Heparinised Saline versus Normal Saline in Maintaining Patency of Arterial and Central Venous Catheters

Introduction: Heparin has been used in flush solutions in attempts to prolong the patency of arterial and central venous pressure monitoring lines. Its use however is not without risks such as hypersensitivity reactions and heparin-induced thrombocytopenia. Recent studies suggest that non-heparinised solutions may be as effective in maintaining catheter patency. Our aim is to determine if there is any difference in maintaining patency of arterial and central venous pressure monitoring lines using normal saline as compared to heparinised saline. Methods: In this randomised controlled trial, patients were randomised to receive either heparinised saline or normal saline flush solutions. Randomisation was achieved using sealed opaque envelopes. Only nurses who had been specially trained in the care of catheters cared for the lines. Data was collected at 8-hour intervals for up to 120 hours post-insertion on acceptability of arterial waveform and presence of backflow of blood in the arterial and central venous lines. Results: A total of 70 patients were enrolled, with 36 in the normal saline group and 34 in the heparinised saline group. There were no differences between the groups in functionality of the arterial catheters as determined by waveform and backflow at 72 hours (p=0.578) and 120 hours (p=0.328) as well as for the venous catheters at 72 hours (p=0.063) and at 120 hours (p=0.173) based on presence of backflow. Conclusion: Normal saline is as effective as heparinised saline as flush solutions. Eliminating heparin use in flush solutions will result in fewer potential adverse events and cost savings

A Qualitative Study into Stroke Caregivers' Educational Needs — Perspectives of Caregivers and Healthcare Professionals

Background: Healthcare professionals (HCPs) often provide information based on what they thought caregivers would need and like to know, rather than on the latter's perceived or actual needs. The current descriptive study was undertaken to find out more about HCP's and caregivers' perceptions of educational needs while the stroke survivor is still being cared for in an acute hospital. Methods: Ten caregivers, five nurses, and two neurologists were interviewed about their perceptions of educational needs during the stroke survivors' stay in acute care. All interviews were audiotaped, transcribed verbatim, and then analysed to identify main patterns of responses. The Framework Approach, which involves the steps of familiarisation, identifying a thematic framework, indexing, charting, mapping, and interpretation was used to inform the analysis. Results: Caregivers and HCPs agreed on the need for information on disease progression, prevention of recurrence, practical and emotional care. However, HCPs felt caregivers should also know about medication, which was not mentioned by any of the caregivers. Caregivers preferred “hands-on experience” and “hearing” from HCP to print materials. While some caregivers felt that their active involvement in caregiving training was not required if a foreign domestic worker (FDW) was to be hired, HCPs interviewed felt strongly that next-of-kin should, nonetheless, be trained as well. Conclusion: The expressed needs on stroke education did not differ greatly between caregivers and HCPs. Perhaps unique to the Singapore context, is the availability of FDWs to take on the care-giving role. HCPs should be aware of differences in expectations in the level of involvement of family members in the presence of a FDW

The Use of Internet to Search for Health Information before Surgery: A Descriptive Study

Introduction: The Internet is becoming increasingly important as a source of health information. In Singapore, two in three households have access to Internet at home and the proportion of Internet users is rising each year 1 . This study seeks to investigate the characteristic of patients who used the Internet to seek for health information before scheduled surgery and their preferred mode of education from the healthcare professionals. Methods: This study was carried out in a general surgical ward. Using convenience sampling, subjects were asked to fill up a standard set of closed-ended questionnaires, which consist of the patients' demographics data, their perception of using the Internet and their preferred mode of education from the health-care professionals. Results: A total of 107 subjects completed this study. The percentage of subjects who owned a computer and had access to the Internet were 90%. Higher level of education and income were more likely to search the Internet before their operation (p=0.03). There was no significance difference between age group and Internet search (p=0.574). The most preferred mode of education were Internet-based when discharge from the hospital (n=48). Conclusions: The findings showed that patients and their love ones are taking a pro-active approach in their health and are resourceful in acquiring information about their surgery. Nurses play a vital role in providing patient education and guiding them to a reliable and accurate websites. Hence, it is imperative to adopt an Internet-based education especially for the IT-literate population

Global knowledge gaps in equitable delivery of chronic edema care: a political economy case study analysis

Background: Most existing research in chronic edema (CO) care takes place in high-income countries and is both clinically and medically focused, although often accorded low prestige and status. A myriad of challenges define the problems and important gaps in understanding and translating what we know into sustainable practice. Less considered, however, are the consequences and socioeconomic significance of this “knowledge gap” in an increasingly globalized world. This article seeks to address this lacuna by suggesting a political economy approach across three different income settings, the United Kingdom (high), Kerala in India (middle), and Uganda (low), to learn from international practice and understand the contribution of local (community-specific) health traditions. Methods and Result: We used a comparative case study approach. In the three case studies we demonstrate how particular thinking, sets of power relationships, and resource distributions influence and structure the provision of CO management more generally. We demonstrate how these intertwined and often invisible processes reflect a market-led biomedical hierarchization that focuses on high-interventionist, high-cost approaches that are then imposed on lower income settings. At the same time, low-cost but evidence-based local knowledge innovation in wound and CO care from low- or middle-income countries is neither recognized nor valued. Conclusion: We conclude that unpacking these dynamics is a necessary route to providing a more equitable health delivery accessible for the many rather than the few

A Randomised Controlled Trial Evaluating the Efficacy of a Nurse Controlled Analgesia (NCA) Protocol in Post Anaesthesia Care Unit (PACU)

Introduction: The purpose of this trial was to determine the efficacy of a Nurse Controlled Analgesia (NCA) protocol in reducing the time taken to achieve a satisfactory postoperative pain score. The safety aspects of the NCA protocol were also evaluated. Method: 120 patients undergoing major surgery were randomised into 2 groups – NCA group and the doctor administered analgesia group (DRA). Nurses in the Post Anaesthestic Care Area (PACU) administered analgesia based on a protocol whereas analgesia was titrated at the discretion of the doctor in the DRA group. Effective pain control was measured by the time taken to obtain first dose of analgesia and the time taken to achieve either a pain score of less than 4/10 or if the patient refused further analgesia. Results: Patients received their first dose of morphine faster in the NCA group compared to DRA group, 6.7 minutes versus 9.5 minutes respectively (p= 0.037). Time taken to achieve a pain score of less than 4 was shorter in the doctor group although this was not significant. Complication rates were not different in both groups. Conclusion: Nurse administered analgesia based on a protocol can provide pain relief for patients in the postoperative period as effectively and safely as doctor administered analgesia