Managing Spaghetti Syndrome in Critical Care With a Novel Device: A Nursing Perspective

Abstract

Background Managing "spaghetti syndrome," the tangle of therapeutic cables, tubes, and cords at patients' bedsides, can be challenging. oBjectives To assess nurses' perceptions of the effectiveness of a novel banding device in management of spaghetti syndrome. Methods A simple color-coded elastomeric banding strap with ribbed flaps was attached to bed rails of adult critical care patients to help organize therapeutic cables, tubes, wires, and cords. Nurses were surveyed before and after use of the bands and after the nursing shift to assess the burden of spaghetti syndrome and the effectiveness of using the bands. results Use of the bands decreased the time spent untangling cords, reduced the frequency of contact of tubing with the floor, and diminished disruptions in care. conclusions Use of a simple flexible latex-free elastomeric band may help organize therapeutic tubing at patients' bedsides and may promote improvements in nursing care. (Critical Care Nurse. 2015;35[6]:38-45) ©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2015321 C ritical care patients often have numerous therapeutic connections (eg, cords, cables, and tubes) at the bedside that can easily become disorganized and tangled, leading to contamination of the connections, nurses' confusion, a physical hazard that increases the risk for falls for both nurses and patients, and the possibility of damage of medical devices.1-6 This phenomenon, known as spaghetti syndrome, makes caring for patients challenging and difficult 1,2 ( Figure 1). Multiple instances of patients' deaths, permanent injury, and life-threatening situations related to entanglement with the cords of medical devices have been reported. 5,[7][8][9][10][11][12][13][14] Ensuring the organization of cords and tubes at a patient's bedside may reduce adverse outcomes such as entanglement of the patient, backflow in tubing, falls by both patients and health care personnel, and connection errors or damage of medical equipment. [5][6][7]12 38 Therapeutic tubing, cables, wires, and cords are a fundamental aspect of daily health care for delivery of medications and fl uids to patients. The often disorganized tubing and cords at the bedside increase the possibility of inadvertently connecting the wrong syringes and tubing and then unintentionally delivering medication or fl uids via the wrong route. In 2006, the Joint Commission issued alerts on tubing misconnections; interventions and procedures to manage and protect medical cords, tubes, and cables as a standard of care, but only a few devices are available to aid in this task. 11,13,15 Few bedside devices for cord control are commercially available, and they vary in complexity and design. The purpose of this study was to test use of a novel simple, sleeved-strap banding device in the management of spaghetti syndrome in a critical care unit and to assess nurses' responses to use of the band. Before the study, no devices or standard protocols were being used to manage the syndrome. MethodsAfter a compa...

Untangling Infusion Confusion: A Comparative Evaluation of Interventions in a Simulated Intensive Care Setting

“…Our study is the first to empirically compare the effectiveness of different interventions to minimize infusion mix-ups and demonstrate that line labels/organizers have the double benefit of decreasing infusion identification time and errors. Our results support previous findings that as follows: infusion mix-ups occur (2–4); line labels improve timely infusion identification (2); and nurses self-report that infusion organizers decrease time to untangle infusions (11). This research should serve as motivation to standardize the use of labels/organizers when a patient is receiving multiple infusions—a seemingly obvious gap in current standards.…”

“…Although line labels/organizers require resources at setup, our findings show they improve infusion identification efficiency, shifting the resource burden to a time before urgent or emergent actions are required (e.g., titration during a code). These findings strengthen existing evidence (2, 11) and recommendations to use labels/organizers (2–4, 8, 10, 11) and provide design details to support their uptake and impact (e.g., label design, number/placements). Future work should focus on creating standard practices and implementation guidance to avoid known challenges (e.g., compliance, stocking labels) (8, 13–15) or potential new errors not evaluated in this study (e.g., label wrong line).…”

“…Labels/organizers have been recommended to augment information along the infusion pathway and reduce physical complexity (e.g., align components, separate tubing) (2–4, 8, 10, 11) ( Fig. 1 B ).…”

“…Current strategies to reduce infusion mix-ups are limited, with infusion setups varying between clinicians, units, and hospitals (4, 8). Although interventions have been proposed (1–4, 8–11), they have not been empirically evaluated except for a study that demonstrated that infusion labels improved timely infusion identification (2). Thus, further empirical assessment of interventions is required to identify effective risk-mitigation strategies.…”

Ergonomical aspects of anaesthetic practice

“…Congestion of wires, tubes and lines in an operating theatre leads to frequent episodes of tipping over (Spaghetti syndrome). Solutions varying from a simple colour coded elastomeric bands holding different sets of tubes and wires,[ 12 ] and use of a single console for multiple set of wires, to use of wireless technology to connect patient sensors with monitors have been tried and suggested. [ 13 ] Ofek et al .…”