Nurses' perceptions and use of near infrared spectroscopy in paediatric cardiac intensive care.

Autor: Pieciak K; Department of Nursing and Clinical Care Services, Cardiac Intensive Care Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., McGowan K; Department of Nursing and Clinical Care Services, Cardiac Intensive Care Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Grade L; Department of Nursing, Cardiac Center, Children's Wisconsin, Milwaukee, Wisconsin, USA., Morrill D; Cardiovascular, Critical Care and Perioperative, Patient Services, Project Coordinator II, Boston Children's Hospital, Boston, Massachusetts, USA., DiPasquale Z; Cardiovascular, Critical Care and Perioperative, Patient Services, Program Administrative Manager III, Boston Children's Hospital, Boston, Massachusetts, USA., Casto E; Department of Cardiology, Quality Improvement Consultant, Boston Children's Hospital, Boston, Massachusetts, USA., Connor JA; Cardiovascular, Critical Care and Perioperative, Patient Services, Director of Nursing Research, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Lisanti AJ; Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.; Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Nursing in critical care [Nurs Crit Care] 2023 Nov; Vol. 28 (6), pp. 1045-1052. Date of Electronic Publication: 2022 Nov 23.
DOI: 10.1111/nicc.12861
Abstrakt: Background: Near-infrared spectroscopy (NIRS) is a non-invasive technology that estimates regional oxygen saturation. Literature demonstrates that NIRS can provide valuable data for clinical staff. However, little research has addressed the nursing care and management of NIRS in the critical care environment.
Aims: To assess nurses' perception around the use of NIRS and current NIRS practice within paediatric cardiac intensive care unit (PCICUs).
Study Design: A 53-item cross-sectional electronic survey was developed to assess indications for NIRS, critical value thresholds and interventions, barriers to use, policies and procedures, and nursing perceptions. Descriptive statistics were used to summarize and aggregate data.
Results: Among the 28 responding sites (63.6% response rate), usage of NIRS was variable and patient-dependent. Most nurses reported using NIRS in patients with unstable physiology such as post-operative single ventricle (n = 25, 89.3%) and concern for shock (n = 21, 75.0%). Critically low cerebral values varied among respondents from less than 40 (n = 3, 10.7%) to less than 60 (n = 4, 14.3%), with lower critical values permitted for single ventricle physiology: less than 40 (n = 8, 28.6%) to less than 50 (n = 6, 21.4%). Reported barriers to using NIRS included skin breakdown (n = 9, 32.1%), lack of consistency in decision-making among physicians (n = 13, 46.4%), and not using NIRS data when developing a plan of care (n = 11, 39.3%). Most (n = 24, 85.7%) nurses reported that NIRS provided valuable information and was perceived to be beneficial for patients.
Conclusions: NIRS monitoring is a common technology in the care of complex congenital heart disease patients. Most nurses valued this technology, but inconsistencies and practicalities around its use in guiding patient management were found to be problematic.
Relevance to Clinical Practice: NIRS is commonly used in the PCICU and although nurses perceived NIRS to be useful for their practice, the variability in the interpretation of values and inconsistent protocols and decision-making by physicians was challenging.
(© 2022 British Association of Critical Care Nurses.)
Databáze: MEDLINE
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