The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [393]
(a) Suction equipment is operational.
(b) The cuff of the endotracheal tube inflates and deflates.
(c) The endotracheal tube is well lubricated.
(d) That catheter mount with swivel connector is ready for use.
To ensure all equipment is working prior to use. E
14 During intubation, the anaesthetist may request cricoid pressure. This involves compressing the oesophagus between the cricoid ring and the sixth cervical vertebra. To prevent the risk of regurgitation of gastric contents and the consequent risk of pulmonary aspiration (Resuscitation Council 2010b, C).
15 Recommence ventilation and oxygenation once intubation is completed. Intubation should interrupt resuscitation only for a maximum of 16 seconds to prevent the occurrence of cerebral anoxia (Handley et al. 1997, R3).
16 Once the patient’s trachea has been intubated, chest compressions, at a rate of 100–120 per minute, should continue uninterrupted (except for defibrillation and pulse check when indicated) and ventilation should continue at approximately 12 breaths per minute. Compression should continue while the defibrillator is charging.
Intravenous access in CPR
Uninterrupted compression results in a substantially higher mean coronary perfusion pressure. A pause in chest compressions allows the coronary perfusion pressure to fall. On resuming compressions, there is some delay before the original coronary perfusion pressure is restored (Resuscitation Council 2010b, C). Reducing preshock pause improves time of compression which has a more favourable outcome for patient.
17 Venous access must be established through a large vein as soon as possible. To administer emergency cardiac drugs and fluid replacement (Resuscitation Council 2010b, C).
18 Asepsis should be maintained throughout. To prevent local and/or systemic infection (Fraise and Bradley 2009, E).
19 The correct rate of infusion is required. To ensure maximum drug and/or solution effectiveness. E
20 Accurate recording of the administration of solutions infused and drugs added is essential.
Defibrillation
To maintain accurate records, provide a point of reference in the event of queries and prevent any duplication of treatment (NMC 2009, C).
21 Apply pads/paddles to chest. It may be necessary to shave the chest. To ensure the pads/paddles are applied correctly and make adequate contact which enhances electrical contact (van Alem et al. 2003, C).
22 Remove oxygen source at least 1 metre from patient unless intubated. To reduce the risk of sparks from igniting the oxygen source (Nolan et al. 2005, C).
23 The person delivering the shock must ask all members of the resuscitation team to stand clear of the patient. To ensure that none of the resuscitation team are in contact with the patient or the bed as they may also receive the shock (Perkins and Lockey 2008, C).
24 Deliver single shock to treat VF/ pulseless VT. To terminate pulseless VT, VF and restart the heart by depolarizing its electrical conduction system and delivering brief measured electrical shocks to the chest wall or the heart muscle itself (Eftestol et al. 2002, C; Wik et al. 2003, R1).
Postprocedure
25 Check patient by assessing airway, breathing, circulation, blood pressure and urine output. To ensure a clear airway, adequate oxygenation and ventilation and aim to maintain normal sinus rhythm and a cardiac output adequate for perfusion of vital organs. To ensure adequacy of ventilation and oxygenation (Perkins and Lockey 2008, C).
26 Check arterial blood gases. To ensure correction of acid/base balance (Resuscitation Council 2010b, C).
27 Check full blood count, clotting and biochemistry. To exclude anaemia as a contributor to myocardial ischaemia. A clotting disorder may have contributed to a major haemorrhage. Replacement stored blood for transfusion has fewer clotting factors and the patient may require replacement of clotting factors usually in the form of fresh frozen plasma. E
To assess renal function and electrolyte balance (K+, Mg2+ and Ca2+). To ensure normoglycaemia. To commence serial cardiac enzyme assay