Pour administrer la formation des internes dans un réseau de formation, la tenue d’un inventaire identifiant les actes techniques (AT) pratiqués et/ou enseignés spécifiquement pour chaque unité apparaît essentielle. L’établissement de ce type d’inventaire qualitatif, à ce stade préliminaire, est le but poursuivi par les auteurs. Du 10 au 31 janvier 2014 une enquête par voie électronique a été adressée aux cadres responsables de la formation des internes dans un réseau de formation régional. Les données ont été recueillies dans un fichier Excel formaté comprenant quelques intitulés d’ATs. Les déclarations ont été faites selon 3 colonnes : un intitulé, la présence de cette pratique (OUI/NON) et l’existence de son enseignement (OUI/NON). Les ATs étaient regroupés en 10 rubriques : monitorage non-, semi- et invasif, sondages, perfusions, techniques d’homéothermie, de ventilation, prévention de lésions corporelles, d’anesthésies locorégionales, de maîtrise de l’équipement. Les résultats sont présentés en effectifs (n = ) dans le Tableau 1. Ces résultats objectivent les bases d’une organisation coopérative de l’encadrement de la formation aux ATs dans un réseau car le nombre et les spécificités des ATs pratiqués/enseignés dans chaque unité ne sont que partiellement superposables. Plus inattendu, existent, dans certaines unités, des ATs pratiqués mais non enseignés. Ces faits impliquent que, pour donner à chaque interne des chances équivalentes de maîtriser tous les ATs, chaque parcours de formation devra tenir compte tant de l’éventail des ATs pratiqués que de leurs enseignements préalables. Pour des raisons d’éthique et de sécurité, le parcours de formation devra d’être gouverné pour chaque interne par le traçage de la connaissance et de la maîtrise obtenue pour chaque AT. Dans une perspective de travail optimalisé en réseau, l’existence d’outils communs d’enseignement des connaissances et de contrôle des critères de qualification devient indispensable. Si le contrôle des connaissances liées à un AT peut s’effectuer hors de la réalité du travail clinique – par un examinateur éventuellement unique –, les différentes étapes de la qualification pratique sont à organiser au niveau du patient donc de pratiquants de terrain qualifiés/qualifiants. Ce changement de paradigme nécessitera le contrôle de la qualification pratique via un outil transversal reconnu et activé par un collège de responsables qualifiants du terrain sous le contrôle des structures d’encadrement des pratiques de soins. En conclusion, tant pour des raisons éthiques, socioéconomiques que de sécurité, l’organisation d’un réseau de formation optimalisé devra aller vers la mise à disposition d’outils communs adaptés au suivi individuel en temps réel de l’expérience des ATs maîtrisés pour chaque interne en formation.

Background.- To assess family satisfaction in the intensive care unit (ICU) and to identify parameters for improvement.Study design.- Prospective observational monocentric study.Patients and methods.- One hundred and twenty families were given a questionnaire of twenty-four items covering: satisfaction with reception and waiting areas, satisfaction with care and satisfaction with information/decision-making. Each item was evaluated by families according to three levels: high, intermediate, and poor satisfaction. Opinions concerning accessibility time, information notice and visitor limitations were also gathered.Results.- Several factors, such as waiting time, respect of family's wishes, visiting hours, lack of social support, and examination's results communication were associated with poor level of satisfaction. Twenty-three percent of families felt restricted by visitation policy for children and 17 % by visitor's number limitation.Discussion.- Quality of family reception in the ICU needs to be improved concerning waiting time, visiting hours, social and emotional support. (C) 2011 Elsevier Masson SAS. All rights reserved.

The non-invasive pulse CO-oximeter provides an immediate and continuous estimation of hemoglobin concentration non-invasively, and so has the potential to improve ICU patient care. We determined whether non-invasive hemoglobin measurement by pulse CO-oximetry could provide clinically acceptable absolute and trend accuracy in critically ill patients, compared with other invasive methods of hemoglobin assessment available at bedside and the gold standard, the laboratory analyzer.

We report the case of a 56-year-old man who presented a section of a chest drain into the pleural cavity. Following an oesogastrectomy with coloplasty for oesophageal carcinoma, the patient developed a pleural effusion. During the implementation of pleural drainage, the intrathoracic drain tip was sectioned. The patient underwent a thoracotomy to remove the foreign body. The drain was probably cut during device removal through the particularly cutting trocar. This observation strengthens the need to refrain from withdrawing the movement tube through a Monod trocar.

Background. - Pulse oximeters are routinely used in severely ill patients to detect hypoxemia early. In various clinical situations, however, conventional devices may be unable to display valid values or any value whatsoever. The usefulness of the Signal Extraction Technology (SET) in these situations has not yet been investigated.Method. - Twenty-five adult patients requiring norepinephrine, regardless of the reason or dosage, or having a defective signal with a conventional oximeter were equipped with both their conventional saturation sensor (Oxymax Nellcor(TM)) and a SET saturation sensor (Masimo(TM)) connected to its monitor. Saturation values displayed by each pulse oximeter and the SaO(2) measured concomitantly by cooximetry were gathered on inclusion and then whenever one of the two sensors did not display a value, or when the difference between the values was greater than five saturation points, or at any time a blood gas analysis was done.Results. - During the study period, 83 measures were collected. Using the Bland and Altman method, SaO(2) estimates by the SET system were more accurate than those by the conventional system (bias +/- 2 S.D. of 0.0% +/- 3.1% vs 2.1% +/- 11.0%, respectively), even when only valid values (values accompanied by a satisfactory quality index) were considered (0.0% +/- 2.7% vs 1.2% +/- 7.0%).Conclusions. - In situations at risk of producing defective signals when using conventional sensors, the SET system provided more valid SaO(2) estimates. (C) 2009 Elsevier Masson SAS. All rights reserved.

Introduction. - The French Society of Anaesthesiology (SFAR) recommends the use of pre printed self-stick syringe labels. However, French anaesthesia-syringe labelling customs is yet unknown.Study design. - Therefore, a national phone survey was performed in order to investigate this issue.Results. - Forty-five percent of the answering centers (324/722) used colour self-stick labels, with a larger proportion in public centers and a large regional variability. The kind of colour code differed from an area to another. Among centers using colour labels, the international recommended colour code was used in only 36% of them. The majority of health care providers declare to be favourable to the use of the colour self-stick labels and the standardization of the colour code as well. A relationship between the University hospital and the surrounded area has been observed for the use of the colour labels and the choice of the colour code.Conclusion. - Colour labels are used in France by nearly half of the centers, but international colour code is less spread. (C) 2008 Elsevier Masson SAS. Tons droits reserves.

Medication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric hospital, and to identify their characteristics and potential predictive factors.This prospective incident monitoring study was conducted between November 2015 and January 2016 in an exclusively paediatric surgical centre. Children <18 yr undergoing general anaesthesia were consecutively included. For each procedure, an incident form was completed by the attending anaesthetist on an anonymous and voluntary basis.Incident forms were completed in 1400 (73%) of the 1925 general anaesthetics performed during the study period with 37 reporting at least one medication error (2.6%). Drugs most commonly involved in medication errors were opioids and antibiotics. Incorrect dose was the most frequently reported type of error (n=27, 67.5%), with dilution error involved in 7/27 (26%) cases of incorrect dose. Duration of procedure >120 min was the only factor independently associated with medication error [adjusted odds ratio: 4 (95% confidence interval: 2–8); P=0.0001].Medication errors are not uncommon in paediatric anaesthesia. Identification of the mechanisms related to medication errors might allow preventive measures that can be assessed in further studies.

1Department of Anaesthesiology and Critical Care, CHU Poitiers, 86021 Poitiers; 2INRA Le Magneraud, 17700 Surgères, France