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Introduction: Peripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter. WE PRESENT 2 CLINICAL CASES: The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of flictenes (blisters). Prolonged treatment and consultation with plastic surgery were required. The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plastic surgeon., Planning Care: We elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment., Discussion: Phlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN. Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2., Conclusion: The nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reduce the incidence of phlebitis, avoid discomfort for the patient and reduce health care cost., (Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Introduction: Participatory action research (PAR) was conducted in an intensive care unit (UCI), with the general purpose of fostering change in clinical practice so as to improve the care offered to families of critically ill patients. As a result of this process, four change-related initiatives were introduced. One specific additional objective was to explore how the unit's background context limited or facilitated change. This paper presents findings based on this objective., Materials and Methods: Qualitative methodology., Design: Participatory-action research (PAR). DATA GATHERING TECHNIQUES: 11 discussion groups incorporating professionals, 5 in-depth interviews with professionals, field diaries kept by the participants, and field diary kept by the lead researcher. Eleven professionals took part in the discussion groups (each one conveyed information made known to them by 3-5 colleagues), 5 professionals were involved in the interviews, and 11 professionals filled in a field diary. A content analysis was performed., Results: Factors limiting change included: 1) Not acknowledging the legitimacy of scientific evidence regarding the families of critically ill patients; 2) Imbalanced power relationships among the members of multi-disciplinary teams; 3) Nurses' lack of involvement in information flow; 4) The organization of time and physical space in the unit. Factors facilitating change: 1) A sense of individual and shared commitment; 2) Leadership in day-to-day matters; 3) A process based on reflection., Conclusions: A process of participatory action research can lead to change in clinical practice, although this is complex and requires substantial input in terms of personal energy. Contextual factors limiting this change are related to the actual structure of the unit, while factors facilitating it are circumstantial ones and are dependent upon individual people. In this sense, professionals working at the bedside are capable of introducing changes to the context in which they work., (Copyright © 2011 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Introduction: Acid-base disorders are associated with many diseases of the critically ill patient. Early treatment with sodium bicarbonate of these metabolic disorders is required for their normalization. This is an alkaline electrolyte solution administered by continuous or intermittent infusion. Its incompatibility due to its alkaline pH has been described, as it produces insoluble carbonate precipitation and causes carbon dioxide gas when mixed with acidic solutions., Material and Method: An in vitro experimental study was performed. Bicarbonate was mixed with 13 drugs simulating Y-site administration. We combined 5 ml bicarbonate with 5 ml of every drug, at highest daily concentration used. The samples were visually examined to detect color changes, cloudiness, precipitation or gas formation, pH measurement and spectrophotometric analysis at 450 nm and 620 nm. The samples were evaluated at 0, 15, 30, 60 and 120 minutes. The compatibility criteria were absence of visual changes, pH changes<0.5 and variability of absorbance <0.01., Results: We studied each drug individually and mixed with bicarbonate with 27 samples, and 135 measurements were performed. The incompatibilities did not always produce visual changes. Knowing the pH of drugs does not guarantee the compatibility of the mixture. Nitroglycerin with pH 4 is compatible with bicarbonate. Thiopental with pH 11 makes precipitation. Higher absorbances showed color changes, cloudiness and precipitation., Conclusions: Bicarbonate is physically compatible with esmolol, furosemide, heparin, insulin, morphine, nimodipine, nitroglycerin and urapidil and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and thiopental., (Copyright © 2010 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Objective: To determine the physical compatibility of amiodarone administered in Y-site with other continuous infusion drugs, in order to ensure stability and safe delivery to the patient., Method: Experimental in vitro study. We determined the physical compatibility of amiodarone with drugs commonly used in the intensive care unit as a continuous infusion, simulating the same conditions as in daily practice: container, solvent, temperature and fluorescent light. All samples were evaluated by visual observation procedures, looking for colour changes, turbidity, precipitation or gas formation, pH measurement and spectrophotometer absorption at wavelengths: 450 nm and 620 nm to detect colour changes, cloudiness and precipitation, respectively. Compatible mixtures were considered as those that showed no physical changes, variability in pH < 0.50 and the spectral range < 0.010., Results: We analysed 39 samples: 14 single, 13 doubles, 6 triples and 6 quadruples, which were examined at different time intervals: 0, 15, 30, 60 and 120 min. Non-compatible mixtures showed immediate visual changes and higher absorbance values of 0.010 nm. There were no significant changes in pH during the study., Conclusions: Amiodarone is physically compatible with cisatracurium haloperidol, insulin, midazolam, morphine, nimodipine, nitroglycerin and urapidil and incompatible with bicarbonate, furosemide, heparin and thiopental., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction: Patients in the intensive care units simultaneously receive concomitantly many drugs, with limited venous accesses. Thus, several different perfusions must be administered jointly through the same catheter. Furosemide is a solution with no buffer capacity that is easily precipitated. In spite of the recommendation on its data sheet stating that it should not be used with other drugs, studies found in the bibliography suggest that it has physicochemical compatibility with other drugs. However, the concentrations studied do not always coincide with those used in the clinical practice., Objectives: To study and verify the physical compatibility of furosemide in intravenous mixture., Material and Method: An experimental study in vitro, in which furosemide was mixed with 12 drugs at a 1:1 proportion was performed. A total of 40 samples were obtained and the following variables were evaluated at different intervals, 0, 15, 30, 60 and 120 min: ph of mixture, color changes, presence of turbidity and precipitation. To do so, visual observation procedures, ph measurements and spectrophotometer absorption at 450 and 620 nm were used., Results: Forty samples, 13 simples, 12 doubles and 15 triples, were obtained. Those mixtures that did not show physical changes, pH variation and absorption variation were considered compatible., Conclusion: Furosemide is physically compatible with bicarbonate solution, heparin, insulin, morphine and nitroglycerin and incompatible with amiodarone, cisatracurium, haloperidol, midazolam and urapidil., (Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Introduction: Within the context of participatory action research (PAR) at an Intensive Care Unit (ICU), 4 proposals for change were agreed by consensus to improve the attention given to families of critical patients. One proposal was the creation of a guideline for attending to family members, inspired by the participants' desire to improve the attention given to this group of users., Objectives: 1) To design a guide that would meet the needs of professionals and users. 2) To reach an agreement on the minimum requirements for attention given to families of critical patients., Materials and Methods: Qualitative methodology, based on PAR. For each of the initiatives, a working group was created, composed mainly of professionals from the ICU coordinated by a researcher. In the case of the guide, an online community was also created as a working tool to speed up communications among the participants, reducing the number of face-to-face sessions. Participation was voluntary. To draft the guideline, a Clinical Practice Guideline for support the family was made available, which had been translated into Spanish, together with an up-to-date bibliography., Results: Twenty four professionals were involved. We developed a guide that contained the following sections: introduction, objectives, the experiences and needs of families of patients in the ICU, strategies for action, specific procedures, and hospital resources. We designed strategies for the diffusion and implementation of the guide., Conclusions: The guide is a useful tool that offers the professionals greater assurances and unifying criteria for action. During subsequent stages of the PAR project, an assessment will be made of the impact on professionals and users., (Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.)

Introduction: The Intensive Care Unit (ICU) is an impersonal and technologically invasive setting. The rules and framework of the unit favor a lack of privacy, an inherent fact for every kind of hospitalization. The objectives of the study are to know the experience of patients admitted to the ICU in relation to the perception of privacy and its impact on their own experience., Material and Methods: Phenomenological qualitative methodology. The participants were patients admitted to the ICU of Son Dureta University Hospital in Palma de Mallorca, who were older than 18 with a minimum stay of 48 hours and who had signed an informed consent. Data collection. By exhaustive semi-structured interviews. Content analysis., Results: The perception of privacy in patients admitted to the ICU is described in relationship with surrounding physical space, family setting and privacy autonomy. The patients evaluated the flexibility of rules, professionalism of the nursing staff and the need for family support when the situation is more stable., Conclusion: To prevent the quality of nursing cares from only depending on their technological knowledge and ability, but also depends on the humane side of caring, it is extremely important to consider the different elements that mould the experience of being admitted to the ICU and respect of the privacy of each person.

The type of information recorded by nurses at admission of critical patients to the Intensive Care Unit was described and the relation between the information recorded and the presence of absence of endotracheal intubation in the patient admitted was analyzed. A sample of 214 admission records of patients admitted to our unit in 1998 was studied using a data sheet based on Virginia Henderson assessment questionnaires. The presence or absence of 71 variables classified into four sections was analyzed: personal data, general data, Virginia Henderson basic needs, and other assessment data. Most data collected at admission were objective data obtained by observation and/or physical examination of the patient. These data were contained in two sections: "Virginia Henderson basic needs" (normal breathing, food and water intake, excretion, mobility, maintaining posture, conserving body temperature, skin hygiene and integrity, and avoiding danger) and "other assessment data" (medical treatment, diagnostic and therapeutic tests, and hemodynamic monitoring). Information about the patient's background in the section "general data" was obtained less frequently. Subjective data obtained from interviews was clearly limited. These data are included in the "Virginia Henderson basic needs" (sleep, rest, dressing and undressing, communicating, values and beliefs, feeling of satisfaction, absence of boredom, and intellectual stimulation).