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CS327
CVP to go! Facilitating early goal directed therapy in severe sepsis
By: C. Lucafo, & S.Jackson; Elliot Hospital; NH
For further information, please contact: clucafo@elliot-hs.org
Purpose: Central venous pressure (CVP) is a critical assessment in early goal directed therapy for the septic patient. This type of specialized monitoring does not need to wait for an ICU admission. A system was developed to rapidly deploy CVP equipment and ICU personnel to the Emergency Department (ED).
Description: CVP monitoring is used to guide fluid resuscitation in the severely septic patient. The ED does not have the experience or equipment to perform CVP monitoring. Rather than undertake a costly education series and equipment acquisition, the ICU provides CVP monitoring equipment and personnel to the ED when severe sepsis patients are identified. A kit was assembled with all of the necessary equipment for CVP monitoring and placed in a centrally located area of the ICU. The bedside monitors in the ED were reconfigured to accept invasive pressure modules. The ED utilizes a central line insertion cart created to facilitate compliance with reducing catheter-related blood stream infections. The ED physician notifies the ICU of a potential septic patient. The intensivist arrives in the ED and the ICU nurse is called to bring the CVP monitoring kit when the central line is inserted. Once the central line is inserted, the ICU RN sets up the CVP monitoring and collaborates with the physician(s) and ED RN on fluid resuscitation goals and treatments until the patient can be transferred to the ICU.
Evaluation/Outcome: The CVP monitoring kit has proven to be an effective way to provide early goal directed therapy to septic patients in the ED. Utilization of staff expertise in pressure monitoring coupled with the availablility of equipment has assisted both departments in managing the fluid resuscitation needs of the severely septic patient. Additionally, hand off communication between the ED and ICU is enhanced through early collaboration of treatment goals.
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