Secondary Insults Related to Nursing Interventions in Neurointensive Care

Abstract

The patients at a neurointensive care unit are frequently cared for in many ways, day and night. The aim of this study was to investigate the amount of secondary insults related to oral care, repositioning, endotracheal suctioning, hygienic measures, and simultaneous interventions at a neurointensive care unit with standardized care and maximum attention on avoiding secondary insults. The definition of a secondary insult was intracranial pressure > 20 mm Hg, cerebral perfusion pressure < 60 mm Hg and systolic blood pressure < 100 mm Hg for 5 minutes or more in a 10-minute period starting from when the nursing intervention began. The insult minutes did not have to be consecutive. The study included 18 patients, seven women and 11 men, aged 36-76 years with different neurosurgical diagnoses. The total number of nursing interventions analyzed was 1,717. The most common kind of secondary insults after a nursing measure was high intracranial pressure (n = 93) followed by low cerebral perfusion pressure (n = 43) and low systolic blood pressure (n = 14). Repositioning (n = 39) and simultaneous interventions (n = 32) were the nursing interventions causing most secondary insults. There were substantial variations between the patients; only one patient had no secondary insult. There were, overall, a limited number of secondary insults related to nursing interventions when a standardized management protocol system was applied to reduce the occurrence of secondary insults. Patients with an increased risk of secondary insults should be recognized, and their care and treatment should be carefully planned and performed to avoid secondary insults.

Physiological changes associated with routine nursing procedures in critically ill are common: an observational pilot study

“…In fact, physiological changes associated with nursing procedures are often considered a part of the procedure and have also often been neglected in studies investigating different types of interventions in critically ill patients, even though they could affect the results of such studies. Although adverse events caused by errors in medication and drug administration have been dealt with in several publications, there are few clinical data on the physiological consequences of routine nursing procedures such as patient position change, endotracheal suctioning, clinical examination or care of wounds, and vascular insertion sites . Use of an improved analgesia policy reduced physiological inadvertent changes associated with change of the patient's position from 37% to 17% in one study .…”

Hemşirelik Girişimleri İkincil Beyin Hasarına Neden Olabilir mi?

“…Nöroşirürji hastalarına farklı pozisyonlar verilerek KİB ve SPB üzerine etkisini inceleyen çalışmalar Tablo 2'de yer almaktadır (1,6,26,(30)(31)(32)(33). Yatak başı kaldırılarak verilen lateral pozisyon (26), başın uzun süreli fleksiyon ve ekstansiyonu (serebral kan akımını değiştirdiğinden) (32), başın 45° yükseltilmesi (31), nöroşirürji hastaları için zararlı olabilecek pozisyonlardır.…”

“…Ağız bakımı geçici ve az düzeyde KİB'ı arttırmaktadır. Ancak bu artışın klinik olarak anlamlı olmadığı ortaya konulmuştur (5,6,34). KİB değeri normal sınırlar içerisinde bulunan hastalarda, ağız bakımı güvenli bir uygulamadır (7,36) olarak beyne giden kan akımını arttırmaktadır.…”

“…Nöroşirürji hastalarında tedavi ve hemşirelik bakımının amacı, KİB ve SPB'ını normal sınırlar içerisinde tutarak ikincil beyin hasarını önlemek ya da en aza indirmektir. Buna karşın bazı hemşirelik girişimleri ikincil beyin hasarına neden olabilmektedir (5)(6)(7).…”

The importance of being meticulous in evaluating the evidence and risks with everyday care

“…In addition, the performance of procedures should be regularly evaluated in terms of whether or not there are adequate precautions made in terms of pharmacological preparations and recruitment of sufficient number of staff, or other facilitating actions. Finally, are the patient‐specific considerations taken into account, and are there recordings of incidents during earlier procedures for the specific patient?…”