Of all the nursing interventions designed to improve patient comfort after angiography, slightly raising the HOB was not a factor in reducing pain/discomfort.

Background Measurement of mixed venous oxygen saturation helps determine whether cardiac output and oxygen delivery are sufficient for metabolic needs. As recommended by the American Association of Critical-Care Nurses guideline, blood samples for determining mixed venous oxygen saturation are obtained by slowly, in 1 to 2 minutes, withdrawing 1.5 mL of blood from the distal port of the pulmonary artery catheter. In theory, the negative force of rapid withdrawal could pull oxygenated blood from the pulmonary capillary bed, causing falsely elevated saturation values. Objective To determine if the speed of withdrawal affects oxygen content in blood samples used to measure mixed venous oxygen saturation. Methods The sample consisted of heart failure patients with pulmonary artery catheters admitted to a cardiac intensive care unit. A prospective, randomized, 2 × 2 crossover design was used to compare mixed venous oxygen saturation in blood samples obtained quickly or slowly. A total of 50 sets of saturation values were analyzed. Each set included 1 blood sample obtained slowly, in 1 to 2 minutes, and 1 obtained rapidly, in 5 seconds. Results The mean difference in saturation values between the fast and the slow groups was -0.3 (CI, -1.5 to 0.8; P = .55), indicating that no meaningful systematic bias is attributable to fast withdrawal of blood. Conclusions Rapid blood sampling does not falsely elevate measurements of mixed venous oxygen saturation.

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Background: Cardiac arrest (CA) claims an estimated 300,000 lives in America each year even with cardio-pulmonary resuscitation (CPR) efforts. Additionally, of the patients who survive CPR and are discharged, many have suffered anoxic brain injury. Clinically, mild therapeutic hypothermia (TH) immediately post CA increases the odds of survival as well as improves neurological recovery and outcomes 6 months post-CA. Studies report that a small percent of CA patients recall their experience, but little is known regarding patient recall of hypothermia treatment post CA. This qualitative study seeks to understand the experience of survivors of CA and TH. Methods: A qualitative phenomenology study was conducted at a single center with survivors 12-24 months following CA and TH. Face-to-face or telephone interviews were audio recorded with each subjects’ permission and then transcribed verbatim. Transcripts were read in their entirety and searched for meaning-units that coalesced into themes. Consensus was achieved by all 3 nurse researchers and member-checked by being posed to a panel of survivors (1 was a subject of this study) which demonstrated thematic saturation yielding credible and trustworthy findings. Results: Six 6 survivors (67% [4 of 6] male, age 19-72 years) were interviewed. Four overall themes emerged: Memory gap - CA- “I can tell you what people told me, because I don’t remember it” and TH -“I don’t remember being cold or uncomfortable or anything like that” ; Filling in the gaps - “Several doctors, from what I understand, told my sister that I would have at least 70% brain loss if I was to wake up” “Everything was told to me”; and Misconceptions - “Even though I have a pacemaker/defibrillator it only operates one side; it doesn’t operate the whole heart. At least that’s what they told me anyway” “Of course, they told me if (my heart rate) got to 300, my heart would explode” ; and Divine coincidence - “My son had just taken a CPR course” “There was a nurse in the restaurant I was at” . Additionally, several patients provided unsolicited compliments of the staff - “I got absolutely outstanding care there ¼ I believe because they got me into hypothermia protocol so quickly, that was probably one of the contributing factors to my success” . Though one patient stated “I wish they’d left me alone” as he had unknowingly been resuscitated against his wishes. Conclusions: Survivors of CA and TH report memory gaps, and then strive to fill in the gaps by family and staff descriptions. Additionally, survivors easily identified an unexplained coincidence that they felt allowed them to successfully recover from their CA. Further study is warranted regarding whether the creation of a specific treatment plan to assist in the accurate recall and story would enhance survivors and family in recovery.