May 2007

May 2007

Ultrafiltration: Evidence-Based Practice in the
Critical Care Center

Plasma fluid removal is needed in a variety of clinical conditions including congestive heart failure (CHF). Diuretics, generally taken intravenously at the hospital and orally at home, have been used traditionally to treat fluid accumulation in CHF patients. These pharmaceuticals cause the body to lose water, but often with notable drawbacks. “Diuretics can impair kidney function and alter the balance of electrolytes (such as potassium and sodium),” says William Haynos, M.D., a heart failure expert with UI Heart Care at University of Iowa Hospitals and Clinics.” They have also been demonstrated to alter the physiology of patients such that their heart failure worsens. And data suggest that many heart failure patients go home after diuretic treatment without having lost much water–so the drugs don’t always work well. Plus, the body seems to develop a tolerance to them, necessitating larger doses and longer hospital stays (patients on diuretics are often hospitalized for many days and have recurring visits). This quickly becomes a financial burden on top of the physical one. With heart failure cases increasing nationwide, therapies are being targeted at reducing frequent and long-lasting hospitalizations,” according to Haynos.

Is there any evidence supporting a better fluid removal intervention when traditional therapy fails? Yes, ultrafiltration or aquapheresis. Ultrafiltration utilizes a mechanical pump, an intravascular dual-lumen catheter, and osmotic pressure to reduce fluid overload. Excess water is removed in a manner similar to dialysis, the method by which kidney failure patients have excess waste products removed. Ultrafiltration removes excess salt and water safely, predictably and effectively without impact on the patient’s blood pressure, heart rate, electrolyte balance, or kidney function. Research has shown a decrease in heart failure readmission rates among ultrafiltration patients compared with patients who received standard care in a multi-center clinical trial (www.unloadstudy.com).

Upon the recommendation of CCC nurses, the medical center purchased Aquadex FlexFlow™ units in March 2007. Nursing staff education took place in April, and the first ultrafiltration patient was treated the same month. To date, 9 patients have undergone ultrafiltration at CVMC. Two of the 9 were transferred to CVMC for treatment. In one instance, 12 liters of fluid were removed from a patient in 36 hours – at which point the patient was discharged. Dr. Hearon and Sara Paul, ANP-C are advocates of this EBP initiative.

Better patient outcomes are being achieved with ultrafiltration for CHF patients that are diuretic resistant. Given that both the duration and rate of ultrafiltration can be controlled, hemodynamic instability is avoided. We applaud the CCC for implementing evidence-based practices to ensure quality patient outcomes.

Focus on the AHEC Library
The Library now has a special section of books on research, statistics, and evidence-based practice. These items can be found on a dedicated shelf in the center part of the library, near the photocopier. In addition, the library subscribes to BMJ’s Evidence-Based Nursing. Come in and scope us out. The library is located next to Organizational Learning in the AHEC building.
Some of the titles include:
Practical Statistics for Nursing and Health Care (2002)
Basic Steps in Planning Nursing Research: From Question to Proposal, 6thed. (2006)
Understanding Nursing Research: Building an Evidence-Based Practice, 4thed. (2007)
Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (2005)
Evidence-Based Practice in Nursing: A Guide to Successful Implementation (2006)
Interpreting the Medical Literature, 5th ed. (2006)

Hats Off

Dana Argiro, RN, BC – medical-surgicalCertification has been earned by:
Rachel Craven, RNC, Veronica Johnson, RNC, Sonya Deal, RNC, BSN – obstetrics

Kim Davis, RNC, BSN, ONC, Wendy Odom, RN, BSN, ONC – orthopedics

Tammy Franklin, ST – sterile processing

Catawba Valley Community College’s Outstanding Clinical Partner Award is determined by vote of the faculty and graduating nursing class. The 2006-2007 recipient was our own Ann Moore, RN, MSN, CEN. Congratulations, Ann.

News Items
Do you want to learn more about research? Some of your colleagues answered this question ‘yes’ and participated in a ‘Winging It Through Research’ workshop on May 22nd or 23rd. You too can discover the steps of the research process incorporated in the chocolate chip tasting study. E-mail Jamie Hoyle to register for one of the July sessions of ‘Winging It Through Research’. Food will be served, it will be fun, and you will earn 1 hour of continuing education credit all at the same time.

Research Strategies for Clinicians –a conference led by Marianne Chulay, RN, DNSc, FAAN, was held in Greensboro May 11, 2007. Dr. Chulay has worked with a number of hospitals across the country in developing unit-based research teams. Amy Whisnant, RN, BSN, CNOR said of unit-based research “it will be helpful for bedside nursing.” Actually applying the theory and concepts in “hand-on activities” during the conference was key for Kimberly Yates, RN, BSN, BC. “It was easy to see how Chulay’s concepts work in everyday nursing situations” said Yates. Susan Knowles, RN, BSN, Melissa Deal, RN, MSN, BC, Rebecca Tart, PhD, and Ann Moore, RN, MSN, CEN also attended the conference.

2007 Nurses Week - CVMC nurses enjoyed a weeklong celebration in recognition of the gifts they share throughout the year. “Karaoke Night” provided nurses with a good time of singing and laughing. The “Wheel of Nursing” game allowed nurses to test their knowledge of Magnet or Shared Governance at CVMC. The ‘ticket’ to walk in the cash/prize walk (like a cakewalk) was a question or an article related to nursing practice. Participants were serious about being the last one standing in the cash/prize walk to receive money or prizes. The Spiritual Care Department traveled throughout the hospital offering “Blessing of the Hands” on Wednesday, and chair massages were offered to nursing staff by massage therapists. The grand finale was the annual nursing banquet on Thursday. Barbara Bartlein, RN, CSP gave a funny and motivational presentation entitled “ The Magic of Making a Difference.”

During this year’s celebration, nurses were asked to submit stories or experiences related to their nursing career. The top 3 story winners were recognized at the banquet. Karen J. McMeechan-Lodge, RNC, MSN, IBCLE, RLC, the Center for Women and Children won 1st place – a gift certificate for a nights stay with dinner at a Bed/Breakfast establishment in Black Mountain. The 2nd place winner was Beth Rudisill, RN, BC, MSN, Psychiatry Services – gift certificate for a day at Rock Barn Spa. Melissa Deal, RN, BC, MSN, Critical Care Center, placed 3rd in the competition winning a gift certificate for dinner and a movie. All submitted stories will be published in a book entitled, The Gift of Nursing at CVMC, which nursing staff will receive in late June.

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