Healthcare Traveler - January 2009 - (Page 40)

Clinical Tips CLINICAL PEARLS FROM THE EXPERTS Piercing ears to test glucose Have you ever thought you’d never get another drop of blood out of a finger for glucose testing? Instead of using cold and callused fingertips, earlobe sampling is an option. Samples from the earlobes and fingertips were compared in 50 participants at a 480-bed community hospital, and the mean difference between the two locations was 5.8 mg/dL. While the differences between finger stick and earlobe glucose results in this study were statistically significant, clinical or practical significance needed to be determined. When considering typical insulin protocols, treatment based on a blood glucose value in error by 6 mg/dL would cause little or no harm in most patients. In the study, 27 patients (54%) had significant differences in blood glucose at the two sites. Of these, 11 (22%) would have received different treatment if the sample insulin protocol were used, depending on which site value was chosen. The treatment difference was 0.5 to 1.0 unit of insulin for the sliding scale protocol and 1.0 to 2.0 units per hour for the insulin infusion protocol. Although statistically significant, the mean difference was not clinically significant. Therefore, the earlobe may be a safe and effective alternative to exclusive use of the fingertips. An unexpected finding was that pierced ears didn’t seem to affect collecting a blood sample from the ear. The earlobe’s surface area isn’t usually any larger than on the fingertip, so site rotation would be a boon for more testing options and enhanced patient comfort. Anzalone, P. (2008). Equivalence of earlobe site blood glucose testing with finger stick. Clinical Nursing Research, 17(4), 251-261. Photo: Getty Images/ ULTRA.F/Digital Vision Getting the pulse on peds Children’s fingers and toes are often too small to properly attach oximeter sensors; therefore, the sensors are often placed on the sole or the palm. However, no study has determined the precision and accuracy of the pulse oximeter readings at these different locations. The study was conducted with 50 critically ill children, newborn to 2 years of age, in a tertiarycare pediatric intensive care unit. As a control, co-oximeter-measured arterial oxygen saturation (SaO2) was compared with simultaneously obtained pulse oximetry saturations (SpO2). Measurements were taken in the upper extremities (finger and palm) and lower extremities (toe and sole). The median SaO2 was 92% (66% to 100%). There was a significant difference when the sole and toe were compared and the toe was more accurate. But there was no significant difference in bias and precision between the palm and the finger. However, there was a significant difference in bias +/- precision when the SaO2 was less than 90%, compared with when SaO2 was greater than or equal to 90%, in the sole and palm; but no significant difference in the finger or toe. Pulse oximeter and sensors were less accurate and precise when used on the sole of the foot or palm of the hand of a child with an SaO2 less than 90%. Sedaghat-Yazdi, F., Torres, A., et al. (2008). Pulse oximeter accuracy and precision affected by sensor location in cyanotic children. Pediatric Critical Care Medicine, 9(4), 393-397. Innovations in Practice The buzz on infection control Photo: Getty Images/BBSUnited (honey)/Photodisc/Brian Deif (globe) Dorling Kindersley RF H oney’s history in healing and infection control began around 3,000 B.C. in Egypt. Lately, however, researchers have revitalized the age-old remedy and turned to examining honey as a wound treatment. In a four-week randomized, controlled trial, manuka honey was put to the test against hydrogel dressing as to their efficacy for desloughing chronic venous leg ulcers. As is often the case, the wounds were breeding grounds for various pathogens. During the treatment, the honey not only worked as a desloughing agent but also wiped out MRSA from 70% of the 40 Healthcare Traveler January 2009 wounds, whereas the hydrogel managed to work in just 16% of the cases. As an additional perk, manuka honey significantly reduced wound pain after one week. The trick to the honey is that its hydrogen peroxide decomposes much more slowly than what’s in standard honey. This special honey is made from the manuka bush, Leptospermum scoparium, only found in New Zealand. Gethin, G. & Cowman, S. (2008). Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. Journal of Wound Care, 17(6), 241-247. Cuff location may skew blood pressure measurement Occasionally, the forearm is used as an alternate site for blood www.healthcaretraveler.com http://www.healthcaretraveler.com

Table of Contents Feed for the Digital Edition of Healthcare Traveler - January 2009

Healthcare Traveler - January 2009 Editor’s Desk Contents By the Numbers Paws for Thought Field Notes In a Flash Med Ec-cerpts Dream Destinations Nursing from the Heart Drug Update Professional Update Clinical Tips On Assignment Cityscape Name It Advertiser’s Index Contest Rules When In… It’s in the Bag Dot.com Tax Facts Big Deals Starter’s Kit Going the Distance Allied Corner Classifieds Tales from the Road

Healthcare Traveler - January 2009

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