• 대한간호학회지
• /
• 제23권2호
• /
• pp.245-254
• /
• 1993

The purpose of this study was to identify effective methods to minimize increases in intracranial pressure(IICP ) during endotracheal suction by means of comparing two methods of hyperventilation and oxygen supply before and after endotracheal suction. In order to evaluate the effects of these two methods, the ICP during suctioning and the sustained time of IICP were measured. For hyperventilation, ambu-bagging was done 10 times for 30 seconds with a tidal volume of 800-900m1. For oxygen supply, 100 percent oxygen was supplied for 2 minutes before and after suction. The subjects for this study were 12 neurosurgical patients who had had a subarachnoid bolt inserted for ICP monitoring and they were all on mechanical ventilatory support in a surgical intensive care unit of Seoul National University Hospital from July 1, 1991 to March 31, 1992. In each patient hyperventilation was performed five times and oxygen supply was given five times and intracranial pressures were measured immediately before and every 30 seconds for 15 minutes after suction. For case assignments counterbalancing and repeated measure designs were combined. And so the total number of experiments were sixty for each group. The effects of hyperventilation and oxygen supply on the IICP and the sustained time of IICP after suction were analyzed by t-test. The results of study were as follows 1. There was a significant difference between the two groups in the increased ICP during suction (t=2.49, p=.014). 2. The sustained time of IICP after suctioning in the oxygen supply group was shorter than that in the hyperventilation group(t=2.35, p=.020) In summary, the Increase in the ICP during suction was lower and the time for the ICP to return to the presuction level was shorter in the oxygen supply group as compared to the hyperventilation group. Therefore, oxygen supply can be re commended before and after endotracheal suction.

• 기본간호학회지
• /
• 제4권2호
• /
• pp.229-243
• /
• 1997

Especially in NICU(Neonatal Intensive Care Unit), handwashing is an important factor in decresing nosocomial infections due to reduced immunity, prematurity and various invasive procedures. The purpose of this study was to investigate the basic characteristics related to handwashing by NICU nurses. It was composed of three parts ; questionnaire survey I (genoral characteristics of handwashing), questionnaire survey II(the awareness degree of handwashing importance) and actual performance. This study was performed from Oct. 8 to 14 in 1994. The results of this study were as follows ; 1. Frequency of handwashing were different by shift of working about 47.1% of the respondents. They were washing most frequently during day-shift about 75% of above. According to self evaluation to handwashing frequency, 64.7% of the respondents said their frequency of handwashing was inadequate, because of being too busy.(45.1%), bothering caused by detergent or disinfectant(17.6%), and too far from handwashing facilities(17.6%). 2. The most common handwashing agent was soap(88.2%), 52.9% of the subjects experienced adverse effects after handwashing ; rough hand(44.5%), dryness(33.3%) All subjects washed their hands with running water, and 70.6% of the subjects washed upto wrist. In duration of handwashing, 52.9% of subjects washed hands 5 to 10 seconds, 29.5% of them did 11 to 15 seconds. 3. 29.4% among subjects had participated to take in the handwashing educational program. About 60% responded they would like to take the course of handwashing if possible. 4. The important nursing activities that need handwashing were chaning of caring ostomy, suctioning, chaning IV dressing site. On the other hand, they responded handwashing was not essential before dealing with omitus, before and after transfering machine, before chaning diaper(stool) 5. Handwashing performance was 61.7%. Among seven nursing activities, suctioning(73.4%) was the highest, the next was dealing with discharge or sampling(71.1%), the lowest was bathing(34.6%). The performance was better after(70.2%) nursing activities that before(52.5%), and day(63.6%) or evening(68.3%) shift than night(56.7%)

• 중환자간호학회지
• /
• 제6권1호
• /
• pp.1-10
• /
• 2013

Purpose: The purpose of this study was to examine the reliability and validity of a Korean version of the Critical Care Pain Observation Tool (CPOT) developed for assessment of pain in critically ill nonverbal patients. Methods: Data were collected from a convenience sample of 30 critically ill patients admitted to a medical ICU in a hospital. The CPOT was tested at before, during and 20 minutes after changing a position and suction. Upon establishment of content and translation equivalence between the English and Korean version of CPOT. Results: The interrater reliability was found to be acceptable with the kappa coefficients of .76-1. The construct validity of the pain scores were increased from 0.43 to 2.5 in changing a position (t=-8.60, p<.001)and 0.1 to 3.23 (t=-9.36, p<.001) in suctioning. The pain scores were decreased from 6.06 to 4.01 in changing a position (t=-10.19, p<.001) and 6.45 to 4.13 (t=-10.39, p<.001) in suctioning. The concurrent validity the correlations between pain scores and physiological indicators, and a increased in Heart rate before and after changing a position (r=.65, p<.001). Conclusion: The CPOT can be used as a reliable and valid measure to assess pain in critically ill nonverbal a medical ICU patients.

• 임상간호연구
• /
• 제19권2호
• /
• pp.245-254
• /
• 2013

Purpose: This study was done to examine predictive validity of Critical Care Non-verbal Pain Scale (CNPS) and develop criteria for pain assessment using CNPS with critically ill patients who have communication problems. Methods: Data were collected from intensive care units at three major general hospitals in Seoul and Kyunggi province. During each observation, a nurse assessed pain severity using CNPS ratings (range 0-9) at four treatment stages: at rest, during central catheter dressing change (nonpainful procedure), position change and suctioning (routine painful procedures). Patients also assessed their pain using a self-report 4-point VRS-4. Results: There were significant differences between the four treatment stages except between "at rest" and "nonpainful procedure". Strong correlations were found between CNPS and VRS-4 for "at rest" (r=.552, p<.001), central catheter dressing change (r=.505, p<.001), position change (r=.709, p<.001), and suctioning (r=.662, p<.001). ROC curve analysis of CNPS based on 3 point on VRS-4 showed the cutoff point was 3 for CNPS, the starting point for pain management with 73% sensitivity, 92.2% specificity, 73% positive predictive value, and 92.8% negative predictive value. Conclusion: Results indicate that CNPS is a valid tool for measuring pain in critically ill patients with communication problems and 3 point should be the standardized pain treatment point.

• Journal of the Korean Data and Information Science Society
• /
• 제25권6호
• /
• pp.1353-1360
• /
• 2014

본 연구는 웹 기반 간호교육 컨텐츠가 간호학과 학생의 간호수기술에 대한 자기효능감, 지식, 수행능력에 미치는 효과를 검증하기 위한 목적으로 수행되었다. 본 연구에서는 모스비 너싱 스킬 간호수기술 프로그램을 적용하여 기관절개관 흡인술에 대한 효과를 검정하였다. 연구설계는 비동등성 대조군 전후 시차설계를 이용한 유사실험 연구설계로 이루어졌다. 연구결과 임상실습 중 웹 기반 간호교육 콘텐츠를 활용한 실험군은 대조군에 비해 지식과 수행능력이 유의하게 높았으나 자기효능감에는 차이가 없었다. 웹 기반 간호교육 콘텐츠는 기존 임상실습 교육의 간호술기 교육을 강화하는데 유용한 교육매체로 확인되었으며, 향후 임상실습 교육에 효과적인 학습 지원도구로 활용될 수 있을 것으로 보인다.

• 임상간호연구
• /
• 제18권1호
• /
• pp.136-148
• /
• 2012

Purpose: The purpose of this study was to develop a reliable and valid pain assessment tool suitable for critically ill patients with communication problem in Korean intensive care unit. Methods: This pain assessment tool, Critical Care Non-verbal Pain Scale (CNPS), was developed based on review of national and international researches. Data were collected from ten intensive care units at five major general hospitals in Seoul. Reliability and validity were tested during performance of position change and endotracheal suctioning. Pain was measured before, during, and 20 minutes after the two procedures. Results: Interrater reliability of the CNPS was analyzed by ICC (Intraclass correlation coefficients). ICC values were significant from .833 to .883. Significant correlation between the FPS (Face Pain Scale) scores and the CNPS scores verified concurrent validity of the CNPS. For position change, CNPS scores increased significantly between before and during (t=-23.399, p<.001) and decreased significantly between during and 20 minutes after (t=22.760, p<.001). For endotracheal suctioning, CNPS scores increased significantly between before and during (t=-29.064, p<.001) and significantly decreased between during and 20 minutes after (t=28.194, p<.001), verifying construct validity of the CNPS. Conclusion: Results indicate that the CNPS can be used to assess pain of critically ill patients who have communication problem.

• Archives of Reconstructive Microsurgery
• /
• 제23권1호
• /
• pp.33-35
• /
• 2014

Mondor's disease is an uncommon condition characterized by a palpable, cord-shaped structure, which causes pain when pressed. Its known pathophysiology is thrombophlebitis of the superficial venous system. Although reported repeatedly, its definite cause is unknown and various possible causes have been identified, including surgery, irradiation, infection, malignancy, and trauma. We diagnosed this case to be Mondor's disease of the antecubital venous system, probably due to thermal injury of the proximal tributaries of the basilic or cephalic vein. Risk of thermal injury to the skin flap or the portal site remains a common complication, and as thermal injury to the blood vessel might also be considered, attention must be given when suctioning the area near a large superficial vessel.

• Journal of Chest Surgery
• /
• 제37권10호
• /
• pp.884-887
• /
• 2004

폐 절제술 후 남아 있는 폐엽의 무기폐는 술 후 흔히 볼 수 있는 합병증이다. 이는 효율적인 객담 제거가 되지 않으면 재원일수의 연장 및 전신 상태가 좋지 않은 환자들에겐 치명적일 수도 있다. 따라서 저자들은 고식적인 방법으로 객담 배출이 원활히 되지 앓는 환자에게 선택적 기관지내 흡입도관 유치술을 시행하였다. 기관지 내시경하에 시행하였으며 4번째 기관지륜 상방에 국소 마취를 하여 중심 정맥 도관을 기관지 내로 삽입하였으며 무기폐가 생긴 엽에 도관 끝을 유치하여 반복적 강제 객담배출을 시행하였다. 아주 효과적인 결과를 경험하였기에 보고하는 바이다.

• Clinical Endoscopy
• /
• 제51권6호
• /
• pp.591-595
• /
• 2018

Intussusception after colonoscopy is an unusual complication. A MEDLINE search revealed only 7 reported cases. We present a report of a 28-year-old man who developed abdominal pain several hours after routine colonoscopy and in whom computed tomography (CT) revealed colocolic intussusception. We postulate that this condition is iatrogenic and induced by suctioning of gas on withdrawal of the colonoscope. A common observation among the reported cases was abdominal pain several hours after colonoscopy and right-sided intussusception. All cases had colonoscopy reaching the right side of the colon. Treatment for adult intussusception remains controversial with regard to reduction versus resection, especially given the high association with a pathological cause and malignancy. Among the 8 reported cases, only the current case did not require surgery. A combination of benign colonoscopy, CT, and the clinical picture should provide sufficient information to initially choose a more conservative treatment approach.

• Neurospine
• /
• 제15권4호
• /
• pp.394-399
• /
• 2018

Subarachnoid pleural fistula (SPF) is an aberrant communication between the pleural cavity and subarachnoid space, resulting in uncontrolled cerebrospinal fluid drainage. The negative pressure of the pleural cavity creates a continuous suctioning effect, thereby impeding the spontaneous closure of these fistulas. Dural tears or punctures in cardiothoracic procedures, spinal operations, and trauma are known to cause such abnormal communications. Failure to recognize this entity may result in sudden neurological or respiratory complications. Hence, a high index of suspicion is required for early diagnosis and prompt management. Noninvasive positive pressure ventilation has been described to be effective in managing such fistulas, thus mitigating the high morbidity associated with exploratory surgery for primary repair. Herein, we describe the typical presentation of SPF and the clinical course, treatment, and follow-up of a patient who sustained SPF following anterior thoracic spinal surgery.