The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [395]
Careful explanation and reassurance must be given to the patient before transfer, particularly if the patient is conscious and aware. The patient’s relatives will require considerable support and will need to be kept informed of the transfer of their relative and to where. It is important that if the family were not present during the arrest, the appropriate member of the medical team contacts the next of kin and informs them of the arrest and its outcome. If the patient has survived, the next of kin/family will need to know that the patient has been moved to a more appropriate environment for continued monitoring.
Please note: whether the resuscitation attempt was successful or not, the pastoral needs of all those associated with the arrest should not be forgotten (Resuscitation Council 2010b, Sandroni et al. 2007).
Documentation
Good record keeping is an integral part of nursing practice, and is essential to the provision of safe and effective care (NMC 2009). There must be documentary evidence of how decisions relating to the patient were made. Accurate recording of the administration of solutions infused and drugs added is essential. All resuscitation attempts should be audited, ideally using a nationally recognized template such as the Utstein template (recommended for use by the Resuscitation Council 2010b). Hospitals should collect data regarding cardiac arrest for the National Cardiac Arrest Audit (NCAA) (Resuscitation Council 2010b).
Education of patient and relevant others
Prevention of cardiac arrest is the most important factor for survival. Education of the patient and relevant others needs to start at first contact with healthcare professionals regarding lifestyle changes, diet, exercise, smoking cessation, and regular check-ups to treat or control any underlying causes such as hypertension and diabetes.
Complications
Some possible complications may arise from cardiopulmonary resuscitation.
Gastric distension due to bagging too forcefully and/or too quickly, causing air to enter the stomach. A nasogastric tube should be inserted as soon as the airway is secure, to help prevent and manage gastric distension which may cause vomiting and possible aspiration into the lungs.
Fractured ribs, sternum, punctured lungs can occur as a result of chest compressions. The correct placement of hands during chest compression is vital in helping to prevent fracturing of ribs and sternum.
Transmission of disease through mouth-to-mouth ventilation. The use of a pocket resuscitation mask with a one-way valve will prevent the transmission of infection from bodily fluids during ventilation (DH 2007).
Websites
British Lung Foundation: www.lunguk.org/
British Thoracic Society: www.brit-thoracic.org.uk
BTS guideline for emergency oxygen use in adult patients: www.brit-thoracic.org.uk/emergencyoxygen/
Intensive Care Society: www.ics.ac.uk/
NPSA Rapid Response Alert May 2008: www.nrls.npsa.nhs.uk
Resuscitation Council UK: www.resus.org.uk
Smoking Cessation Programme Development Group at NICE: www.publichealth.nice.org.uk/page.aspx?o=SmokingCessationPGMain
References
AHA/ILCOR (American Heart Association/International Liaison Committee on Resuscitation) (2000) Guidelines 2000 for CPR and emergency care: an international consensus on science. Resuscitation, 46 (1), 73–92, 109–114.
Ahrens, T. and Tucker, K. (1999) Pulse oximetry. Critical Care Nursing Clinics of North America, 11 (1), 87–98.
Austin, R. and Snow, A. (2000) Defibrillation, in Resuscitation: A Guide for Nurses (ed. A. Cheller). Harcourt, London, pp. 141–157.
Ball, C. (2000) Optimizing oxygen delivery: haemodynamic workshop. Part 3. Intensive Care Nursing, 16 (2), 84–87.
Baskett, P.J., Nolan, J.P., Handley, A., Soar, J., Biarent, D. and Richmond, S. (2005) European Resuscitation Council guidelines for resuscitation