O slideshow foi denunciado.
Utilizamos seu perfil e dados de atividades no LinkedIn para personalizar e exibir anúncios mais relevantes. Altere suas preferências de anúncios quando desejar.

Ecografia applicata all'infermieristica

12.039 visualizações

Publicada em

Publicada em: Saúde e medicina
  • Dating direct: ❤❤❤ http://bit.ly/2ZDZFYj ❤❤❤
       Responder 
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • Dating for everyone is here: ❶❶❶ http://bit.ly/2ZDZFYj ❶❶❶
       Responder 
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Responder 
    Tem certeza que deseja  Sim  Não
    Insira sua mensagem aqui

Ecografia applicata all'infermieristica

  1. 1. VII° Congresso provinciale collegio Ipasvi Lucca Lucca 25 Maggio 2012 “Professione infermieristica: la sfida della modernità. Le nuove esperienze dell’esercizio professionale”Ecografia applicata all’infermieristica l’esperienza pluriennale dell’Azienda USL2 Lucca Infermiere Luca RomeiPronto soccorso zona Valle del Serchio Az.USL2 Lucca
  2. 2. Nurse’s Sonography, Why?In the land of the blind, the one eyed man is king Desiderius Erasmus 1466- 1536, Adagia (III, IV, 96)
  3. 3. Ecografia come “imaging”• Vedere ciò che non si vede• Vedere meglio ciò che già si vede• Vedere cosa si fa e se si fa bene• Vedere (presto) le complicanze• …………….
  4. 4. Ecografia focused
  5. 5. Ecografia infermieristica campi di applicazione Ausilio a procedure
  6. 6. Accessi venosi periferici ecoguidati
  7. 7. Semeiotica vascolare• Il vaso c’è ?• Ha una posizione tipica ?• Ha un calibro adeguato ?• E’ pervio ?• Ha un decorso tipico ? Tutto ciò è verificabile con la tecnica blind?
  8. 8. ACCESSI VENOSI PERIFERICI Costantino TG, et al Ultrasonography-guided peripheral intravenous accessversus traditional approaches in patients with difficult intravenous access Ann Emerg Med 2005;146:456-461 MATERIALI e METODI Studio prospettico condotto in un dipartimento di emergenza su 60 pazienti con accesso venoso superficiale difficoltoso (obesità, malattie mediche croniche, abuso di stupefacenti per via endovenosa), dopo almeno 3 tentativi falliti di posizionamento da parte di infermieri in servizio. Randomizzazione dei pazienti ad ulteriore tentativo di accesso con ecoguida (giorni pari) o con metodo tradizionale (giorni dispari). Confronto tra i due gruppi delle seguenti variabili di esito: successo nell‘incannula-mento, numero di punture, tempo all‘incannulamento, soddisfazione dei pazienti. RISULTATI ECO TRAD DIFFERENZA (IC 95%) Successo nell‘incannulamento 97% 33% 64% (39-91%) all‘incannulamento 13 m 30 m 17 m (0.8-25.6) Tempo dopo la prima puntura 4m 15 m 11 m (8.2-19.4) Numero di punture 1.7 3.7 2.0 (1.27-2.82) Soddisfazione dei pazienti (scala 1-10) 8. 5.7 3.0 (1.82-4.29)
  9. 9. ACCESSI VENOSI PERIFERICI Brannam L, Blaivas M, Lyon M, Flake MEmergency nurses utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients Acad Emerg Med. 2004;11:1361-63 MATERIALI e METODI Studio prospettico osservazionale condotto in un trauma center (75000 accessi/anno) su pazienti con accesso venoso superficiale difficoltoso (obesità, malattie mediche croniche, abuso di stupefacenti per via endovenosa, emodialisi), dopo tentativi ripetuti falliti di posizionamento da parte di infermieri in servizio. Ulteriore tentativo di accesso con ecoguida da parte di infermieri addestrati su modello inanimato dopo sessione teorica di 45‘. Descrizione dell‘attività post-addestramento (casi trattati, condizioni favorenti la difficoltà all‘incannulamento, efficacia della metodica). RISULTATI Tentativo di accesso con ecoguida in 321 casi, con incannulamento riuscito in 280 (87%). Fallimento in 41 casi (13%): in 20 successivo incannulamento con ecoguida da parte di un altro operatore, in 9 accesso in giugulare esterna (senza ecoguida), in 12 posizionamento di CVC. Incidenza di complicanze 1.2% (4 punture arteriose).
  10. 10. ECOGUIDA ACCESSI VENOSI quando ? Obesi Anziani con fragilitàdelle vene superficiali Terapie ev ripetute Tossicodipendenti Dializzati Shock, ipovolemia Ustionati pediatrici PICC
  11. 11. ECOGUIDA ACCESSI VENOSI perché ?Diminuzione del numero di puntureDiminuzione tempiDiminuzione rischio puntura su trombosiDiminuzione dei CVC “evitabili”Diminuzione complicanze (stravaso ematico o infusionale)Riuscita di accesso venoso altrimenti impossibileAumento soddisfazione da parte degli utenti
  12. 12. Approccio trasversale Approccio complanare
  13. 13. Accessi arteriosiL’utilizzo degli ultrasuoni aumenta il tasso disuccesso con riduzione del tempo diinserimento del catetere arterioso.Levin PD,Sheinin O. Gozal Y:“Use of ultrasound guidance in the insertion of radial artery cathetersCritical care medicine 2003 n°32
  14. 14. TEST DI ALLENControllo ecografico più sensibileper la rilevazionedel circolo collateraleLevin PD,Sheinin O. Gozal Y:“Use of ultrasound guidance in the insertion of radial arterycathetersCritical care medicine 2003 n°32
  15. 15. Ausilio ecografico nel cateterismo vescicale
  16. 16. DEFINIZIONE• L’ecografia Infermieristica Pelvica è un metodo di valutazione non invasiva del volume della vescica, del suo contenuto, della salienza intravescicale della regione prostatico-trigonale e della determinazione in tempo reale del posizionamento del catetere vescicale. Non ha finalità diagnostiche, ma di supporto a procedure operative.
  17. 17. Calculated bladder volume Volume = d.LL x d.AP x d.CC x 0.52
  18. 18. Problemi intercorrenti: Contenuto vescicale
  19. 19. Intercurrent problems: salience prostatic
  20. 20. Posizionamento del catetere
  21. 21. IMPIEGO DELL’ECOGRAFIA INFERMIERISTICAPER L’USO, LA SCELTA E LA GESTIONE DEICATETERI VESCICALIRomei L, Sabatini A, Biagioni C. Emergency Care Journal 2008) Valutazione Stima Strumento Implicazione Azione Volumetria Quantitativa Calcolo Necessità di Applicazione della vescica dell’ellissoide cateterismo di catetere Residuo Quantitativa Calcolo Necessità di Applicazione vescicale dell’ellissoide cateterismo di catetere Malfunzionamento Revisione del di catetere catetere Contenuto Qualitativa 3 gradi* Previsione del Applicazione vescicale calibro e del tipo di di un catetere catetere idoneo Prostata Qualitativa 2 gradi** Previsione di Catetere complicanze idoneo e azioni appropriate Passaggio Qualitativa “Eyeball” Livello Catetere “Real time” dell’eventuale idoneo e del catetere ostacolo azioni appropriate
  22. 22. Ecografia infermieristica campi di applicazione Oltre la procedura
  23. 23. Valutazione clinica• Valutazione infermieristica raccolta dati oggettivi e soggettivi• Valutazione clinica indispensabile nel processo di Nursing• La valutazione clinica anche attraverso lo studio dei segni la semeiotica• Integrazione semeiotica ecografica
  24. 24. Le funzioni vitali: Tre targets per l’ecografia• Il cuore (C)• I polmoni (A/B)• Il precarico (C)
  25. 25. AAA• Procedura di Area vasta (area vasta Nord Ovest –Az.Osp.Univ.Pisana)• Percorso: Gestione del paziente con aneurisma dell’aorta addominale rotto o sospetto tale.
  26. 26. Ruolo dell’infermiere di triage• ……….è da considerare la possibilità futura di eseguire al triage un’ecografia addominale da parte di personale Infermieristico adeguatamente formato, con l’unica finalità di ricercare la presenza di AAA, all’evidente scopo di velocizzare l’iter……..
  27. 27. Fast?• Esperienza emergenza territoriale 118 Milano
  28. 28. Formazione
  29. 29. “Per noi che prestiamo assistenzainfermieristica, la nostra assistenzainfermieristica è qualche cosa che,se non contribuiremo a farprogredire ogni anno, ognimese,ogni giorno, contribuiremo afar regredire.” 1872 Florence Nightingale
  30. 30. “Colui che lavora con le sue mani è un lavoratore.Colui che lavora con la sua testa e le sue mani è un artigiano” San Francesco da Assisi Grazie per l’attenzione Infermiere Luca Romei lucaromei@libero .it http://www.facebook.com/ecografiainfermieristica

×