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CS336
Implementation of a Carotid Stent Program with a Progressive Care Unit as Primary Recovery Site
By: M.A. Smith, C. Huth-Thompson, & M. Kinsella; Exempla St Joseph Hospital, Denver, CO
For further information, please contact: smithma@exempla.org
Purpose: To assure appropriate placement and monitoring of patients post-Carotid Artery Stent (CAS) procedure, including use of a validated stroke scale and adequate hemodynamic support.
Description: Most patients receiving carotid stents are recovered in an ICU. Our Interventional Telemetry unit (PCU) recovers 120-150 interventional procedures/month. We believed we could successfully recover patients receiving carotid stents. Our challenge was to identify and meet unique requirements for CAS patients while assuring consistency of care regardless of hemodynamic status and location. Education for all staff (ICU, CVL and PCU) included information on carotid anatomy, indications for CAS, and use of the modified National Institute of Health Stroke Scale, with mandatory joint evaluation at every handoff of care. Additionally, PCU staff received training on titrating Dopamine to a maximum of 8mcg/kg/min. Telemetry (PCU) staffing level was adapted for more intensive recovery (initially a 3:1 nurse: patient ratio, which we modify to 4:1 based on patient status). Vital Signs with stroke scale are monitored q 15 x 8, q 30 x 2 and q 1hour x 4, then q 4 hours.
Evaluation and Outcomes: 35 CAS cases were completed between 3/05 and 1/07. Eleven required pressor support post procedure, 5 with neosynephrine were recovered in ICU and 7 received Dopamine on our PCU. 2 patients on dopamine were transferred to ICU for increased vasopressor support. Only 2 embolic events were identified by PCU staff post procedure but did not require transfer to ICU. 80% of patients receiving CAS were safely and successfully recovered in PCU.
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