Devices In Intensive Care Unit Research Articles

Labelling of intravenous drug delivery devices in critically ill patients: A scoping review.

Labelling is a strategy that contributes to the correct and faster identification of drugs, minimizing misidentification. There is a gap in knowledge on optimal labelling standards for intravenous (IV) devices applied to the care of critically ill patients. The goal of this article was to map existing knowledge on the labelling of IV drug delivery devices in critically ill patients for the prevention of medication errors. This was a scoping review conducted according to the JBI methodology in the LILACS, MEDLINE, CINAHL, IBECS, Scopus, Embase and Web of Science databases, and on the websites of specialized institutions. Searches were conducted up to December 2022 for scientific articles and grey literature that addressed the labelling of IV devices in intensive care units, emergency departments, and anaesthesia units. The data were collected using a structured form and were later classified, summarized, and aggregated to map the knowledge related to the review question. Twenty-one documents were included, which demonstrated variability in label use with IV drug delivery devices. The following features of structure and design stood out: printed format, colour coding, letter size differentiation, and the use of sturdy material. In terms of information, the name of the drug, dose, date and time of preparation, identification of the patient, and who prepared it were found. The identified patterns contributed to the reduction of drug misidentification and the development of timelier drug labelling and administration. The evidence supports the development of standardized labels for the prevention of medication errors.

Factors Affecting Medical Device-Related Pressure Injuries in Intensive Care Units

Context: Medical device-related pressure injuries (MDRPI) are a common complication that can occur in critically ill patients and require medical devices in the intensive care unit. MDRPI can occur when pressure from a medical device, such as a ventilator, catheter, or feeding tube, is exerted on the patient's skin for prolonged periods, causing tissue damage and leading to pressure injuries. MDRPI can result in pain, discomfort, prolonged hospital stays, and increased healthcare costs. Therefore, preventing and managing MDRPI in ICU patients is crucial to improving patient outcomes.
 Aim: The study aimed to assess factors affecting medical devices related to pressure injury in intensive care units.
 Methods: A descriptive and exploratory research design was employed to fulfill the objectives of this study. The study included two distinct samples: a purposive sample of 157 adult patients admitted to the intensive care unit and connected to various medical devices such as NGT, EET, CVC, UC, and CPAP masks, as well as a convenience sample of 50 nurses working in the intensive care unit who provided care to the same group of patients. Data were collected through a self-administered questionnaire, nurses' practice observational checklists, patient assessment records, and medical device assessment records.
 Results: The findings from this study reveal that 40% of the nurses under investigation demonstrated a moderate level of knowledge concerning Medical Device-Related Pressure Injuries (MDRPI). In comparison, 68.8% exhibited unsatisfactory practice in this area. Moreover, 56% of the nurses displayed a negative attitude towards factors associated with pressure injuries caused by medical devices in intensive care units. Concurrently, 58% of the patients in the study were found to have pressure injuries linked to medical devices, with 48% of these cases being attributed to CPAP masks. Furthermore, a highly significant statistical correlation was identified between the total knowledge scores of the nurses and their overall practice.
 Conclusion: The current study's conclusions indicate that the highest percentage of the participating nurses possessed an average level of knowledge, displayed inadequate practice, and harbored negative attitudes regarding factors contributing to medical device-related pressure injuries in intensive care units. Consequently, it is recommended that an educational training program be implemented to enhance nurses' competence in preventing medical device-related pressure injuries in intensive care units.

Application of Overall Equipment Effectiveness for Optimizing Ventilator Reliability in Intensive Care Units and Emergency Departments

Healthcare organizations seek to offer a comprehensive medical services system framework with safety and high quality. This needs continuously developing integrated governance systems that provide safe, reliable, and maintaining high-quality care and value-based care for patients. In addition to improving access to health services in time, increasing efficiencies in providing medical services, reducing the risk-based medical services, and selecting a suitable maintenance policy for maintaining the medical devices. This paper adopted a quantitative analysis method based on Reliability-Based Maintenance (RCM) to comprehensively evaluate the overall medical equipment's effectiveness. RCM is an integrated approach to continuous improvement of the maintenance programs because it can predict early medical equipment failure and determine the mean time between failures. It also assesses the risk level to the patient's life in case of a medical equipment breakdown while provisioning medical services. This study targeted biomedical engineering, intensive care units, and emergency departments at 24 public hospitals in a top 20 OECD country. It selected these departments due to the rise in the rate of patients needing ventilator equipment availability during COVID-19, risk based on the sudden breakdown of the ventilator machines, and increasing the annual budget percentage required to provide medical services, where 239 of the ventilator equipment were investigated. Staff Experience-based Evidence was adopted to collect data by interviewing staff and distributing the survey. The study found that the average OEE for ventilator devices in Intensive Care Units and Emergency Departments was 63%. The device's performance was rated at 65%, while its availability and quality rate were both rated at 100%. These findings suggest that the use of the OEE metric has improved ventilator device reliability and performance in selected hospitals. The OEE metric may have potential benefits for improving the performance of other medical devices as well.

An optimisation approach for determining the efficiency of vital medical devices in intensive care units with COVID-19 patients using Apriori algorithm

An optimisation approach for determining the efficiency of vital medical devices in intensive care units with COVID-19 patients using Apriori algorithm

An optimisation approach for determining the efficiency of vital medical devices in intensive care units with COVID-19 patients using Apriori algorithm

Improving the process of strategic management in hospitals preparation and equipping the intensive care units (ICUs) and the availability of medical devices plays an important role for knowing consumer behaviour and need. This cross-sectional study was performed in the ICU of Farhikhtegan Hospital, Tehran, Iran for a period of six months. During these months, ten medical devices have been used 5,497 times. These devices include: ventilator, oxygen cylinder, infusion pump, electrocardiography machine, vital signs monitor, oxygen flowmeter, wavy mattress, ultrasound sonography machine, ultrasound echocardiography machine, and dialysis machine. The Apriori algorithm showed that four devices: ventilator, oxygen cylinder, vital signs monitoring device, oxygen flowmeter are the most used ones by patients. These devices are positively correlated with each other and their confidence is over 80% and their support is 73%. For validating the results, we have used equivalence class clustering and bottom-up lattice traversal (ECLAT) algorithm in our dataset.

Prevalence and Profile of Device Associated Infection in Precisely Tribal Sickle Cell Disease children above 10 years of Age Admitted to ICU of a Tertiary Care Hospital of Tribal Area

Background:Sickle cell disease (SCD) children are more susceptible to bacterial infection due tomultifactorial causewith poorimmunization status in tribal area.Device associated infections (DAIs) , due toextensive use of invasive devices in intensive care units , further increases morbidity and mortality in thesepatients . In the present study ,our aim is to define , the total burden and profile of DAI as presentation ,spectrum of bacterial isolate and susceptibility in SCD children, in specific to, ICU of a tertiary care Hospital inTribal area. Methodology:This prospective study was conducted overDevice Associated infections (DAIs)in Sickle cell disease (SCD) tribal children, having an inserted indwelling device, in the ICU of atertiary carehospital.Demographic ,clinical and date of device insertion data were recorded . Depending on the typeof specimen, samples were cultured and analyzed .Antimicrobial susceptibility testing was performed ondifferent isolates. Result: Out of 31 exposed SCD children to indwelling devices,the confirmed DAI caseswere, 1 central line-associated bloodstream infections (CLABSI), 1 ventilator-associated pneumonia (VAP),and 3 catheter-associated urinary tract infections (CAUTI ). The overall DAI rate was 16.1% with 29.7 per1000 device days . The Organism causing infection were Gram-negative in 3(60% ) cases , Gram-positivein 2 (40% ), and as mixed infection with fungal organisms in 2( 40%) cases. Most isolates were susceptibleto Co-Trimoxazole , Ceftriaxone and Gentamycin . CONS and Klebsiella were showing multidrugresistantto more antibiotics tested.Conclusion:Since,In view of high DAIrate in Sickle cell Disease Tribal childrenin the ICU of tribal area,the preventive strategies should be plannednot only to improve immunity but alsoreduce morbidity ,mortality , to ensure a good quality health care in them.

Infections associated with vascular access devices in intensive care units across Australia

Infections associated with vascular access devices in intensive care units across Australia

Using disinfection devices in Intensive Care Units

Introduction: Intensive unit microflora mainly consists of organism capable of surviving in moist media, such as gram-negative bacteria, skin-colonizing microorganisms, those with the ability to adhere to medical devices, and microorganisms resistant to conventional antibiotics. Therefore, cleansing and disinfection of intensive care units is of great importance in the prevention and control of hospital infections.Material and Methods: The use of the device was demonstrated in the isolation room of the intensive care unit after a patient colonized with hospital bacterial strains was discharged. The first sampling was carried out immediately after the patient was discharged, the second after the standard medical cleansing of the equipment and space, and the third after the disinfection with the “SterisafePro”. The analysis of the smears was performed at the OU Clinical Microbiology. Quantitative method analyses was performed according to standard operative procedure (SOP). The results of the analysis are calculated according to the formula and expressed in the values of CFU / cm2.Results: After the patient was discharged and the area cleaned mechanically, the Acinetobacter baumanii was isolated in three samples, coagulase negative staphylococci in one, while two smears remained sterile. Acinetobacter baumanii and coagulase negative staphylococci were isolated in three samples. After using the disinfecting device, all swabs were sterile.Conclusion: Disinfection of the hospital with the “Sterisafe”Pro” device has proved to be very successful. The advantages of using the “Sterisafe”Pro” device are that is uses no chemicals, has a low labor and usage costs, is harmless to the patients and staff, and is very easy to use.

Accidental removal of devices in intensive care unit: An eight-year observational study

BackgroundIn the intensive care unit, invasive devices can be accidentally removed by the patient or by the operators, increasing workload, staff stress level and hospitalisation costs. Objective: to know the incidence of accidental removal of devices in critical patients, to identify their cause, when they occur and if they are repositioned. MethodsRetrospective observational study carried out in an academic, tertiary-level critical care department composed of three intensive care units. All adult patients recovered between 2011 and 2018 were enrolled. We calculated rates per 1000 device-years. ResultsIn the study period 10514 patients (194372 device-days) were admitted to the intensive care units and the number of reported accidental removal of devices was 451, corresponding to a rate of 2.3 episodes per 1000 device-days (95% confidence interval: 2.1–2-5). The overall rates of accidental removals were as follows: gastric tubes 10.2 (n = 270), intracranial devices 3.9 (n = 9), endotracheal tubes 2.4 (n = 27), central venous catheters and arterial catheters 1.5 (n = 92), peripheral intravenous catheters 1.2 (n = 25), surgical drains 0.5 (n = 15), urinary catheters 0.4 (n = 11), Extra Corporeal Membrane Oxygenation cannulas 0.4 (n = 1), tracheostomy cannulas 0.1 (n = 1). ConclusionCompared to the literature, this study shows fewer incidents of accidental removal of devices. The number of accidental removals could be an indicator of the quality and safety of the care.

Can Diaphragm Dysfunction Be Reliably Evaluated with Pocket-Sized Ultrasound Devices in Intensive Care Unit?

Background Diaphragm dysfunction (DD) is frequently seen in critically ill patients, and ultrasound could be a useful tool to detect it and to predict extubation success or failure in mechanically ventilated patients. Besides, it would also be useful in differential diagnosis of dyspnea and respiratory failure. The aim of this study is to evaluate usefulness and accuracy of pocket-sized ultrasound devices (PSDs) in assessment of DD in intensive care unit (ICU) patients in comparison with standard ultrasound devices (SD). Methods In this prospective observational study, we compared the performance of PSD and SD in visualization of diaphragm, detection of paradoxical movement, measurement of tidal and maximal thickness, tidal and maximal excursion, and calculation of thickening fraction (TF) of the diaphragm. We used Bland and Altman test for agreement and bias analysis and intraclass correlation analysis to evaluate interobserver variability. Results Thirty-nine patients were included in the study. In 93% of the patients, diaphragm was visualized with PSD. There was very good agreement between the measurements of the devices, and there was no proportional bias in the measurements of tidal inspiratory and expiratory thickness, tidal TF, tidal excursion, and maximal inspiratory thickness. In interobserver reliability analysis of all measurements for both devices, ICC coefficients were higher than 0.8. Total diaphragm examination times of the devices were similar (p > 0.05). Conclusion These results suggest that PSD can be useful in ICU patients for evaluating DD. But further studies are required to determine the exact place of these devices in evaluation of DD in ICU patients.

Implementation of automated dispensing cabinets for management of medical devices in an intensive care unit: organisational and financial impact

BackgroundAutomated dispensing cabinets (ADCs) have been tested and approved for medication management in hospitals.ObjectivesFirst, to evaluate the logistics and organisational effect of a similar system for management of sterile medical...

Full or hypocaloric nutritional support for the critically ill patient: is less really more?

In critically ill patients we typically observe a catabolic response and changes in metabolic demands varying from increased energy expenditure during the initial inflammatory response to decreased energy expenditure in later phases of critical illness. In addition, sedation and immobilization may reduce exercise-induced energy expenditure in all stages of intensive care unit (ICU) stay. Therefore, it is recommended to estimate energy expenditure based on indirect calorimetry. However, the availability of such devices in ICUs is low. As a consequence most healthcare providers still use formulae to calculate the estimated energy expenditure, although these estimates have been shown to be unreliable (1).

Pain Assessment: Validation of the Physiologic Indicators in the Ventilated Adult Patient

Pain is one of the major stressors for critically ill patients. The first step for effective pain management is pain assessment. Due to the availability of physiologic monitoring devices in intensive care units, observing changes in vital signs provides a fast, simple, and objective method. However, the validity of physiologic indicators in pain assessment is still debatable. The aim of this study was to validate the discriminant and criterion validity of physiologic indicators for pain assessment in nonverbal patients. The study included 120 patients from the intensive care unit of a medical center of Taiwan. Patients were observed under two nursing procedures to examine the discriminant validity of physiologic indicators: 1) a nociceptive procedure: suctioning; 2) a non-nociceptive procedure: taking noninvasive blood pressure. Forty-four consciously ventilated patients were also asked to provide self-reported pain intensity. Discriminant validity was supported with higher heart rate and blood pressure during suctioning than the values before and after suctioning. Moreover, the heart rate and blood pressure during suctioning were significantly higher than the values during noninvasive blood pressure measurement. In terms of criterion-related validity, there was no significant correlation between patient's self-report of pain intensity and heart rate and blood pressure. As recommended by other scholars and researchers, heart rate and blood pressure can only be used as a cue for pain assessment. If pain is suspected, further appropriate assessment is necessary to provide accurate judgment.

Infecciones intrahospitalarias asociadas a dispositivos invasivos en unidades de cuidados intensivos de un hospital nacional de Lima, Perú

In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012. A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1). The main infectious agents isolated were Pseudomona sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI. The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure.

Overview of Critical Factors Affecting Medical User Interfaces in Intensive Care Unit (ICU)

This paper provides a comprehensive overview of critical factors, which affect on-screen user interfaces of medical devices in Intensive Care Unit (ICU). A literature survey with relevant research publications has led to selection of thirty eight critical factors in ICU. The critical factors identified are categorized into various groups based on three major aspects – system evaluation parameters, constituents of patient management and user interface design. Physicians’ survey, in which five physicians are involved, is used to categorize the identified critical factors into related groups. In the process, fourteen critical factors are mainly selected, which affect on-screen user interface design of medical devices. The applicability of such factors is demonstrated with the help of a case study of head-injury patient admitted in ICU. The critical factors identified are definitely useful to device manufacturers, user interface designers, ICU administrators and physicians for improved device design, ICU resource management and patient care.

Study on the Resistant Genes to Carbapenems and Epidemiological Characterization of Multidrug-ResistantAcinetobacter baumanniiIsolates

The purpose of this study was to examine the carbapenemase-encoding resistance genes and analyze homologous of multidrug-resistant Acinetobacter baumannii (MRAB) isolates from nosocomial infections. Seventy-six A. baumannii strains were collected from inpatients and object surface of devices in intensive care units from May 2008 to February 2011. Antibiotic susceptibility testing of 18 antimicrobial agents was performed. The presence of carbapenemase-encoding resistance genes was investigated by polymerase chain reaction. Genotyping and dendrogram analysis of A. baumannii strains from nosocomial infections were performed using the DiversiLab System. All of the 76 clinical A. baumannii isolates were shown multidrug resistance. The bla(OXA-23) gene was identified in the 76 MRAB strains, while bla(OXA-24), bla(OXA-58), VIM, IMP-1, IMP-4, SIM, and blaNDM-1 were absent in all. Twenty-four A. baumannii strains from the samples with nosocomial infections were classified into four unrelated groups and nine patterns. In conclusion, production of bla(OXA-23) in MRAB is one of the molecular mechanisms responsible for carbapenem resistance. The MRAB strains from unrelated groups show different drug resistance, but the homologous strains also have different drug resistance. Homologous analysis can provide scientific evidence for evaluation of epidemic status of nosocomial infection caused by MRAB.

Integration solution for the communication with Healthcare devices in Intensive Care Units

This paper presents a free Critical Care Information System (CCIS) that shows an essential infrastructure for critical care medical and nursing practice. Specifically, a Patient Integral Analysis Aid System (SAIP) in Intensive Care Units (ICU) has been developed to cover the needs discovered in these scenarios. An importart part of this system is related to medical equipment that offers important information to help in medical diagnosis. ICU patients are usually connected to several of these devices which register their physiological parameters. The integration of these devices, in order to exchange the generated information, is difficult because they are developed by different manufacturers and with different communication protocols and information representations. To reach this objective, the developed drivers have a common interface for the access and collection of medical device data. The main goal of the present paper is to show the work done to obtain a real interoperability among medical devices from different manufacturers and with different communication protocols in ICU services for automatic data collection, storage and retrieval.