Stroke/ER Nurses' Input Needed

Nurses General Nursing

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Hi Y'all,

I am a Neuroscience ICU RN who is currently working on a project to reduce door-to-groin puncture (mechanical thrombectomy) time for patients presenting to the ER with large vessel occlusions when the Neuro Interventional Radiology team is on-call (weekends/nights). Currently our aim is to be a support RN, responding to code "strokes" in the ER and helping to manage/transport the patient to and from CTA/CTP/Neuro IR. We also look to help the IR team setup the suite for procedure and manage the vitals/gtts intraoperatively.

To the stroke/ER nurses: Do you see any benefit in having a Neuro ICU nurse respond to code "strokes?" The goal is not to step on anyones' toes or take over that position, but to simply improve patient outcomes by reducing puncture times and monitoring/relaying status to the ICU physicians. What barriers do you foresee?

Any insight is greatly appreciated!

Thanks,

Andrew

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Specializes in Emergency/Cath Lab.

What would you be able to do that would reduce the puncture times?

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My hospital has IR, but I don't think we do mechanical thrombectomies. At least none of my patients or patients I have heard about have had them.

As an ER nurse, what exactly do you plan on doing to help me? Help with transport to CT is great, but unless you are down in the ER within 5 minutes of us calling a code stroke, we will already be on our way to CT before you get down there and our docs have already called the intensivists.

Will you be with the patient the whole time until they go to IR or are you kind of in and out? Because having to keep another person updated when I am probably pretty swamped doesn't sound like something I want to do. What if they are a candidate for tPa? Or it is a hemorrhagic stroke? Would you just go back to the ICU? I like the idea of someone helping with transport and managing drips (I always love and extra set of hands and eyes), but part of what makes the ER great is the teamwork and trust we have with each other. Just throwing a random person in there could be awkward, especially if it's an ICU nurse that isn't necessarily nice when the ER brings up other patients.

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What are your current times and what part of the process is the current time waster?

Regardless, I'd take you. You can be in charge of documentation.

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Is the ED involved in the project? They'll be the best ones to identify barriers to physically getting the pt to IR. Your hospital should also have some kind stroke coordinator-type RN job that reviews stroke cases from activation to discharge with statistics and all that.

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Specializes in Adult and pediatric emergency and critical care.

I don't see a benefit. Door to first slice is currently the biggest push in most institutions, after that most of the delay is from neurorad reading and neuro making a decision for TPA/IA. I could place an introducer into the femoral artery but I doubt that it would actually speed up any patient outcomes. Not waiting for an EKG, Creat, using something quicker than that 64 slice scanner circa 2000, et cetera is what will speed up outcomes; all of these require big changes in how your institution manages stoke alerts and mo'money.

I know that this will come off as uncouth, but I see this as the next group who wants to come play in the ED but not do any of the work. Are you going to stay when we find out that the patient is out of window? What if we find out the patient is pregnant and we have to MR instead because the patient refused CT? Are you going to watch the patient when we give TPA or be catching up with your buddy who came down to the ED 3 months ago and haven't seen?

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Yeah I don't see any logic behind this at all, unless you are talking about somebody with a DVT who is on an ekkos machine. The NIH stroke protocol is pretty much nationwide, and more likely than not because most strokes occur in the very elderly who have last been seen as "normal" 12 hours ago, they aren't candidates for TPA. Are you talking about something like the Arctic sun?

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Hi just out of curiosity are you activating when an ambulance calls in a code stroke? or not until the CT is done?

Annie

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Specializes in Medical Oncology, ER.

I dont see a benefit, for large vessel occlusions we call a code "ELVO", and then to cath lab for the pt. Waiting for an icu nurse to come in would be taking up resources unless you plan on taking the stroke pt as a 1:1 or 2:1. Biggest benefit is ct asap and then treat as approproate.

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Specializes in Surgical, quality,management.

We have the best door to intervention times in my country. There is no ICU nurse on the team.

The ambulance call through a potential stroke enroute. Code stroke activated. Interventional neurologist and ED team meet pt at the door. Bloods that were pulled in the ambulance are labelled and sent. ID band applied, inital obs taken and off to cath lab. If pt self presents and triage nurse suspects stroke then similar process commenced with the WR nurse pulling bloods, ECG, IV insertion.

Post intervention go to a monitored stroke bed only to ICU if complications or other issues.

Our stroke ambulance has a stroke nurse but they carry out many roles. Mobile Stroke Unit | The Royal Melbourne Hospital

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