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This study was designed to determine if the forced warm air system is more effective than warmed cotton blankets or radiant heat lamps for rewarming postoperative patients. PACU admission temperatures were taken on 370 adult patients. The study population of 90 patients with admission temperatures of 35 degrees C (95 degrees F) or less was randomly assigned to one of three intervention groups: (b) warmed cotton blankets, (L) radiant heat lamps, or (A) forced warm air. Oral or axillary temperatures were monitored every 15 minutes and the warming intervention continued until the patient reached the discharge criteria of 36 degrees C (96.8 degrees F). The three groups were comparable for sex, age, admitting temperature, OR time, and OR fluid. The mean rewarming times for patients who shivered were similar for all groups. For those patients who did not shiver, those treated with forced warm air rewarmed significantly faster than patients in the other groups. Nonshivering patients treated with forced warm air were ready for discharge somewhat sooner than those treated with either of the other two interventions.

1. Needlestick injuries are the most common type of occupational injury experienced by nursing personnel. Sixty percent to 90% of needlestick injuries in medical centers are incurred by nurses. 2. Future increases in patient acuity and more advanced technology are likely to increase the risk of nurses experiencing accidental needlesticks. 3. Needle devices that require disassembly of equipment, especially those related to intravenous piggybacks and prefilled cartridge syringes, are placing nurses at an increased risk for injury. 4. Needle-less devices or devices which keep the needle recessed except during intended use have been designed. The assessment instrument can identify needlestick injury incidence and trends and can be used to evaluate and justify the increased costs of purchasing new safety equipment.

The present research was designed to describe the character, severity, and factors associated with postoperative pain following total hip replacement (THR) and total knee replacement (TKR) surgery, and to identify amounts of opioid required to relieve that pain. It was the investigators' intention to investigate the impact of age on severity of pain and amount of opioid required after surgery. Complete data were obtained on 29 white subjects, 16 of whom were men. Subjects' ages ranged from 27 to 88 years (mean, 66). The mean age for the men was 61 years and the mean age for the women was 72 years. Twelve subjects underwent THR and 17 underwent TKR. Eight patients received general anesthesia and 21 received spinal anesthesia. Pain was described using the McGill Pain Questionnaire-Short Form and quantified using a visual analogue scale. Amount of opioid required to relieve pain over 24 hours was recorded using a patient-controlled analgesia pump. Data analysis indicated that most patients do not report their pain as being controlled when discharged from the PACU, and that patients who receive spinal anesthesia require more postoperative opioid to control pain than patients who receive general anesthesia. In general, patients who undergo TKR experience more pain than patients who undergo THR. Pain was described as moderate to severe aching. As age increases, patients self-administer less postoperative opioid, but they do not report less postoperative pain.

Amphotericin-B is the only parenteral agent currently available to treat systemic fungal infections. Pyrogenesis, accompanied by severe shivering, is a distressing side effect. Possible risk factors of developing this reaction have not been reported. A case series was developed to document the occurrence and duration of shivering in patients who received amphotericin-B and to investigate whether these responses were associated with a diagnosis of diabetes mellitus, receipt of insulin or beta blockers, the amount of body fat content, an immunocompromised state, age, and gender. Medical records were reviewed and abstracted for patients who received 20 milligrams or more of amphotericin-B per day for at least 10 consecutive days between January 1, 1984, and September 1, 1988. Results indicated that a diagnosis of diabetes, insulin therapy, and advancing age were inversely associated with the amphotericin-B-induced rigors response. Shivering was noted to occur first at the test dose, with the percentage of patients who shivered increasing with each successive dose (this peaked at the fifth therapeutic dosage). Of the factors under study, only advancing age appeared to be related to the duration of shivering. It is possible that identification of the descriptive characteristics of amphotericin-B-induced rigors will facilitate the nursing care of patients who receive this treatment; it also may be an important first step in the identification of risk factors for this clinical complication.

The goal of this study was to assess the accuracy of the axillary site as an indicator of core body temperature. Data from 30 core body temperatures, 30 electronic axillary temperatures, and 30 mercury-in-glass axillary temperatures in nonpostoperative intensive care unit patients are reported. Core and axillary temperatures were simultaneously measured in each patient. The correlation between core and axillary-mercury was r = 0.90. The mean difference between core and axillary-mercury was 0.35 degrees F (0.19 degrees C). The correlation between core and axillary-electronic was r = .87. The mean difference between core and axillary-electronic was 0.6 degrees F (0.33 degrees C). Only three, or 5%, of the 60 core-axillary pairs met the expected 2 degrees F (1.2 degrees C) difference. These findings support the accuracy of axillary temperature measurement as a reflection of core body temperature measurement in nonpostoperative patients. These researchers suggest that mercury thermometers be used in cases where small differences in temperature are clinically meaningful.

Though therapeutic advances have been made in the treatment of ovarian carcinoma, success at achieving a cure in women with advanced disease has been elusive. Since advanced ovarian carcinoma is frequently confined to the peritoneum, the use of intraperitoneal (IP) chemotherapy is being studied. Dose-limiting toxicity and extended nausea and vomiting associated with intraperitoneal chemotherapy are problems with several of the drugs under study. The most beneficial drug for intraperitoneal use would be one that offers the maximum pharmacologic value without toxicity. An investigation at the Dartmouth-Hitchcock Medical Center in New Hampshire is exploring the use of alpha interferon in treating advanced ovarian carcinoma. This case report describes an individual's course of treatment and the challenges in managing the administration of the IP immunotherapy, anticipating problems, and identifying interventions necessary to achieving optimal patient comfort during this Phase I-II investigation.

The authors determined the accuracy of the Ohmeda 3700 (version J) pulse oximeter in healthy volunteers rendered hypoxic (SaO2 from 60-98%) by breathing mixtures of O2 in N2. When equipped with an ear probe, the pulse oximeter reading (y) reliably predicted arterial saturation (x) under steady-state conditions (y = 1.05x - 4.66, r = 0.98) as well as when oxygen saturation was rapidly decreasing (y = 1.05x - 6.38, r = 0.96). Conversely, when equipped with a finger probe, the oximeter tended to significantly underestimate steady-state arterial saturation (y = 1.21x - 19.1, r = 0.98, P less than 0.001). In response to this information, the manufacturer modified the oximeter's software (version XJ1), resulting in improved agreement between oximeter readings and arterial values (y = 0.96x + 4.59, r = 0.99). Despite the close correlation between steady-state oximeter readings and arterial saturation, the 99% prediction limits for both the ear and finger probes (version XJ1) were +/- 8%. Finger probe readings did not reliably reflect radial arterial oxygenation during rapid desaturation (y = 0.55x + 45.2, r = 0.78). This may be related to the time required to "arterialize" the blood in the finger; during acute resaturation, we found that the ear- to finger-probe delay was 24.0 +/- 2.3 s (means +/- SE, P less than 0.001).