Blood Withdrawal from Intravenous Catheters by ED Nurses: Comparison of Two Practices

Nazaretian, H.H. et al. Journal of Emergency Nursing | Published online: 25 April 2017

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Problem: Laboratory tests are essential to diagnosis and treatment in the emergency department, but they can result in prolonged waiting times for patients, multiple needle pricks, and complaints about pain and discomfort. The goal of this project is to assess if a change in the blood collection process will lead to any improvement and benefit in care delivered with regard to time, patient comfort, and cost.

Implications for Practice: Allowing registered nurses to withdraw blood with the start of a peripheral intravenous line will significantly reduce length of stay and costs and enhance patient experience in the emergency department at American University of Beirut Medical Center.

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Blood test shows promise in detecting abusive head trauma in infants

Researchers have developed and refined a blood test that could help clinicians identify infants who may have had bleeding of the brain as a result of abusive head trauma, sometimes referred to as shaken baby syndrome | ScienceDaily

The serum-based test, which needs to be validated in a larger population and receive regulatory approval before being used in clinical practice, would be the first of its kind to be used to detect acute intracranial hemorrhage, or bleeding of the brain. Infants who test positive would then have further evaluation via brain imaging to determine the source of the bleeding.

However, approximately 30 percent of AHT diagnoses are missed when caretakers provide inaccurate histories or when infants have nonspecific symptoms such as vomiting or fussiness. Missed diagnoses can be catastrophic as AHT can lead to permanent brain damage and even death.

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1: 1 transfusion strategies are right for the wrong reasons

Savage, S. et al. Journal of Trauma and Acute Care Surgery. Published online: 28 February 2017

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Abstract: Introduction: Early assessment of clot function identifies coagulopathies following injury. Abnormalities include a hypercoagulable state from excess thrombin generation, as well as an acquired coagulopathy. Efforts to address coagulopathy have resulted in earlier, aggressive use of plasma emphasizing 1:1 resuscitation. The purpose of this study was to describe coagulopathies in varying hemorrhagic profiles from a cohort of injured patients.

 

Conclusion: Hemorrhagic profiles suggest a rapid onset of clot formation in all subgroups but significantly suppressed thrombin burst and diminished clot strength in the most injured. Patients are both hypercoagulable, with early and precipitous clot formation, and also have a demonstrable hypocoagulability. The exact cause of traumatic hypocoagulability is likely multi-factorial. Goal-directed resuscitation, as early as institution of the massive transfusion protocol, may be more effective in resuscitating the most coagulopathic patients.

Read the abstract here