The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice. Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care. Here is the first of our series entitled "Clinical Inquiry".
Q: Why do we use sterile water to flush NG tubes? Why can't we use bottled or tap water?
A: Bottled or tap water is only indicated for hydration in healthy patients who are not immunocompromised. Acutely ill patients or those with chronic conditions that have any alterations to the GI tract are vulnerable to nosocomial infections from non-sterile products including water. This also holds true for patients who are immunocompromised but not acutely ill. Because tap water contains metals, medications should only be diluted in sterile water to prevent reduction of bioavailability. Tap water also has the potential to be a source of contamination when reconstituting formula. Filtration of water may be beneficial but still poses a risk for contamination. Sterile water is solute-free and free of chemical or microbial contaminants; therefore, it is the only type of water that should be used to flush NG tubes, dilute medications and reconstitute formula.
response written by Kathleen Pentecost, SRN CBU, BA Sociology & Carla I. Morales, SRN CBU, BS Psychobiology
Bankhead, R., Boullata, B.S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., et al. (2009) A.S.P.E.N. Enteral nutrition practice recommendations. Journal of Enteral and Parenteral Nutrition, 33, 122-69.
Wednesday, August 06, 2014
Monday, August 04, 2014
St. Joseph Hospital Staff Publishes Article
Congratulations to the following St. Joseph Hospital staff
for their newly published article on blood culture accuracy: Beth Winokur, RN, PhD, CEN, Debra Pai, RN, BSN, CEN, Dana Rutledge, RN, PhD, Kate Vogel, MA, CLS, MT, Sadeeka Al-Majid, RN, PhD, Christine Marshall, RN, MSN, CEN, CPEN and Paul Sheikewitz, MD! SJO
employees have access to the full article through Burlew Medical Library. Contact library staff for more details.
J Emerg Nurs. 2014 Jul;40(4):323-9. doi:
10.1016/j.jen.2013.04.007. Epub 2013 Jun 29.
Blood culture accuracy: discards from central venous
catheters in pediatric oncology patients in the emergency department.
Winokur EJ1, Pai D2, Rutledge DN2, Vogel K2, Al-Majid S2,
Marshall C2, Sheikewitz P2.
Abstract
INTRODUCTION:
Lack of specific guidelines regarding collection of blood
for culture from central venous catheters (CVCs) has led to inconsistencies in
policies among hospitals. Currently, no specific professional or regulatory
recommendations exist in relation to using, reinfusing, or discarding blood
drawn from CVCs before drawing blood for a culture. Repeated wasting of blood
may harm immunocompromised pediatric oncology patients. The purpose of this
comparative study was to determine whether differences exist between blood
cultures obtained from the first 5 mL of blood drawn from a CVC line when
compared with the second 5 mL drawn.
METHODS:
During 2009-2011, 62 pediatric oncology patients with CVCs
and orders for blood cultures to determine potential sepsis were enrolled
during ED visits. Trained study nurses aseptically drew blood and injected the
normally discarded first 5 mL and the second specimen (usual care) into
separate culture bottles. Specimens were processed in the microbiology
laboratory per hospital policy.
RESULTS:
Positive cultures were evaluated to assess agreement between
specimen results and to determine that the identified pathogen was not a
contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive
results. In all positive-positive matches, the normal discard specimen
contained the same organism as the usual care specimen. In 4 matches, the
normally discarded specimen demonstrated notably earlier time to positivity (4
to 31 hours) compared with the usual care specimen, which resulted in earlier
initiation of definitive antibiotics.
DISCUSSION:
These findings support the accuracy of the specimen that is
normally discarded and suggest the need to reconsider its use for blood culture
testing.
Monday, July 14, 2014
St. Joseph Hospital Nurse Publishes Article
Congratulations to St. Joseph Hospital RN Lupe Ramos, MSN, NP-C, ACNP for her newly published article on cardiac diagnostic testing! SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details.
Critical Care Nurse.
2014 Jun;34(3):16-27; quiz 28. doi: 10.4037/ccn2014361.
Cardiac diagnostic testing: what bedside nurses need to know.
Ramos LM.
Abstract: Coronary artery disease affects more than 385000 persons annually and continues to be a leading cause of death in the United States. Recently, the number of available noninvasive cardiac diagnostic tests has increased substantially. Nurses should be knowledgeable about available noninvasive cardiac diagnostic testing. The common noninvasive cardiac diagnostic testing procedures used to diagnose coronary heart disease are transthoracic echocardiography, stress testing (exercise, pharmacological, and nuclear), multidetector computed tomography, coronary artery calcium scoring (with electron beam computed tomography or computed tomographic angiography), and cardiac magnetic resonance imaging. Objectives include (1) describing available methods for noninvasive assessment of coronary artery disease, (2) identifying which populations each test is most appropriate for, (3) discussing advantages and limitations of each method of testing, (4) identifying nursing considerations when caring for patients undergoing various methods of testing, and (5) describing outcome findings of various methods.
Critical Care Nurse.
2014 Jun;34(3):16-27; quiz 28. doi: 10.4037/ccn2014361.
Cardiac diagnostic testing: what bedside nurses need to know.
Ramos LM.
Abstract: Coronary artery disease affects more than 385000 persons annually and continues to be a leading cause of death in the United States. Recently, the number of available noninvasive cardiac diagnostic tests has increased substantially. Nurses should be knowledgeable about available noninvasive cardiac diagnostic testing. The common noninvasive cardiac diagnostic testing procedures used to diagnose coronary heart disease are transthoracic echocardiography, stress testing (exercise, pharmacological, and nuclear), multidetector computed tomography, coronary artery calcium scoring (with electron beam computed tomography or computed tomographic angiography), and cardiac magnetic resonance imaging. Objectives include (1) describing available methods for noninvasive assessment of coronary artery disease, (2) identifying which populations each test is most appropriate for, (3) discussing advantages and limitations of each method of testing, (4) identifying nursing considerations when caring for patients undergoing various methods of testing, and (5) describing outcome findings of various methods.
Wednesday, April 02, 2014
Danielle's Picks from the Literature - April 2014
Here are my picks from the nursing literature for April. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.
1. Ruptured thought: rupture as a critical attitude to
nursing research.
Beedholm, Kirsten; Lomborg, Kirsten;
Frederiksen, Kirsten;
Nursing Philosophy, 2014 Apr; 15 (2): 102-11.
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Abstract: In this paper, we introduce the notion of
'rupture' from the French philosopher Michel Foucault, whose studies of
discourse and governmentality have become prominent within nursing research
during the last 25 years. We argue that a rupture perspective can be helpful
for identifying and maintaining a critical potential within nursing research.
The paper begins by introducing rupture as an inheritance from the French
epistemological tradition. It then describes how rupture appears in Foucault's
works, as both an overall philosophical approach and as an analytic tool in
his historical studies. Two examples of analytical applications of rupture
are elaborated. In the first example, rupture has inspired us to make an
effort to seek alternatives to mainstream conceptions of the phenomenon under
study. In the second example, inspired by Foucault's work on discontinuity,
we construct a framework for historical epochs in nursing history. The paper
concludes by discussing the potential of the notion of rupture as a response
to the methodological concerns regarding the use of Foucault-inspired
discourse analysis within nursing research. We agree with the critique of
Cheek that the critical potential of discourse analysis is at risk of being
undermined by research that tends to convert the approach into a fixed
method.
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