Lately there seems to be a buzz in the ICU over SCVO2 and sepsis bundles. I am seeing hospitals in trials for the PreSep and Flowtrac Edwards product.
Has your hospital instituted these new catheters in the ICU?
Is a sepsis bundle protocol being implemented in your facility with SCVO2
I think it is time for a talk on this topic at INS and AVA as I find myself with little real knowledge in this area.
Kathy Kokoits RN BS MBA
PICC Business Analyst
Bard Access Systems
We had participated in the Surviving Sepsis campaign from beginning to end. The resuscitation bundle included the SVO2 monitoring. At our institution this was done initially when a line was placed(drawing a blood sample). We did not do continous SVO2 monitoring during the campaign because our physicians would rarely place a central line. They depend on the PICC team to place a PICC on these septic pt. We recently had a physician speak to us about the use of the Precept catheter and sepsis. This sparked some interest in our physicians but haven't seen one placed yet. Since the surviving sepsis campaign is over, we have chosen new goals which include fluid rescusitation, antibiotics and lactate clearance. We also will do CVP trends off the PICC's. The SVO2 is still in the literature but we have not made it one of our goals as alot of the literature now focuses on "appropriate fluids" and lactate clearance.
Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA
We have used the Presep catheter for Sepsis. We also use the FloTrac sensor to do pulse-counter cardiac output monitoring through a simple radial arterial line. Both use the same small monitor. The entire topic of hemodynamic monitoring through a CVC and/or a radial arterial catheter is very interesting. ScvO2 can substitute as a surrogate for Cardiac Output and reflects O2 delivery and consumption. Arterial line pulse contour CO is an even better parameter. Using that modality and a simple passive leg raising maneuver, it is possible to quickly determine if a patient has reached an optimum level of pre-load. It is a very accurate parameter to use when doing a goal directed fluid resuscitation. It is a very good way to avoid both over and under resuscitaion. When we have used it and it works very well. Unfortunately, we don’t use it often enough. Physicians can be very slow to adopt new concepts. The Sepsis Resuscitation Bundle was endorsed by over 12 different professional societies (that is an astonishing level of agreement). But it only got 36% compliance in the Surviving Sepsis Campaign.
Richard Simpson RN, CCRN
Critical Care Coordinator
Rome Memorial Hospital
Rome, N.Y.
[email protected]
Richard Simpson RN, CCRN