The Impact of Routine Nursing Care on Cerebral and Renal Hemodynamic Activity Utilizing Near-Infrared Spectroscopy in the Premature Neonate

2.50
Hdl Handle:
http://hdl.handle.net/10755/183034
Category:
Abstract
Type:
Presentation
Title:
The Impact of Routine Nursing Care on Cerebral and Renal Hemodynamic Activity Utilizing Near-Infrared Spectroscopy in the Premature Neonate
Author(s):
Stikes, Reetta; Hayes, P.; Ipsan, C.; Adams, G.; Goldman, M.; Mainous, R.
Author Details:
Reeta Stikes, RN, MSN, University of Louisville, Louisville, KY, email: Junest@ulh.org; P. Hayes; C. Ipsan; G. Adams; M. Goldman; R. Mainous
Abstract:
Problem: Routine nursing care can affect the physiologic stability of the very low birth weight preterm neonate. There are few studies that address the frequency at which nursing assessments and/or endotracheal suctioning should be performed. In addition, the impact of these interventions as it relates to oxygenation at the tissue level in the kidney and the brain is not well known. New technology is now available for use in the preterm population that uses infrared light to assess the uptake of oxygen at the tissue level and may provide clinical utility to determine the impact of routine nursing care. Purpose: To assess the impact of routine nursing assessments and endotracheal suctioning on cerebral and renal regional tissue saturation levels (rSO2) in preterm neonates.
Method: Utilizing near-infrared spectroscopy (NIRS), an observational descriptive study of renal and cerebral rSO2 values was undertaken in preterm neonates 24 to 32 weeks gestation. Sensors were placed on the forehead and flank. Recordings were obtained during the first 24 hours after placement of an umbilical artery catheter (UAC). Event markers noted each nursing assessment and suctioning episode. Findings: Data from eleven neonates, 24-27 weeks gestation, with event markers for nursing assessment and suctioning were analyzed. Four neonates with birth weights ranging from 730 grams to 970 grams showed a dramatic drop in tissue oxygenation levels in renal and cerebral organ systems during assessments and three during suctioning. Three of the four neonates showed an inversion of renal and cerebral rSO2 values indicating shunting of blood from the periphery to more vital organs such as the brain. On average, the drop in baseline for cerebral oxygenation was 35% and renal oxygenation was 51% with a 14 minute recovery time. The manufacturer proposes that a greater than 20% decrease from baseline is significant, although it is unclear if baseline values in each of the four neonates were initially within a normal range, or were already demonstrating decreased perfusion which makes the findings particularly significant. Discussion: In this neonatal intensive care unit, routine nursing assessments including physical exam, skin care, diapering, and suctioning are required every four hours. Data revealed that routine assessments and suctioning may have a clinically significant negative impact on cerebral and renal tissue perfusion. More advanced non-invasive monitoring, such as NIRS technology, could be used to guide routine clinical practices. Findings from this study support the need to decrease the frequency of nursing assessments and suctioning that may be routine only. Additional investigation is warranted to determine the critical level for change in rS02 from baseline and the impact of circulatory changes in premature neonates. Further research is needed to facilitate development of protocols that minimize the iatrogenics of neonatal intensive care using NIRS technology.
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2010
Conference Name:
7th Annual Florida Magnet Research Conference
Conference Host:
University of South Florida College of Nursing; Sigma Theta Tau International; Florida Organization of Nurse Executives
Conference Location:
Naples, Florida, USA
Description:
7th Annual Florida Magnet Research Conference - Theme: Research at the Point of Care. Held 11-13 February 2010 at the Naples Grande Beach Resort, Naples, Florida, USA.
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleThe Impact of Routine Nursing Care on Cerebral and Renal Hemodynamic Activity Utilizing Near-Infrared Spectroscopy in the Premature Neonateen_GB
dc.contributor.authorStikes, Reettaen_US
dc.contributor.authorHayes, P.en_US
dc.contributor.authorIpsan, C.en_US
dc.contributor.authorAdams, G.en_US
dc.contributor.authorGoldman, M.en_US
dc.contributor.authorMainous, R.en_US
dc.author.detailsReeta Stikes, RN, MSN, University of Louisville, Louisville, KY, email: Junest@ulh.org; P. Hayes; C. Ipsan; G. Adams; M. Goldman; R. Mainousen_US
dc.identifier.urihttp://hdl.handle.net/10755/183034-
dc.description.abstractProblem: Routine nursing care can affect the physiologic stability of the very low birth weight preterm neonate. There are few studies that address the frequency at which nursing assessments and/or endotracheal suctioning should be performed. In addition, the impact of these interventions as it relates to oxygenation at the tissue level in the kidney and the brain is not well known. New technology is now available for use in the preterm population that uses infrared light to assess the uptake of oxygen at the tissue level and may provide clinical utility to determine the impact of routine nursing care. Purpose: To assess the impact of routine nursing assessments and endotracheal suctioning on cerebral and renal regional tissue saturation levels (rSO2) in preterm neonates. <br/>Method: Utilizing near-infrared spectroscopy (NIRS), an observational descriptive study of renal and cerebral rSO2 values was undertaken in preterm neonates 24 to 32 weeks gestation. Sensors were placed on the forehead and flank. Recordings were obtained during the first 24 hours after placement of an umbilical artery catheter (UAC). Event markers noted each nursing assessment and suctioning episode. Findings: Data from eleven neonates, 24-27 weeks gestation, with event markers for nursing assessment and suctioning were analyzed. Four neonates with birth weights ranging from 730 grams to 970 grams showed a dramatic drop in tissue oxygenation levels in renal and cerebral organ systems during assessments and three during suctioning. Three of the four neonates showed an inversion of renal and cerebral rSO2 values indicating shunting of blood from the periphery to more vital organs such as the brain. On average, the drop in baseline for cerebral oxygenation was 35% and renal oxygenation was 51% with a 14 minute recovery time. The manufacturer proposes that a greater than 20% decrease from baseline is significant, although it is unclear if baseline values in each of the four neonates were initially within a normal range, or were already demonstrating decreased perfusion which makes the findings particularly significant. Discussion: In this neonatal intensive care unit, routine nursing assessments including physical exam, skin care, diapering, and suctioning are required every four hours. Data revealed that routine assessments and suctioning may have a clinically significant negative impact on cerebral and renal tissue perfusion. More advanced non-invasive monitoring, such as NIRS technology, could be used to guide routine clinical practices. Findings from this study support the need to decrease the frequency of nursing assessments and suctioning that may be routine only. Additional investigation is warranted to determine the critical level for change in rS02 from baseline and the impact of circulatory changes in premature neonates. Further research is needed to facilitate development of protocols that minimize the iatrogenics of neonatal intensive care using NIRS technology.en_GB
dc.date.available2011-10-28T16:11:44Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T16:11:44Z-
dc.conference.date2010en_US
dc.conference.name7th Annual Florida Magnet Research Conferenceen_US
dc.conference.hostUniversity of South Florida College of Nursingen_US
dc.conference.hostSigma Theta Tau Internationalen_US
dc.conference.hostFlorida Organization of Nurse Executivesen_US
dc.conference.locationNaples, Florida, USAen_US
dc.description7th Annual Florida Magnet Research Conference - Theme: Research at the Point of Care. Held 11-13 February 2010 at the Naples Grande Beach Resort, Naples, Florida, USA.en_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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