RESUMEN
Placement of peripheral pediatric intravenous (IV) catheters in infants and children is difficult, even in skilled hands. This large, 2-institution prospective study used real-time independent observations to describe the effect of nurse experience and competence on the length of time and the number of attempts to establish a successful IV placement in the hospitalized child. Data from a convenience sample of 592 evaluable patients and 1135 venipunctures showed that successful IV placements required an average of 2 venipunctures over 28 minutes. Although nurse experience and self-rated competence were correlated with attaining a successful IV placement, time of day, predicted difficulty of the venipuncture, and cooperativeness of the child appeared to be better predictors of success.
Asunto(s)
Cateterismo Periférico/métodos , Competencia Clínica/normas , Infusiones Intravenosas/métodos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/enfermería , Protección a la Infancia , Preescolar , Femenino , Humanos , Infusiones Intravenosas/efectos adversos , Infusiones Intravenosas/enfermería , Modelos Logísticos , Masculino , Análisis Multivariante , North Carolina , Flebotomía , Estudios Prospectivos , Curva ROC , Estadística como Asunto , Factores de TiempoRESUMEN
Observations of changes in the properties of ocean waters have been restricted to surface or intermediate-depth waters, because the detection of change in bottom water is extremely difficult owing to the small magnitude of the expected signals. Nevertheless, temporal changes in the properties of such deep waters across an ocean basin are of particular interest, as they can be used to constrain the transport of water at the bottom of the ocean and to detect changes in the global thermohaline circulation. Here we present a comparison of a trans-Pacific survey completed in 1985 (refs 4, 5) and its repetition in 1999 (ref. 6). We find that the deepest waters of the North Pacific Ocean have warmed significantly across the entire width of the ocean basin. Our observations imply that changes in water properties are now detectable in water masses that have long been insulated from heat exchange with the atmosphere.