Effects of leg and body position on transcutaneous oxygen measurements in healthy subjects and subjects with peripheral artery disease after lower-extremity arterial revascularization: A pilot study

Transcutaneous oxygen (TcPO(2)) measurements provide a noninvasive, objective determination of the oxygen level at the skin surface. This offers a means of estimating the underlying circulation and tissue oxygenation. The purpose of the pilot study was to measure the TcPO(2) value of the lower extremity of healthy men and women and of patients with peripheral arterial disease (PAD) in 4 different body and leg positions 24 hours after peripheral vascular surgery reconstruction. The specific aim was to determine if lower-extremity TcPO(2) measurements were affected by changes in extremity position in these subject populations. A convenience sample of 4 healthy health care professionals and 4 patients who had peripheral vascular reconstruction surgery 24 hours before the measurements were studied. Subjects were studied in 4 different leg and body positions: supine with legs extended, sitting with legs dependent, a 5 degrees head-up reverse Trendelenburg, and supine with legs elevated 10 in. The Radiometer TCM30 TcPO(2) monitor was used to carry out these measures. Findings revealed a statistically significant difference in TcPO(2) measurements between the 2 groups, with the healthy subjects having a significantly higher TcPO(2) measurement in all extremity positions compared with the revascularized subjects with PAD (P =.02-.05). Significant changes were noted in both the foot temperature (P =.03) and TcPO(2) measurements with extremity positions within the healthy subject group (P =.001). The foot and leg TcPO(2) measurements affect from leg and body position did not reach significance (P =.09) in the subjects with PAD. No change in foot temperature with extremity positioning (P =.42) was noted in the subjects with PAD. This pilot study provides a base in which additional research will be performed with TcPO(2) measurements in both the healthy and revascularized person.     

Neonatal and Infant Tachyarrhythmias: Differentiation and Treatment

Cardiac arrhythmia recognition is essential in the neonatal population, because premature newborns are at risk for arrhythmias due to immature heart muscle, function, and congenital heart abnormalities. An increased heart rate is the appropriate reaction to stress, and some tachycardias can lead to congestive heart failure or death if not treated appropriately. Although bradycardia is the most frequently seen arrhythmia in the newborn period, four additional arrhythmias may occur in the neonatal and infant populations: sinus tachycardia, supraventricular tachycardia, ventricular tachycardia, and complete heart block. As the tachyarrhythmias appear similar on the monitor, the treatment of each is very different. The nurse must be able to differentiate them. The nurse must take the initiative to discern the differences between the arrhythmias, have complimentary assessment skills to determine the severity of the associated signs, and be able to communicate this to the care provider to ensure appropriate treatment. An educated nurse is the most important link in this process.     

Validation of an Instrumented Sleep-Wake Assessment Against a Biobehavioral Assessment

Because of the vulnerability of preterm infants and the important functions of sleep to health and recovery, researchers have used the assessment of sleep-wake states extensively in research with preterm infants. Sleep-wake states have been used to evaluate the safety and effectiveness of interventions, as an outcome measure of interventions to promote sleep-wake state development and as a predictor of developmental outcome. The usual observations of infant behavior and polysomnography methods of sleep-wake state assessment are very resource-intensive, therefore limiting their widespread use. The purpose of this study was to examine the validity of a new, less resource-intensive, instrumented measure of infant sleep-wake states using infant respiration, body movements, and rapid eye movements against an accepted behavioral observation measure. The instrumented measure demonstrated significant reliability for assessing sleep states but was less reliable for waking states.     

Efficacy and utilization of skin-to-skin care in the NICU

Research to date suggests that kangaroo care, or skin-to-skin care, is safe and therapeutic for the infant and the parent. A review of the kangaroo/skin-to-skin care research found that the practice is safe and has many positive outcomes. This article closely examines recent research results. It compares and contrasts the strengths and weaknesses in the sampling, methodology, and outcomes of the studies. Recommendations for implementation in the neonatal intensive care unit are made and goals for future research areas are identified. Copyright 2002, Elsevier Science (USA). All rights reserved.