Saturday, January 11, 2014

January 2014 PARADIGM BYTES

PARADIGM BYTES

Newsletter for Paradigm 97
January 10, 2014
PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/Please copy, paste, and bookmark it.

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPETS
Tracheostomy care: An evidence-based guide to suctioning and dressing changes (Permission granted by American Nurse to have the full article here)
Tracheostomy care and tracheal suctioning are high-risk procedures. To avoid poor outcomes, nurses who perform them—whether they’re seasoned veterans or novices—must adhere to evidence-based guidelines. In fact, experienced nurses may overestimate their own trach care competence.
Tracheostomy patients aren’t seen only in intensive care units. As patients with more complex conditions are admitted to hospitals, an increasing number are being housed on general nursing units. Trach patients are at high risk for airway obstruction, impaired ventilation, and infection as well as other lethal complications. Skilled bedside nursing care can prevent these complications. This article describes evidence-based guidelines for tracheostomy care, focusing on open and closed suctioning and site care.

Suctioning a trach tube

A trach tube may have a single or double lumen; it may be cuffed or uncuffed, fenestrated (allowing speech) or unfenestrated. Each variation requires specific management. For instance, before suctioning a fenestrated tube, you must insert a plain inner tube, because a suction catheter may puncture the small opening of the fenestrated tube. (See Trach tube positioning by clicking the PDF icon above.)
Regardless of the type of tube used, suctioning always involves:
  • assessment
  • oxygenation management
  • use of correct suction pressure
  • liquefying secretions
  • using the proper-size suction catheter and insertion distance
  • appropriate patient positioning
  • evaluation.
Also, be sure to keep emergency equipment nearby. (See Be prepared for trach emergencies by clicking the PDF icon above.)

When to suction

Suctioning is done only for patients who can’t clear their own airways. Its timing should be tailored to each patient rather than performed on a set schedule.
Start with a complete assessment. Findings that suggest the need for suctioning include increased work of breathing, changes in respiratory rate, decreased oxygen saturation, copious secretions, wheezing, and the patient’s unsuccessful attempts to clear secretions. According to one researcher, fine crackles in the lung bases indicate excessive fluid in the lungs, and wheezing patients should be assessed for a history of asthma and allergies.

Suctioning technique

Before suctioning, hyperoxygenate the patient. Ask a spontaneously breathing patient to take two to three deep breaths; then administer four to six compressions with a manual ventilator bag. With a ventilator patient, activate the hyperoxygenation button.
Experts recommend using suction pressure of up to 120 mm Hg for open-system suctioning and up to 160 mm Hg for closed-system suctioning. For each session, limit suctioning to a maximum of three catheter passes. During catheter extraction, suctioning can last up to 10 seconds; allow 20 to 30 seconds between passes.
For open-system suctioning, catheter size shouldn’t exceed half the inner diameter of the internal trach tube. To determine the appropriate-size French catheter, divide the internal trach tube size by two and multiply this number by three.
A #12 French catheter is routinely used for closed suctioning. Premeasure the distance needed for insertion. Experts suggest 0.5 to 1 cm past the distal end of the tube for an open system, and 1 to 2 cm past the distal end for a closed system.

Liquefying secretions

The best ways to liquefy secretions are to humidify secretions and hydrate the patient. Do not use normal saline solution (NSS) or normal saline bullets routinely to loosen tracheal secretions because this practice:
  • may reach only limited areas
  • may flush particles into the lower respiratory tract
  • may lead to decreased postsuctioning oxygen saturation
  • increases bacterial colonization
  • damages bronchial surfactant.
Despite the potential harm caused by NSS use, one survey found that 33% of nurses and respiratory therapists still use NSS before suctioning. Other researchers have found that inhalation of nebulized fluid also is ineffective in liquefying secretions.

Evaluation

When evaluating the patient after suctioning, assess and document physiologic and psychological responses to the procedure. Convey your findings verbally during nurseto-nurse shift report and to the interdisciplinary team during daily rounds.

Trach site care and dressing changes

Tracheostomy dressing changes promote skin integrity and help prevent infection at the stoma site and in the respiratory system. Typically, healthcare facilities have both formal and informal policies that address dressing changes, although no evidence suggests a particular schedule of dressing changes or specific supplies for secretion absorption must be used. On the other hand, the evidencedoes show that:
  • secretions can cause maceration and excoriation at the site
  • the site should be cleaned with NSS
  • a skin barrier should be applied to the site after cleaning
  • loose fibers increase the infection risk
  • the trach tube should be secured at all times to prevent accidental dislodgment, using the two-person securing technique described below under "Securing the trach tube."
Start by assessing the stoma for infection and skin breakdown caused by flange pressure. Then clean the stoma with a gauze square or other nonfraying material moistened with NSS. Start at the 12 o’clock position of the stoma and wipe toward the 3 o’clock position. Begin again with a new gauze square at 12 o’clock and clean toward 9 o’clock.
To clean the lower half of the site, start at the 3 o’clock position and clean toward 6 o’clock; then wipe from 9 o’clock to 6 o’clock, using a clean moistened gauze square for each wipe. Continue this pattern on the surrounding skin and tube flange.
Avoid using a hydrogen peroxide mixture unless the site is infected, as it can impair healing. If using it on an infected site, be sure to rinse afterward with NSS.

Dressing the site

At least once per shift, apply a new dressing to the stoma site to absorb secretions and insulate the skin. After applying a skin barrier, apply either a split-drain or a foam dressing. Change a wet dressing immediately.

Securing the trach tube

Use cotton string ties or a Velcro holder to secure the trach tube. Velcro tends to be more comfortable than ties, which may cut into the patient’s neck; also, it’s easier to apply.
The literature overwhelmingly recommends a twoperson technique when changing the securing device to prevent tube dislodgment. In the two-person technique, one person holds the trach tube in place while the other changes the securing device.

Review trach tube policy and procedures

To achieve positive outcomes in patients with trach tubes, keep abreast of best practices and develop and maintain the necessary skills. Every nurse who performs trach care needs to be familiar with facility policy and procedure on trach tube care. If your facility’s current policy and procedures don’t support evidencebased practice, consider urging colleagues and managers to conduct a patient-care study comparing different approaches to suctioning. Then follow the evidence by advocating for changes if necessary.
Selected references
Chulay M. Suctioning: endotracheal or tracheostomy tube. In: Wiegand DJ, Carlson KK, eds. AACN Procedure Manual for Critical Care. 6th ed. Philadelphia, PA: Elsevier Saunders; 2010:62-70.
Dennis-Rouse MD, Davidson JE. An evidence-based evaluation of tracheostomy care practices. Crit Care Nurs Q. 2008;31(2):150-160.
Edgtton-Winn M, Wright K. Tracheostomy: a guide to nursing care. Aust Nurs J. 2005;13(5):1-4.
Harkreader H, Hogan MA, Thobaben M. Fundamentals of Nursing: Caring and Clinical Judgment. 3rd ed. Philadelphia, PA: Saunders; 2007.
Klockare M, Dufva A, Danielsson AM, et al. Comparison between direct humidification and nebulization of the respiratory tract at mechanical ventilation: distribution of saline solution studied by gamma camera. J Clin Nurs. 2006;15(3):301-307.
Kuriakose A. Using the Synergy Model as best practice in endotracheal tube suctioning of critically ill patients. Dimens Crit Care Nurs. 2008;27(1):10-15.
Lewis SL, Dirksen SR, Heitkemper MM, Bucher L, Camera I. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 8th ed. St. Louis, MO: Mosby; 2010.
Smith-Miller C. Graduate nurses’ comfort and knowledge level regarding tracheostomy care. J Nurses Staff Dev. 2006;22(5):222-229.
Wiegand DJ, Carlson KK, eds. AACN Procedure Manual for Critical Care. 6th ed. Philadelphia, PA: Elsevier Sauders; 2010.
Betty Nance-Floyd is a clinical assistant professor at the University of North Carolina at Chapel Hill School of Nursing.
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5 Things That Make a Good Nurse Great By: Val Gokenbachon
Prior to discussing my opinion of what the attributes of a great nurse are, it is important to first understand what nursing truly is and how we evolved into the most honored and trusted profession in the world. The reasons are simple; nursing is a profession steeped in rich values based on the work of Florence Nightingale, which has not degraded over time due to the character of the individuals that commit to the calling. Nursing, in my opinion, is a much higher spiritual calling than merely a profession. Our fundamental tenets have not changed over time, either. Those are described as:
  • Nursing is founded on specific human values.
  • Nursing is a scientific knowledge.
  • Nursing is a technical skill.
These tenets are based on specific nursing values that have been studied in literature and remain pretty consistent globally. These include:
  • Family values
  • Happiness
  • Sense of accomplishment
  • Honesty
  • Responsibility
  • Intellect
  • Human dignity
  • Equality
  • Prevention of suffering

In my opinion, a great nurse lives these values and clearly understands themselves and their role in this fine profession. In an attempt to translate the values into behaviors, I would identify the actions as follows:
  1. A great nurse is compassionate. Compassionate is defined as the feeling of concern and sympathy for others. We need to remember that our patients, apart from cosmetic work or delivering babies, are generally not in the healthcare setting because they want to be. They are fearful and at risk of losing their health, possibly their lives, and concurrently, those visitors with them may be at risk of losing precious loved ones. They are not in control and are frightened, and they need us for support. This also means that we are consummate advocates for the patient and willing to speak up when we do not feel the environment is as safe as it can be.
  2. A great nurse is empathetic. Empathetic is defined as the ability and willingness to share in the feelings of others. It does not mean that we agree with the patient or completely understand what they are going through. It simply means that we are willing to make a concerted effort to listen to them, to put ourselves in their place and to attempt to understand their challenges. This needs to be done without judgment and with the understanding that everyone has their own set of values and their own life experiences that have brought them to this point.
  3. A great nurse is selfless. Selfless is defined as the ability to give to others at the expense of themselves. I have countless stories of nurses over the years that illustrate this ability to give to others. This could be as simple as missing lunch to hold a patient’s hand or to do something extraordinary for someone else. I had one trauma nurse I will never forget who was caring for a homeless man hit by a car. When the patient was being discharged back to the street, the nurse realized that his shoes were not removed during the trauma because he did not own any. His foot size was the same as the patient’s, so he gave him his shoes and wore shoe covers for the rest of the day. I felt that this was a tremendous example of selflessness. We recognized him as an everyday hero. The stories go on and on and we need to celebrate them when they happen.
  4. A great nurse is self-aware. Self-aware is defined as a high degree of emotional intelligence. We are more effective in anything that we do when we understand ourselves, the way we think, and where our values are in reference to others as well as our personal strengths and limitations. Having 15 years of Emergency experience taught me a great deal about myself. There were situations where I felt extremely vulnerable and ineffective, such as dealing with abuse or trauma of small children that basically rendered me emotionally distraught for some time after the events. In that situation, I needed to learn coping mechanisms to deal with the situations or needed the support of my colleagues to trade with me or help me when those times got tough. We all need to support and help each other get through our tough days.
  5. A great nurse is technically strong with a thirst for knowledge. It is our obligation as nurses to continue to remain on the cutting edge of our practice regardless the discipline. As nursing leaders, we should be reading on healthcare economics, leadership theory and other issues that impact those in leadership roles. Within the independent disciplines it is important to read journals, achieve certifications, continue our academic pursuits and read all of the information that comes from our healthcare organizations in regard to policy, product or process changes. Lack of knowledge can lead to adverse patient outcomes, and for that ignorance is no excuse but rather our responsibility.
Currently we live in unprecedented economic times that will affect the quality of care we deliver. The new healthcare challenges are changing the work environment for nurses and creating value conflicts more than before in the areas of personal, professional, institutionally and social. It is time for us to put the patient at the center of all we do and work to be what we have dedicated our lives to be - The greatest nurse!
What do you think makes a good nurse great?!

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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Signs of 'sudden' cardiac death may come weeks before: study
(Reuters) - Signs of approaching "sudden" cardiac arrest, an electrical malfunction that stops the heart, usually appear at least a month ahead of time, according to a study of middle-age men in Portland, Oregon.
"We're looking at how to identify the Tim Russerts and Jim Gandolfinis - middle aged men in their 50s who drop dead and we don't have enough information why," said Sumeet Chugh, senior author of the study and associate director for genomic cardiology at the Cedars-Sinai Heart Institute in Los Angeles.
Some 360,000 out-of-hospital cardiac arrests occur each year in the United States, largely involving middle-aged men, with only 9.5 percent surviving, according to the American Heart Association.
Patients can survive if they are given cardiopulmonary resuscitation (CPR) immediately and their hearts are jolted back into normal rhythm with a defibrillator.
Earlier clinical trials have focused only on symptoms or warnings signs within an hour of such attacks. But Chugh's study set out to determine whether signs and symptoms occurred as much as a month before sudden cardiac arrests. ...
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Word Origin : e'lan -- When someone does something with great "e'lan," energy, skill, and even elegance are involved--as when for example, and Olympic-class gymnast performs an exceptional floor routine. All those senses are in the original French e'lan, but without its martial origins: the word cames from eslan, "rush ahead," which in turn comes from eslancer, meaning "to hurl a lance."
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Braden Scale for Predicting Pressure Sore Risk: 9.8 Contact Hours
The Braden Scale for Predicting Pressure Sore Risk involves assessing 6 subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. It can be completed in less than one minute and allows us to quickly determine pressure sore risk and implement appropriate preventive strategies for our patients. Explore the articles in the collection for more information on using this tool so that you can prevent pressure sores and provide quality care.
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RANDOM TIDBITS

Your ears secrete more earwax when you're afraid than when you aren't.

The easiest sound for the human ear to hear is "ah."

The smell in your right nostril is more pleasant, but your left nostril is more accurate.

The droplets in a sneeze can travel 12 feet and remain in the air for as long as three hours.

If saliva can't dissolve it, you can't taste it.

The sensors in your nose can detect as many as 10,000 different odors.
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Quiz Time
The average setting for a temporary transvenous pacemaker is:
a. 2 mA.
b. 300 mA.
c. 200 mA.
d. 10 mA.
Answer at end of newsletter:
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Red Tape -- The words "red tape" are customarily preceded by the adjective "bureaucratic" for good reason. In the government offices of Great Britain, and until very recently, official documents such as deeds and licenses were kept not in file folders, but in bundles of paper held together by red linen ribbons called "tapes." Getting paperwork done in the first place was a chore, and getting t inserted in to the bundle was still another chore, leading to our phrase.
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(Reuters) - The U.S. Food and Drug Administration warned physicians on Wednesday that two chemicals used to conduct cardiovascular stress tests can cause heart attacks and death, and it suggested resuscitation equipment and trained staff be available when the tests are conducted.
The injectable products, Lexiscan and Adenoscan, are marketed by Astellas Pharma US Inc. They work by stressing the heart, allowing physicians to take images that can show areas of low blood flow and damaged heart muscle. The tests are given to patients who are physically unable to exercise.

The FDA said heart attacks may be triggered by the tests because the chemicals dilate the heart's arteries and increase blood flow to help identify obstructions. Blood flows more easily to unblocked arteries, which can reduce blood flow to an obstructed artery. In some cases, that can lead to a heart attack, the agency said....http://www.huffingtonpost.com/2013/11/20/stress-test-chemicals-heart-attack-death-fda_n_4310325.html
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2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) FREE
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. ...
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Scans show retired American football players have brain deficits
(Reuters) - Scientists have found "profound abnormalities" in scans of brain activity in a group of retired American football players, adding to evidence indicating that repeated blows to the head can trigger longer-term aggression and dementia.
Although the former National Football League (NFL) players in the study were not diagnosed with any neurological conditions, brain-imaging tests showed unusual activity that correlated with the number of times they had left the field with a head injury during their football careers.
Adam Hampshire at Imperial College London, who led the study, said the ex-NFL players showed "some of the most pronounced abnormalities in brain activity" he had ever seen.
"And I have processed a lot of patient data sets in the past," he said in a statement about the research.
A growing body of scientific research shows that repeated knocks to the head can lead to a condition known as chronic traumatic encephalopathy, which can lead to loss of decision making control, aggression and dementia. ...
(Actually, any sport that involves getting the player's head hit repeatedly-- such as soccer --should always require a helmet).
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A New intravaginal ring developed
Researchers have developed a new intravaginal ring for the sustained 90-day co-delivery of tenofovir and levonorgestrel, an anti-human immunodeficiency virus (HIV) drug and a contraceptive. Tenofovir is the only topical prophylactic shown to be effective at reducing the sexual transmission of HIV when formulated in a gel....
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The One Thing You're Not Doing That Will Completely Boost Your Focus
For many of us, true silence only comes when we close our eyes and turn in for the night.
Even when we're "listening," our minds churn an inner dialogue: We're deciding what we'll say next, contemplating the way the speaker's mouth is moving, thinking about what's for lunch.
A healthy fix of silence -- whether its a week-long retreat or a few, simple moments focusing on the breath -- could do you some good.
In many eastern traditions, Mauna, or observing silence, is an integral practice: Not speaking, and turning inward is thought to bring peace, clarity and spiritual purity. And in the west, even during secular events, we practice "moments of silence," to respect and reflect.

And in our hyper-connected, buzzing world where there's a constant soundtrack to our lives (be it a whizzing car, the bark of a dog or the low hum of a computer at work) you'll have to seek silence deliberately in order to reap its benefits. But, you'll find it to be worth the effort: Your relationship with quiet -- and the act of restoring -- could improve your skills when it comes to work, friendships and happiness....

http://www.huffingtonpost.com/2013/08/28/benefits-of-quiet_n_3757687.html?ncid=webmail27

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Sliced and diced, digitally: autopsy as a service

(Reuters) - Malaysian entrepreneur Matt Chandran wants to revive the moribund post-mortem by replacing the scalpel with a scanner and the autopsy slab with a touchscreen computer.
He believes his so-called digital autopsy could largely displace the centuries-old traditional knife-bound one, speeding up investigations, reducing the stress on grieving families and placating religious sensibilities.
He is confident there's money in what he calls his Autopsy as a Service, and hopes to launch the first of at least 18 digital autopsy facilities in Britain in October, working closely with local authorities.
Around 70 million people die each year, says Chandran, and around a tenth of those deaths are medico-legal cases that require an autopsy. "That's a huge number, so we're of the view that this is a major line of services that is shaping up around the world," he said in an interview. ...

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Esperion's drug lowers blood fat in mid-stage study
(Reuters) - Esperion Therapeutics Inc said its drug reduced levels of bad blood fat in a mid-stage trial among patients with high levels of cholesterol, when added to a standard of care treatment.
The company said the drug lowered bad cholesterol by an additional 22 percent, compared with a placebo, after eight weeks of use with another drug atorvastatin. The placebo group showed no additional reduction in cholesterol.
The drug was well tolerated and no serious adverse events were reported, Esperion said.
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Hint 1:
If your new shoes are too tight put the nozzle of your blow dryer into shoe and turn on low. When shoe gets warm, stuff with paper or socks to stretch it.

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Hint 2:

To make nail polish stay on nails longer first coat fingernails with white vinegar using a cotton ball. Let dry then apply nail polish. To quickly dry nail polish dip fingers into a bowl of cold water. Then shake excess water from hands and allow hands to air dry.
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Increased RN Staffing Hours Are Correlated with Higher Quality Patient Care
An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse (LPN) or nursing assistant (NA) hours.

The study's authors -- Gestur Davidson, Ira Moscovice and Kathy Belk -- posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a new research brief on the Robert Wood Johnson Foundation website
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HUMOR SECTION
Favorite Police Emergency Calls:

Dispatcher: Nine-one-one
Caller: Hi, is this the police?
Dispatcher: This is 911. Do you need police assistance?
Caller: Well, I don't know who to call. Can you tell me how to cook a turkey? I've never cooked one before.

Dispatcher: Nine-one-one What is the nature of your emergency?
Caller: I'm trying to reach nine eleven but my phone doesn't have an eleven on it.
Dispatcher: This is nine eleven.
Caller: I thought you just said it was nine-one-one
Dispatcher: Yes, ma'am nine-one-one and nine-eleven are the same thing.
Caller: Honey, I may be old, but I'm not stupid.

Dispatcher: Nine-one-one What's the nature of your emergency?
Caller: My wife is pregnant and her contractions are only two minutes apart.
Dispatcher: Is this her first child?
Caller: No, you idiot! This is her husband

Dispatcher: Nine-one-one
Caller: Yeah, I'm having trouble breathing. I'm all out of breath. Darn...I think I'm going to pass out.
Dispatcher: Sir, where are you calling from?
Caller: I'm at a pay phone. North and Foster. Damn....
Dispatcher: Sir, an ambulance is on the way. Are you an asthmatic?Caller: No
Dispatcher: What where you doing before you started having trouble breathing?
Caller: Running from the police.

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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
Please follow me on Twitter as Dr Robert Hess.
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
This is an excellent nursing site, check it out:http://nursingpub.com/

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance
info@sharedgovernance.orgwww.sharedgovernance.org

Decubqueen's website: www.accuruler.com
RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

 Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Low Molecular Weight Heparins: Drug Safety Communication - Recommendations to Decrease Risk of Spinal Column Bleeding and Paralysis

ISSUE: The U.S. Food and Drug Administration (FDA) is recommending that health care professionals carefully consider the timing of spinal catheter placement and removal in patients taking anticoagulant drugs, such as enoxaparin, and delay dosing of anticoagulant medications for some time interval after catheter removal to decrease the risk of spinal column bleeding and subsequent paralysis after spinal injections, including epidural procedures and lumbar punctures. These new timing recommendations, which can decrease the risk of epidural or spinal hematoma, will be added to the labels of anticoagulant drugs known as low molecular weight heparins, including Lovenox and generic enoxaparin products and similar products.
Health care professionals and institutions involved in performing spinal/epidural anesthesia or spinal punctures should determine, as part of a preprocedure checklist, whether a patient is receiving anticoagulants and identify the appropriate timing of enoxaparin dosing in relation to catheter placement or removal. To reduce the potential risk of bleeding, consider both the dose and the elimination half-life of the anticoagulant:
  • For enoxaparin, placement or removal of a spinal catheter should be delayed for at least 12 hours after administration of prophylactic doses such as those used for prevention of deep vein thrombosis. Longer delays (24 hours) are appropriate to consider for patients receiving higher therapeutic doses of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily).
  • A post procedure dose of enoxaparin should usually be given no sooner than 4 hours after catheter removal.
  • In all cases, a benefit-risk assessment should consider both the risk for thrombosis and the risk for bleeding in the context of the procedure and patient risk factors.

For Complete MedWatch Safety Alert including link to Drug Safety Communication: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm373918.htm
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-Ruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
No new members this time

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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address. RNFrankie@AOL.com
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)

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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
We may have found a cure for most evils; but it has found no remedy
for the worst of them all -- the apathy of human beings.
--Helen Keller
Correct answer: d. A temporary transvenous pacemaker may be set between 0 and 20 mA; the average setting is 10 mA.
Hope to hear from you..... Frankie

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