Running head: PICOT PROPOSAL
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PICOT Proposal
Katherine Jackson
University of South Florida
PICOT PROPOSAL
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University of South Florida College of Nursing
NUR 4169C EBP for the Baccalaureate RN
PICOT Proposal Form
Briefly describe the
opportunity for clinical
improvement.
Briefly describe the
background of the
problem. Why is this
issue important for your
clinical setting or
organization?
List 1-2 background
pertinent questions.
State the PICOT
question.
Describe the ideas you
have for solving the
problem.
Type Information/Response in this Column
There is an opportunity to lessen the amount of time pediatric
patients undergoing cardiac catheterizations spend in states of
hypoxia. The use of Near Infrared Spectroscopy for prompt
detection of impaired tissue perfusion may be used. Prompt
identification of impaired oxygenation can help shorten the time
patients spend in a hypoxia, essentially reducing complications of
impaired perfusion.
Cardiac catheterization is recommended for diagnostic purposes in
pediatric patients with congenital heart defects, predominantly
when noninvasive interventions are unsuccessful in diagnosing
CHD. Inadequate tissue oxygenation is often a pre-existing
condition for patients in this population, constructing impaired
tissue oxygenation a strong possibility during the perioperative
period. Cerebral hypoxia complications are among the most
common complications encountered in pediatric patients
undergoing cardiac catheterization. Traditionally, pulse oximetry
allows for a simple, noninvasive estimation of arterial oxygen
saturation; pulse oximetry has been the gold standard utilized in
pediatric intensive and perioperative care. More recently, NIRS has
been used to monitor tissue oxygenation in cerebral and organ
tissue of pediatric patients. NIRS measures the spectral differences
in tissue caused by the presence of oxygenated hemoglobin and
deoxygenated hemoglobin. Perhaps NIRS can be proven more
prompt in detecting impaired oxygenation compared to pulse
oximetry. Timeliness in addition to the accuracy of NIRS, will
provide a solid argument NIRS should be utilized as the new gold
standard on pediatric patients undergoing cardiac catheterizations
and other high-risk procedures.
What is impaired tissue perfusion? What are complications of
impaired tissue perfusion? Specifically, why are pediatric patients
undergoing cardiac catheterization at risk for impaired tissue
perfusion? What is the difference in mechanism of NIRS compared
to pulse oximetry?
In pediatric patients undergoing cardiac catheterization, is NIRS
compared with pulse oximetry more prompt in diagnosing impaired
tissue perfusion during the intraoperative and postoperative period?
Data will be collected from NIRS simultaneously with data
collected from pulse oximetry; the patient will have a pulse
oximeter probe attached to the finger and NIRS probes attached to
the head. Data collected from each method will be compared to
observe at what point in time impaired tissue perfusion is detected,
in other words, which method detects impaired perfusion sooner.
PICOT PROPOSAL
Describe your proposed
goals/objectives for the
project. What do you
hope to achieve?
How will you
measure/evaluate the
outcome of your
change/improvement?
Describe the members of
your proposed project
team (by position or job
title) and their roles.
Institution where the
project might be
implemented in the
future.
List 3 peer reviewed
research papers that will
provide the evidence for
the PICOT on the
reference page.
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Post-procedural care will be performed in the usual manner. The
data collected will be the amount of time the patients spend within
the normal range of tissue oxygenation (SctO2 70%-80% with the
NIRS and SaO2 94%-100% with pulse oximeter), and the actual O2
readings for each method will be recorded. A difference in time
between the initial NIRS alert versus the initial pulse oximeter alert
of impaired tissue oxygenation will show which method is more
time efficient in detecting impaired tissue perfusion in pediatric
patients.
I would like to show the reliability of NIRS in identifying impaired
tissue perfusion in a narrower time range compared to pulse
oximetry. The benefit of NIRS in detecting compromised perfusion
sooner than the gold standard of pulse oximetry, will produce the
outcome of earlier interventions and ultimately shorter periods of
hypoxia in pediatric patients.
A pulse oximeter probe will be placed on the patient’s finger and
NIRS probes will be placed on the patient’s head during the
catheterization period. The nurse will record measurements of
oxygen levels (SaO2 and SctO2) on a data collection tool, including
the time of each measurement and the time of detected oxygenation
impairments-if any-for NIRS and the pulse oximetry probe.
Comparing the data will illustrate which method detects
compromised tissue perfusion earlier.
Cardiac CRNA-The Certified Registered Nurse Anesthetist(s)
implements/monitors the use of NIRS and pulse oximetry during
cardiac catheterizations in pediatric patients.
CVICU RN-The staff nurse(s) continue monitoring NIRS and pulse
oximetry during the post-cardiac catheterization period in pediatric
patients.
Clinical Research Coordinator, RN-Coordinates research in
pediatric cardiology; a wonderful source of information, including
how to interpret and organize data. Helps get authorization from the
IRB to undergo research.
Any facility that offers pediatric cardiac catheterizations. The
catheterization labs/OR, PACU, and CVICU.
See reference page.
PICOT PROPOSAL
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References
Cristia, A., Dupoux, E., Hakuno, Y., Lloyd-Fox, S., Schuetze, M., Kivitis, J., Bergvelt, T.,
Gelder, V.M., Fillipin. L., Charron, S., & Minagawa-Kawai, Y. (2013). An online
database of infant functional near infraRed spectroscopy studies: a communityaugmented systematic review. PLOS|one, 8(3), 1-10. Doi:10.1371/journal.pone.0058906
Feltes, T.F., Bacha, E., Beekman, R.H.; Cheatham, J.P., Feinstein, J.A.; Gomes, A.S., Hijazi,
G.G., Ing, F.F., Moore, M., Morrow, R.W., Mullins, C.E., Taubert, K., & Zhaun, E.
(2011). Indications for cardiac catheterization and intervention in pediatric cardiac
disease: a scientific statement from the American Heart Association. American Heart
Association, 123(22), 2607-2652. Doi: 10.1161/CIR.0b013e31821b1f10
Fouzas, S., Priftis, K., & Anthracopoulos, M.B. (2011). Pulse oximetry in pediatric practice. The
American Academy of Pediatrics, 128(4), 740-752. Doi: 10.1542/peds.2011-0271
Frost, E. (2012, April). Cerebral oximetry: Emerging applications for an established technology.
Anesthesiology News, 1-7. Retrieved from
http://www.anesthesiologynews.com/ViewArticle.aspx?t=Blogs&d=Special+Edition+%2
F+Educational+Reviews&d_id=161&i=October+2012&i_id=890&a_id=21822
Hansen, J.H., Schlangen, J., Armbrust, S., Jung, O., Scheewe, J., & Kramer, H.H. (2013).
Monitoring of regional tissue oxygenation with near-infrared spectroscopy during the
early postoperative course after superior cavopulmonary anastomosis. European Journal
of Cardio-Thoracic Surgery, 43(2), 37-43. Doi: 10.1093/ejcts/ezs581
PICOT PROPOSAL
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Hirsch, J., Charpie, J., Gurney, J., & Ohye, R. (2010). Role of near infrared spectroscopy in
pediatric cardiac surgery. Progress in Pediatric Cardiology, 29(2), 93-96.
Doi:10.1016/j.ppedcard.2010.06.003
Schachner, T., Bonaros, N., Bonatti, J., & Kolbitsch, C. (2008). Near infrared spectroscopy for
controlling the quality of distal leg perfusion in remote access cardiopulmonary bypass.
European Journal of Cardiothoracic Surgery, 34(6), 1253-1254. Doi:
10.1016/j.ejcts.2008.08.027
Tobias, J.D., & Hoerneschemeyer, D.G. (2007). Near infrared spectroscopy identifies
compartment syndrome in infant. Journal of Pediatric Orthopaedics, 27(3), 311-313.
Doi: 10.1097/BPO.0b013e3180326591
Yu,G., Shang,Y., Zhao, Y., Cheng, R., Dong, L., & Saha, S.P. (2011). Intraoperative evaluation
of the revascularization effect on ischemic muscle hemodynamics using near infrared
diffuse optical spectroscopies. Journal of Biomed Optical Spectroscopy, 16(2), 270-274.
Doi: 10.1117/1.3533320