Managing for success!

The managing for success in our job is really important for the benefit of our patients!
We need think in 6 topics:
- The right person;
- The right skills;
- The right job;
- The right place;
- The right equipment;
- The right time.

Now is time to reflect about this in our care. :)

F. Ferreira

Tetralogy of Fallot.avi

Bentall Operation Using Valsalva Conduit - Cardiac Surgery Unit UMG Cata...

Bentall Operation Using Valsalva Conduit - Cardiac Surgery Unit UMG Cata...

Neste momento encontro-me a trabalhar na Cirurgia Cardiaca! Espectacular e uma grande mudança na minha carreira!
Ainda só comecei a 2 semanas, e tenho ainda muito que aprender, mas está a ser fantastico.
Hoje tive oportunidade de ser a segunda instrumentista e foi esta a cirurgia!
Espero que ajude alguns colegas que estejam também a começar na cirurgia cardiaca, a perceber um pouco melhor.

Boas praticas

F.Ferreira

Update!

Aqui deixo mais um site interessante!

http://reference.medscape.com/

Boas práticas.

F.Ferreira

Pediatric Dose Calculator

Para quem estiver interessado aqui está um site onde se pode fazer o calculo da dose das drogas em Pediatria!

Basta preencher os campos obrigatorios e aparece a lista de medicamentos com as respectivas dosagens, de acordo com os valores que foram colocados.

Mais uma ajuda para as nossas boas práticas!

http://www.pana.org/pedform.htm

Auscultação

Aqui está outro site, desta vez sobre auscultação cardiaca e torácica!

http://www.virtual.unifesp.br/unifesp/torax/

Boas Práticas

F. Ferreira

Electrocardiograma

Para os interessados em saber um pouco mais de ECG aqui está um site interessante!

http://www.virtual.epm.br/material/tis/curr-bio/trab2003/g5/menu.html

Boas Práticas

F.Ferreira

Guidelines para Prevenção de Infecções nos Cateteres Endovenosos

CDC Updates IV Catheter Infection Prevention Guidelines
Laurie Barclay, MD



Learn more April 4, 2011 — The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) have updated intravascular catheter infection prevention guidelines. The new recommendations and review of underlying supporting evidence, entitled "Guidelines for the Prevention of Intravascular Catheter-Related Infections," will also appear in a special supplement of the American Journal of Infection Control and are published online in the March 30 Advance Access issue of Clinical Infectious Diseases. The American Journal of Infection Control will also present a video roundtable highlighting the viewpoints of healthcare professionals on the anticipated effects of this new guideline on infection prevention practices.


Preparation for intravascular catheter insertion

"The updated CDC guidelines are rich with new recommendations that are based on additional scientific research that has emerged since the prior version was published," said Russell N. Olmsted, MPH, CIC, 2011 president of the Association of Professionals of Infection Control and Epidemiology (APIC), in a news release. "This is an important resource to support efforts toward the elimination of catheter-related bloodstream infections [CRBSIs].... The timing for this updated guideline is perfect because, starting this year, hospitals that accept Medicare patients are required to report their central line–associated bloodstream infections to the Centers for Medicare & Medicaid Services, or risk losing 2 percent of their Medicare payments."

Collaborative Project

The updated recommendations replace previous guidelines published in 2002 by the CDC and were formulated by a working group led by the Society of Critical Care Medicine. In addition to the CDC and HICPAC, also collaborating on this project were the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Surgical Infection Society, American College of Chest Physicians, American Thoracic Society, American Society of Critical Care Anesthesiologists, APIC, Infusion Nurses Society, Oncology Nursing Society, American Society for Parenteral and Enteral Nutrition, Society of Interventional Radiology, American Academy of Pediatrics, and Pediatric Infectious Diseases Society.

Goals of New Recommendations

"The goal of an effective prevention program should be the elimination of CRBSI from all patient-care areas," write Naomi P. O'Grady, MD, from the National Institutes of Health in Bethesda, Maryland, and colleagues from HICPAC. "Although this is challenging, programs have demonstrated success, but sustained elimination requires continued effort. The goal of the measures discussed in this document is to reduce the rate to as low as feasible given the specific patient population being served, the universal presence of microorganisms in the human environment, and the limitations of current strategies and technologies."

The new recommendations are addressed to healthcare personnel responsible for intravascular catheter insertion as well as those involved in surveillance and containment of infections in hospital, outpatient, and home healthcare settings.

Multidisciplinary strategies and topics addressed in the updated guidelines include education, training, and staffing; selection of catheters and sites; peripheral catheters and midline catheters; central venous catheters (CVCs); hand hygiene and aseptic technique; maximal sterile barrier precautions; skin preparation; catheter site dressing regimens; patient cleansing; catheter securement devices; antimicrobial/antiseptic impregnated catheters and cuffs; systemic antibiotic prophylaxis; antibiotic/antiseptic ointments; antibiotic lock prophylaxis, antimicrobial catheter flush and catheter lock prophylaxis; anticoagulants; replacement of peripheral and midline catheters; replacement of CVCs, including peripherally inserted central catheters (PICCs) and hemodialysis catheters; umbilical catheters; peripheral arterial catheters and pressure-monitoring devices for adult and pediatric patients; replacement of administration sets; needleless intravascular catheter systems; and performance improvement.

Recommendations

Some of the specific recommendations include the following:

•For peripheral and midline catheters, an upper-extremity site is preferred in adults. In pediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used.
•Steel needles should be avoided when administering fluids and medications that might cause tissue necrosis if extravasation occurs.
•When the duration of intravascular therapy is likely to be more than 6 days, a midline catheter or PICC is preferred to a short peripheral catheter.
•The catheter insertion site should be evaluated daily, and peripheral venous catheters should be removed if signs of phlebitis develop.
•Risks and benefits of a central venous device to reduce infectious complications should be weighed against the risk for mechanical complications.
•In adult patients, use of the femoral vein for central venous access should be avoided. For nontunneled CVC placement, a subclavian site is preferred to a jugular or a femoral site. To avoid subclavian vein stenosis, the subclavian site should be avoided in hemodialysis patients and patients with advanced kidney disease.
•For patients with chronic renal failure, a fistula or graft instead of a CVC for permanent access for dialysis should be used.
•Ultrasound guidance by those fully trained in its technique should be used to place CVCs.
•A CVC should have the minimal number of ports or lumens essential for patient treatment.
•Any intravascular catheter that is no longer essential should be promptly removed.
•When adherence to aseptic technique cannot be ensured, such as for catheters inserted during a medical emergency, the catheter should be replaced as soon as possible (within 48 hours).
•Systemic antimicrobial prophylaxis before insertion or during use of an intravascular catheter is not routinely recommended to prevent catheter colonization or CRBSI.
More information on the guidelines is available on this particular CDC Web site.

Some of the study authors have disclosed various financial relationships with the ABIM Subspecialty Board for Critical Care Medicine, Infusion Nurses Society, 3M, Becton Dickinson, Smiths Medical, Institute of Healthcare Improvement, Theradoc, Medline, APIC, Clorox, Merck, Baxter, Ortho-McNeil, Targanta, Schering-Plough, Optimer, Cadence, Cardinal, BDGeneOhm, WebEx, Cerebrio, Tyco, Medscape, ASHP, IDSA, ASM, American College of Surgeons, NQF, SHEA/CDC, HHS, Trauma Shock Inflammation and Sepsis Meeting, University of Minnesota, Ethicon, Angiotech, Astellas, Theravance, Pfizer, Ash Access, CorMedix, Catheter Connections, Carefusion, Sage, Bard, Teleflex, Cubist, Enzon, Basilea, Great Lakes Pharmaceuticals, Inventive Protocol, Cook, Inc, American Medical Systems, Cook Urological, TyRx, Medtronic, Biomet, Eisai Pharmaceuticals, Discovery Laboratories, Molnlycke, Cardinal Healthcare Foundation, Sanofi-Pasteur, Semprus, and/or Society for Healthcare Epidemiology of America.

Clin Infect Dis. Published online March 30, 2011. Extract

Understanding Malignant Hyperthermia

Muito bom video!! Vale a pena ver!

F. Ferreira

Mixing the Antidote For Malignant Hyperthermia

Esta semana vou fazer uma apresentação sobre Hipertermia Maligna e como tal além de muita pesquisa feita e do trabalho já estar completo, decidi procurar videos que me pudessem ajudar na parte do dantroleno, visto não ter hipotese de preparar na altura.
Aqui vai um que está simples, mas explica uma das coisas mais importantes, as primeiras coisas básicas a fazer, e como se preapara o dantroleno.

Boas práticas

F. Ferreira

Anestesia

Para os interessados em anestesia, este livro é bastante recente e fala sobre tudo em anestesia.
Caso estejam interessados podem aceder ao site:

http://www.amazon.co.uk/Training-Anaesthesia-Oxford-Specialty/dp/0199227268/ref=sr_1_11?s=books&ie=UTF8&qid=1283185811&sr=1-11

Caso já conhecam o livro e queriam dar a vossa opinião fico grata!

Boas práticas

F.Ferreira

I-Gel

Esta é uma mascara laringea super simples de utilizar e espectacular!
Se já a conhecem deêm a vossa opinião, se não conhecem deem uma espreitadela pelo vídeo.

Boas práticas

F.Ferreira

Orthopaedics vs Anaesthesia (Orthopedic or Orthopedic vs Anesthesia)

Uma pequena brincadeira para se rirem!:)

F.F.

Functional Endoscopic Sinus Surgery (FESS)

Olá!
Hoje andei pelo bloco de otorrino, e além das coisas banais, como excisão de lesões, das amigdalectomia entre outras coisas que já tive oportunidade de instrumentar, vou instrumentar o meu primeiro FESS. :)
Como minha experiência em otorrino é pouca cá andei a pesquisar pela net, para melhor perceber qual o objectivo desta cirurgia.

Espero que ajude os colegas que também não sabem o que é, e aos que sabem espero que gostem e deem opinião.

Desculpem ser em inglês...

Boas práticas

F.F.

"One way FESS differs from traditional sinus surgery is that a thin rigid optical telescope, called an endoscope, is used in the nose to view the nasal cavity and sinuses. This technique was developed in Europe and introduced into the US by Dr. David W. Kennedy from the University of Pennsylvania in the mid 1980s. It has revolutionized the surgical treatment of chronic sinusitis. FESS generally eliminates the need for an external incision. The endoscope allows for better visualization and magnification of diseased or problem areas. This endoscopic exam, along with CT scans, may reveal a problem that was not evident before.

Another difference is that FESS focuses on treating the underlying cause of the problem. The ethmoid sinuses are usually opened. This permits direct visualization of the maxillary, frontal, and sphenoid sinuses and diseased or obstructive tissue can be removed if necessary. There is often less removal of normal tissue and surgery can frequently be performed on an outpatient basis without the need for painful packing that was used in the past. Generally, there are not external scars, little swelling, and only mild discomfort.

The goal of FESS is to open the sinuses more widely. Normally the openings to the sinuses are long narrow bony channels covered with mucosa or the lining of the sinuses. If this lining swells from inflammation, the sinuses can become blocked and an infection can develop. FESS removes some of these thin bony partitions and creates larger openings into the sinuses. After FESS, patients can still develop inflammation from allergies or viruses, but hopefully when the sinus lining swells, the sinus will still remain open. This will permit easier treatment of subsequent exacerbations with more rapid resolution and less severe infections.

Powered instrumentation can be useful during FESS to precisely remove polyps and other diseased tissue, while sparing the surrounding normal sinus lining and adjacent structures. The latest generation of hand instruments allows the surgeon to meticulously open the sinuses, while avoiding the “grab and tear” techniques of the past. Once the diseased tissue is removed and the inflammation subsides, the injured sinus lining often returns to a normal state with time."

http://www.muschealth.com/nose/fess.htm


Aqui fica uma imagem ilustrativa:

http://www.muschealth.com/nose/sinusdiagram400x300.jpg

WHO Surgical Safety Checklist

Como deve ser do cuidado de todos os enfermeiros perioperatórios, temos de ter em conta a elaboração de checklist para diminuir os riscos de acidentes relacionados com a cirurgia, com o material utilizado e com os nosso cuidados de saúde.

Aqui vai um site muito interessante onde já se encontram algumas checklists, tal como a checklist para os doentes de cirurgia da catarata.

Continuação de boas práticas

http://www.nrls.npsa.nhs.uk/resources/patient-safety-topics/documentation/?entryid45=59860


F.Ferreira

Eyes!

Hoje andei a pesquisar sobre cirurgias oftálmicas, mais precisamente sobre a Cirúrgia da Catarata. A empresa que está mais vocacionada para esta área é a ALCON. Dei uma volta pelo site, e pode ter coisas interessantes para quem está a começar nesta área, mas em termos cirúrgicos diz pouco.

Assim entre muita pesquisa sobre cataratas, encontrei estes vídeo do Youtube que explicam o que é a catarata e a Facoemulsificação.

http://www.youtube.com/watch?v=WiEFwKEBd04
http://www.youtube.com/watch?v=WLlgIb7jxvk

Outro site é o das lentes utilizadas nestas cirúrgias, onde explica também um pouco o que acontece e tem outro vídeo explicativo.

http://www.acrysofrestor.com/cataract-surgery.asp

Boas práticas e bom estudo, sempre! Porque aprendemos todos os dias :)

F. Ferreira

Link de Ortopedia

Olá a todos!

Hoje adicionei um novo link, aos links de interesse. Hoje é sobre técnicas de ortopedia, demonstradas pela Arthrocar Sports Medicine. Caso estejam interessados e usem instrumental da Arthrocar deêm uma vista de olhos nas técnicas cirúrgicas!

Um abraço e boas práticas

F. Ferreira

http://international.arthrocaresportsmedicine.com/

Segurança no Período Perioperatório: 10 Passos para Anestesia Segura

Check out this SlideShare Presentation:

Segurança no Período Perioperatório: 10 Passos para Anestesia Segura

View more documents from SMA.

Implementation Manual Surgical Safety Checklist

A gestao do risco cirurgico e responsabilidade nao so do medico como tambem dos enfermeiros, que contribuem para a seguranca e bem estar dos pacientes no bloco operatorio.
Como tal devemos estar atentos nao so a confirmacao do nome do doente, procedimento cirurgico a ser realizado, como tambem a varias outras coisas, como a esterilizacao do material, a funcionalidade dos instrumentos e aparelhos utilizados, como tambem pela contagem das compressas e instrumentos, sendo no total um conjunto de passos essencias para uma seguranca eficaz do paciente.

A WHO tem uma checklist com os passos essencias a serem verificados a cada cirurgia efectuada.

Aos interessados este e o link de acesso:

http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Manual_finalJun08.pdf

Boas Praticas a todos

F. Ferreira