[Establishment of a nursing-driven sedation protocol: effect on the sedation level and accidental withdrawal of tubes and catheters].
BACKGROUND
Mechanically ventilated patients require sedation during ventilatory support. Our study has aimed to determine if the effects on the sedation level of a nursing-driven sedation protocol has any influence in the accidental removal of tubes and catheters.


METHODS
A quasi-experimental intervention study was performed in a medical-surgical intensive care unit. A 17-month pre-intervention observational period was followed by a 17-month intervention period where a nursing-driven sedation protocol based on the Glasgow Coma Score modified by Cook and Palma was implemented. In both periods, we registered the accidental removals of endotracheal tube, nasogastric tube, urinary catheter and intravascular catheters.


RESULTS
A total of 176 patients (age: 65 +/- 17 years; SAPS II: 43 +/- 14) were included in the observation period and 189 patients (age: 65 +/- 15 years; SAPS II: 40 +/- 13) in the intervention period. In second period, the percentage of patients excessively sedated decreased (20% vs. 41%; p = 0.001) and the percentage of patients with optimal sedation increased (53% vs. 35%; p < 0.001). The rate of accidental removals of enteral tubes in the first period was 15.8 per 1,000 tube-days vs. 5.6 in the second period (p = 0.001). No accidental removal of intravascular catheters was found in the second period vs. a rate of 2.6 central venous catheters per 1,000 catheter-days and a rate of 3.4 intra-arterial catheters per 1,000 catheter-days during the first period.


CONCLUSIONS
Implementation of a nursing-driven sedation protocol increases the percentage of patients with an optimal sedation and decreases the incidence of accidental removal of tubes and catheters.
Enfermera, Servicio de Cuidados Intensivos y Unidad de Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid. España. sariasrivera@aim.com
S
S
Arias-Rivera
M M
MM
Sánchez-Sánchez
R
R
Sánchez-Izquierdo
M J
MJ
Gallardo-Murillo
R I
RI
Santos-Díaz
F
F
Frutos-Vivar
D000368:Aged; D002404:Catheterization; D016292:Procedural Sedation / Q000451:nursing*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009730:Nursing Assessment; D011446:Prospective Studies