• Purpose To examine critical care nurses’ knowledge about the use of the ventilator bundle to prevent ventilator-associated pneumonia. • Method Published reports were reviewed for current evidence on the use of the ventilator bundle to prevent ventilator-associated pneumonia, and education sessions were held to present the findings to 61 nurses in coronary care and surgical intensive care units. Changes in the nurses’ knowledge were evaluated by using a 10-item test, given both before and after the sessions. Changes in the nurses’ practices related to ventilator-associated pneumonia, including elevation of the head of the bed to 30° to 45°, were observed in 99 intubated patients. • ResultsAfter the education sessions, the nurses performed better on 8 of the 10 items tested (P from .03 to <.001). The areas of most significant improvement were elevation of the head of the bed (P < .001), charting of the elevation of the head of the bed (P= .009), oral care (P= .009), checking of the nasogastric tube for residual volume (P = .008), washing of hands before contact with patients (P < .001), and limiting the wearing of rings (P < .001) and nail polish (P = .04). Even after the education sessions, the nurses’ compliance with hand-washing recommendations before contact with patients was low, though statistically some improvement was apparent. Contraindications to elevation of the head of the bed did not appear to affect the nurses’ practices (P= .38). • Conclusion Education sessions designed to inform nurses about the ventilator bundle and its use to prevent ventilator-associated pneumonia have a significant effect on participants’ knowledge and subsequent clinical practice.

No abstract

A meta-analysis of the effects of nonnutritive sucking (NNS) on heart rate and transcutaneous oxygen tension (TcPaO2) was performed. Four studies of NNS on heart rate without stimulations, three studies on heart rate during painful stimulations, and three studies on TcPaO2--all conducted over the past 30 years--were found through a computer search. Using the Fisher combined test, NNS significantly decreased heart rate without stimulations (p = .002) and during painful stimulations (p = .0001), and significantly increased TcPaO2 (p = .0001). The total weighted effect size for heart rate without stimulations was small (0.17); however, it was large for heart rate during painful stimulations (1.05) and TcPaO2 (0.69). Larger effects were noticed for preterm infants than for term infants and for longer NNS. More studies of NNS effects with independent treatment and control groups, using the physiological outcome variables of heart rate and oxygenation for different age groups of preterm infants, are needed to examine the fundamental mechanisms of NNS effects. Clinically, a low-risk intervention such as NNS can be more broadly used during any painful procedures to decrease infant distress.

•Background Pulse oximetry is commonly used to monitor oxygenation in neonates, but cannot detect variations in hemoglobin. Venous and arterial oxygen saturations are rarely monitored. Few data are available to validate measurements of oxygen saturation in neonates (venous, arterial, or pulse oximetric). •Purpose To validate oxygen saturation displayed on clinical monitors against analyses (with correction for fetal hemoglobin) of blood samples from neonates and to present the oxyhemoglobin dissociation curve for neonates. •Method Seventy-eight neonates, 25 to 38 weeks’ gestational age, had 660 arterial and 111 venous blood samples collected for analysis. •Results The mean difference between oxygen saturation and oxyhemoglobin level was 3% (SD 1.0) in arterial blood and 3% (SD 1.1) in venous blood. The mean difference between arterial oxygen saturation displayed on the monitor and oxyhemoglobin in arterial blood samples was 2% (SD 2.0); between venous oxygen saturation displayed on the monitor and oxyhemoglobin in venous blood samples it was 3% (SD 2.1) and between oxygen saturation as determined by pulse oximetry and oxyhemoglobin in arterial blood samples it was 2.5% (SD 3.1). At a Pao2 of 50 to 75 mm Hg on the oxyhemoglobin dissociation curve, oxyhemoglobin in arterial blood samples was from 92% to 95%; oxygen saturation was from 95% to 98% in arterial blood samples, from 94% to 97% on the monitor, and from 95% to 97% according to pulse oximetry. •Conclusions The safety limits for pulse oximeters are higher and narrower in neonates (95%–97%) than in adults, and clinical guidelines for neonates may require modification.

Gastric tube placement practices were identified by a telephone survey of 113 Level II and Level III nurseries in five states (Indiana, Kentucky, Michigan, Ohio, and Pennsylvania). The purpose was to examine current practice and the rationale for practice with fragile preterm infants. Twenty-one percent of the nurseries inserted only orogastric (OG) tubes, 13% used only nasogastric (NG) tubes, and 66% used both NG and OG tubes. Of those that placed an NG or OG tube, 50% did so continuously, 5% placed it intermittently, and 45% placed the tube both continuously and intermittently, for different reasons. The average time interval to change a tube was 47.81 hr (+/-36.37), and the range was 8 to 168 hr. To calculate the length of tube insertion. 98% of nurseries measured from nose or mouth to earlobe then to the xiphoid process. To validate tube placement, 82% used an auscultation technique, and 60% had rules about replacing gastric aspirates. These findings indicate a great variability of practices in gastric tube placements and a reliance on tradition of practitioners working with preterm infants. The findings point to the need for further research on the most efficient practices and the importance of using research findings in nurseries.

The left-shifted oxyhemoglobin curves warrant the importance of accurate measurements of oxygenation status for neonates. Fetal hemoglobin determination is essential for accurate So(2) measurements and the assessment of proper oxygenation status in neonates.

There are obvious health disparities among White and non-White women experiencing high-risk pregnancies and births. Future studies are needed to develop interventions targeted to different racial/ethnic groups during pregnancy to reduce preterm and high-risk births.

Accurate HbF and related oxygen saturation measurements need to be determined, especially for premature neonates, to minimize the risk of oxygen toxicity.