Good Afternoon, One of the many things that concerns me about these discussions is the validity of BP values obtained and utilized for sepsis reporting.
As a critical care nurse for over 30 yrs I can assure you that many invasive and non-invasive BP readings are not valid or worth trusting when not obtained properly. Arterial lines can be damped with additional proper transducer management steps missed or not appreciated and NIBPs can be unreliable due to cuff size, location of placement and patient position and movement. I find these circumstances in my role as a Rapid Response nurse frequently in both my hospital and others that I respond to in my other role when I am called to see a patient. Many hospitals allow upload of vital signs data directly into the medical record with little or no editing of erroneous data by bedside clinicians. The most accurate component of a non-invasive cuff pressure reading is the MAP and why do we consider SBP so much in septic shock when MAP and DBP may more accurately reflect hemodynamic compromise in patients with early sepsis or severe sepsis. Also, each NIPB manufacturer has its own proprietary algorithm on how it obtains an NIBP reading. Heart dysrhythmias can also influence an NIBP readings accuracy. Accuracy in BP acquisition is so important and can lead to much erroneous data and in ED’s ICU’s and wards so little attention to these details and limitations are considered. Even the way CRT is assessed has nuance. Thank you. Rich Gillard BSN RN CCRN Flight Nurse and Rapid Response Nurse Milwaukee WI. > On Feb 21, 2019, at 15:05, "sepsisgroups-requ...@lists.sepsisgroups.org" > <sepsisgroups-requ...@lists.sepsisgroups.org> wrote: > > Send Sepsisgroups mailing list submissions to > sepsisgroups@lists.sepsisgroups.org > > To subscribe or unsubscribe via the World Wide Web, visit > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > or, via email, send a message with subject or body 'help' to > sepsisgroups-requ...@lists.sepsisgroups.org > > You can reach the person managing the list at > sepsisgroups-ow...@lists.sepsisgroups.org > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Re: Hypotension (Roney, Jamie) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Sat, 16 Feb 2019 20:58:07 +0000 > From: "Roney, Jamie" <jro...@covhs.org> > To: "Duane, Molly" <mdu...@dmc.org>, 'Christina Ford' > <cf...@limamemorial.org>, "'sepsisgroups@lists.sepsisgroups.org'" > <sepsisgroups@lists.sepsisgroups.org> > Subject: Re: [Sepsis Groups] Hypotension > Message-ID: <1550350673369.24...@covhs.org> > Content-Type: text/plain; charset="iso-8859-1" > > I think it is important to remember septic shock has hypovolemic, > distributive, and cardiogenic shock components simultaneously occurring. > Distributive shock leads to macrovascular and microvascular dysruption of > normal blood flow, subsequently leading to tissue hypoperfusion despite > normal or high cardiac outputs. Definitely follow the guidelines, but always > treat the patient's hypoperfusion knowing the data we typically look at > doesn't reflect the cytopathic hypoxia or impaired microvascular flow. I > always refer back to Dr. Rivers findings in the EGDT RCT highlighting these > phenomena. > > > Hope it helps! > > > Jamie > > > Jamie Roney, DNP, RN-BC, BSHCM, CCRN-K > > Regional sepsis coordinator/Nursing Professional Development Specialist IV > > 3615 19th Street, Lubbock, TX 79410 > > T: (806) 725-4689 C: (806) 773-1914 > [cid:image5066f5.GIF@a56d5650.41b66b11]<http://www.flightforlife.org> Richard Gillard, CCRN Flight Nurse rgill...@mrmcffl.org<mailto:rgill...@mrmcffl.org> Office: Fax: 414-778-5429 414-778-5431 www.flightforlife.org<http://www.flightforlife.org> 2661 Aviation Road, Waukesha, WI 53188 [Facebook]<http://> [Twitter] Follow @FlightForLife<http://> | @fflmc<http://> | @fflfdl<http://> ________________________________ > From: Sepsisgroups <sepsisgroups-boun...@lists.sepsisgroups.org> on behalf of > Duane, Molly <mdu...@dmc.org> > Sent: Tuesday, February 12, 2019 2:41 PM > To: 'Christina Ford'; 'sepsisgroups@lists.sepsisgroups.org' > Subject: Re: [Sepsis Groups] Hypotension > > The hypotension guidelines for the sepsis measure use SBP <90 and/or MAP <65 > or 40 mmHg drop from baseline. Just one value is required (e.g. MAP >65, but > SBP <90; use the SBP). > > On the topic of hypotension, we had a miss for <30 m/kg given within 3 hours > of initial hypotension. The initial hypotension occurred about 4 ? hours > prior to Severe Sepsis time zero. According to the CMS guidelines we should > have given 30 ml/kg for the hypotension, even though at the time the patient > did not have Severe Sepsis criteria. Can anyone explain this to me? I don't > understand why we are expected to treat Severe Sepsis prior to the presence > of all criteria. > > Thanks, > Molly > > Molly Duane RN, BSN, CCRN-K > Sepsis Program Coordinator > Detroit Receiving Hospital > Harper-Hutzel Hospital > Office: 313-745-4340 > Cell: 248-709-6218 > > Email: mdu...@dmc.org<mailto:mdu...@dmc.org> > > From: Sepsisgroups [mailto:sepsisgroups-boun...@lists.sepsisgroups.org] On > Behalf Of Christina Ford > Sent: Thursday, February 07, 2019 11:31 AM > To: 'sepsisgroups@lists.sepsisgroups.org' > Subject: [Sepsis Groups] Hypotension > > Trying to get a good handle on the Hypotension aspect of this. Should we be > looking at the bp and MAP or just the MAP. I have been using both - however > the argument was brought to me that is the MAP is still above 65 the patient > is profusing so intervention should not be needed?? > Also are there set parameters for bp when looking for hypotension or are we > to use the standard of below 120/80? > Can you give any information on the proper way to screen and/or abstract ?? > > Chris > Christina Ford, BSN-RN > Quality Resource and Improvement Manager > Lima Memorial Health System > 419-226-5197 ext 2580 > cf...@limamemorial.org<mailto:cf...@limamemorial.org> > > [LMHS Logo] > > > > Confidentiality Note: This message is intended for use only by the individual > or entity to which it is addressed and may contain information that is > privileged, confidential, and exempt from disclosure under applicable law. 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