Duygu Sönmez Düzkaya

Assessment of Pain During Endotracheal Suction In the Pediatric Intensive Care Unit

This research was planned as a two-level definitive and comparative study to evaluate pain during endotracheal suction (ETS) in pediatric intensive care units (PICUs). This study was comprised of patients admitted to and the nurses working in the PICU. Cases were selected among PICU patients (N = 65) who met the study criteria and nurses (N = 18) who cared for them from January 1 to July 2, 2008. Routine ETS was applied as the first level of the study. For the second level, an inquiry on the knowledge of nurses about suction was given to the nurses, and they were asked to apply suction according to the guidelines they were given. All the obtained data were evaluated by statistical package for the social sciences (SPSS) for Windows 14.0. In summary, 33.8% (n = 22) of the patients were between ages 1 and 12 months, and 64.6% (n = 42) were boys. Although group 2 patients (patient who is in experimental group) had higher scores on the Wong-Baker faces pain rating and Face, Legs, Activity, Cry, Consolability scales, no statistical difference was found between the two groups (p > .05). Patients who received bolus doses of analgesia and sedative drugs had lower Wong-Baker faces pain rating (4.38 ± 0.96; n = 4) and Face, Legs, Activity, Cry, Consolability scores (4.61 ± 1.94; n = 4) (p > .05). According to these findings, the patients were distressed because of the pain related with suction. Therefore, it is recommended that suction guidelines be used in PICUs during ETS.

Effect of two different feeding methods on preventing ventilator associated pneumonia in the paediatric intensive care unit (PICU): A randomised controlled study

BACKGROUND For infants and children who require intubation in the paediatric intensive care unit (PICU), ventilator-associated pneumonia (VAP) is a significant cause of secondary morbidity and mortality linked with extended use of intubation. Nurses are primarily responsible for the prevention of VAP and there are a number of procedures that contribute towards this end. Although enteral nutrition has been reported to be effective in the prevention of VAP, this remains controversial. OBJECTIVE To compare and evaluate the effects of intermittent feeding through a nasogastric catheter with those of continuous feeding through a nasoduodenal catheter in preventing VAP in the PICU. DESIGN The research design was a randomised, controlled experimental study. METHODS Forty paediatric patients were randomised and divided into two groups of 20: one group for nasoduodenal (ND) feeding and the other for nasogastric (NG) feeding. Patients were assessed for the development of VAP using the clinical pulmonary infection score and Centers for Disease Control and Prevention criteria while working in accordance with the VAP prevention bundles introduced within the unit. RESULTS The incidence of paediatric VAP was 15%. The rate of VAP in patients who were ND fed was 10%, whereas the rate of VAP in patients who had NG feeding was 20%. No statistically significant difference was observed between the ND- and NG-fed patients (p=0.661). CONCLUSION Although the results of our study were not statistically significant, nasoduodenal feeding helped to reduce the incidence of VAP.

Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial

PURPOSE: The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study. METHODS: Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI. RESULTS: CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05). CONCLUSION: We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.

The Effects of Bundles on Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit.

Background: There are few studies in the literature from developing countries regarding the rates of catheter-associated urinary tract infection (CAUTI), which is frequently encountered in pediatric intensive care units (PICUs). Aim: The aim of this study is to evaluate the 2-year rates of CAUTI in a PICU where a CAUTI Prevention Bundle was implemented. Design: This was an interventional prospective study. Methods: The study was conducted with 390 patients in the PICU of Istanbul Faculty of Medicine, Turkey, from July 2013 to July 2015. The patients were selected based on the diagnostic criteria of the Centers for Disease Control and Prevention. Results: Urinary colonization occurred in 8 (2.2%) patients in the prebundle group and 3 (0.8%) patients in the postbundle group, and contamination occurred in 10 (2.8%) patients in the prebundle group and 6 (1.5%) patients in the postbundle group. The CAUTI incidence and rates were 5.8% and 6.1 per 1000 urinary catheter days and 1.5% and 1.8 per 1000 urinary catheter days prebundle and postbundle, respectively. There was a statistically significant difference between the prebundle and postbundle CAUTI rates. Conclusion: Our findings support that clinical nurse specialists in developing countries should consider the use of CAUTI bundles to prevent CAUTIs.

The Effect of Oral Care Using an Oral Health Care Guide on Preventing Mucositis in Pediatric Intensive Care

Objectives To evaluate the effectiveness of standard‐of‐care oral care guides developed specifically for children in intensive care to prevent mucositis. Design and Methods This prospective, interventional and single‐group study design was performed in the pediatric intensive care unit of a university hospital in Istanbul between January and December 2014. Daily oral care was implemented to pediatric patients in the study group in line with an oral care guide developed by the researchers. Data were collected using the data collection form and oral mucositis assessment scale published by the World Health Organization (WHO). Results Oral mucositis occurred in 16 (5.2%) patients in the pre‐intervention group and 7 (2.5%) in the post‐intervention group, 10 patients had grade 1, and 6 patients had grade 2 oral mucositis in the pre‐intervention group, and in the post‐intervention group, three patients had grade 1, and four patients had grade 2 oral mucositis. Although more patients in the pre‐intervention group had mucositis than in the post‐intervention group, the differences were not statistically significant (P = 0.067). Conclusions Oral mucositis can be reduced through the practice of administering oral care in accordance with oral healthcare guidelines. Practice Implications Oral care implemented in line with an evidence‐based oral care guide and frequent observation of patients are the most important steps in preventing oral mucositis. HighlightsThe number of studies conducted towards preventing oral mucositis in children in intensive care is limited.Nurses in intensive care units have an important role in the prevention or reduction of mucositis.Oral care implemented was effective in preventing mucositis and reducing oral health assessment scores.

Yoğun Bakımdan Taburcu Olan Tıbbi Teknolojiye Bağımlı Çocuklara Verilen Evde Bakım Hizmetlerinin Değerlendirilmesi

A Amac: Bu calisma, bir universite hastanesinin Cocuk Yogun Bakim Unitesinden taburcu edilen tibbi teknolojiye bagimli cocuklara verilen evde bakim hizmetlerini degerlendirmek amaciyla yapildi. Gerec-Yontem: Tanimlayici tipte gerceklestirilen a rastirmanin evrenini; Istanbul Universitesi Istanbul Tip Fakultesi Hastanesi, Cocuk Yogun Bakim Unitesinden taburcu edildikten sonra evde bakilan 42 hasta, orneklemi ise calismaya katilmayi kabul eden 30 hasta olusturdu. Veriler arastirmacilar tarafindan literatur dogrultusunda hazirlanan “Veri Toplama Formu” ile elde edildi. Veri toplama formu; hastalarin yogun bakim unitesine trakeostomi kanul degisimi, nazoduodenal sonda degisimi vb ihtiyaclari nedeniyle getirildigi sirada veya aileler ile yapilan telefon gorusmesi ile arastirmacilar tarafindan dolduruldu. Bulgular: Calisma grubundaki cocuklarin; ortalama yasinin 85.63±58.40 ay oldugu, %56.7’sinin erkek ve %40’inin norolojik hastalik tanisi ile takip edildigi saptandi. Yogun bakimdan taburcu edilen cocuklarin tamaminin trakeostomisi oldugu, %96.7’sinin ev tipi mekanik ventilator kullandigi ve %93.3’unun enteral yolla beslendigi belirlendi. Taburcu edildikten sonra hastalarin %56.7’sinin yogun bakima tekrar yattigi belirlendi. Ailelerin %86.7’sinin evde saglik hizmetleri koordinasyon merkezine basvurdugu ancak yalnizca % 36.7’sinin bu birimlerden destek hizmet aldigi ve alinan hizmetin en cok %23.3 oraninda tibbi tedavi veya izlem oldugu goruldu. Evde bakim hizmetleri ekipleri tarafindan; trakeostomi degisimi, trakeostomi bakimi, aspirasyon, nazogastrik/orogastrik sonda takma, idrar sondasi takma, egzersiz, vucut bakimi vb. yapilmadigi belirlendi. Ailelerin %93.3’u evde a cil durumlarda geri dondurulemeyecek sorunlar ile karsilasabileceklerini bildirmistir. Sonuc: Yogun bakimdan taburcu edilen tibbi teknolojiye bagimli cocuklar evde bakim hizmetleri ekiplerinden yeterince yararlanamamaktadirlar. Bu hastalarin evde bakimlari aileleri tarafindan yapilmaktadir . Tibbi teknolojiye bagimli yogun bakim hastalarina yonelik e vde bakim hizmetlerinin gelistirilmesi onerilebilir.

Umbilical Cord Care and Infection Rates in Turkey

Objective: To compare the efficacy of umbilical cord sponging with 70% alcohol, sponging with 10% povidone–iodine, and dry care on the time to umbilical cord separation and bacterial colonization. Design: Prospective, interventional experimental study design. Setting: Three different family health centers in Istanbul, Turkey. Participants: In total, 194 newborns were enrolled in one of three study groups: Group 1, 70% alcohol (n = 67); Group 2, 10% povidone–iodine (n = 62); and Group 3, dry care (n = 65). Methods: Data were collected between January 2015 and July 2015. Umbilical separation time and umbilical cord bacterial colonization were considered as the study outcomes. Results: The most commonly isolated bacteria were Staphylococcus aureus, Escherichia coli, and enterococci. There was no significant difference among the groups for umbilical cord separation times (p > .05). Conclusion: Dry care may be perceived as an attractive option because of cost benefits and ease of application.

Yoğun Bakımdaki Çocuklarda Oral Mukozit Gelişme Durumu

Amac: Arastirma, yogun bakimindaki cocuklarda oral mukozit gelisme durumunu degerlendirmek amaciyla yapildi. Yontem: Arastirma, Ocak-Aralik 2015 tarihleri arasinda Istanbul’da bir universite hastanesinin cocuk yogun bakim unitesine yatisi yapilmis olan 181 cocugun Mart -Nisan 2016 tarihleri arasinda hasta dosyalari taranarak retrospektif olarak gerceklestirilmistir. Arastirma verileri, hasta dosyalarinda yer alan bilgiler taranarak arastiricilar tarafindan toplanmistir. Bulgular: Hasta dosyalarindan elde edilen veriler degerlendirildiginde; cocuklarin yas ortalamalarinin 48.69±3.29 ay oldugu, %37.5’inin solunum sistemi hastaligi tanisi ile yogun bakimda yattigi, %92.2’sinin oral beslenemedigi, %86.1’inin oksijen tedavisi ve %77.3’unun steroid tedavisi aldigi goruldu. Hastalarin %2.7’sinde oral mukozit olustugu, oral mukozit gelisen hastalarin ucunun yogun bakimdan taburcu olmadan iyilestigi, ikisinin ise 1. evre oral mukozit ile taburcu edildigi belirlendi. Sonuc: Calismanin yurutuldugu yogun bakimdaki cocuklarda, risk faktorlerine ragmen, oral mukozit oraninin dusuk oldugu belirlendi.