divided into two groups and underwent a PICC placement procedure between August 2014 and November 2014 and were then observed until February 2015. Thirty of them (group A) underwent a PICC placement procedure, after proper ultrasound scan and under local anesthesia, of the veins of the upper limb, internal jugular and axillary veins. The mean (±standard deviation) age of patients was 54.8 ± 9.2 years (range, 18–80 years). The primary success rate was 100% for all patients in both the groups. The procedure was not painful for the patients. In group A, after 3 months of surveillance, 7 devices were removed because the patients’ therapy came to an end, and only in one incident, the catheter was removed due to soft tissue infection. Tunneled PICCs seem to be a safe option and an easy alternative to perform in contrast to placement without a tunnel. It is an easy, cheap procedure that allows us to catheterize the vein with a larger caliber and create an exit point at any preselected point on the upper limb