POLL: Do you still use trendelenburg?

  1. Hi all. I am currently switching jobs. At my old job, using trendelenberg was a complete no-no because of the evidence-based studies. At my new job, however, when I mention this I get weird looks and nurses tell me that of course they've used it everywhere they've worked. So, do you?
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  2. Poll: Do you use trendelenburg position for hypotension (of any nature) at your current job

    • Yes, my facility requires trendelenburg for all hypotensive pts

      11.01% 12
    • NO, my facility has banned the use of trendelenberg

      7.34% 8
    • There is no specific policy, use of trendelenburg is at the discretion of the RN

      81.65% 89
    109 Votes
  3. 21 Comments

  4. by   canoehead
    At the point we use Trendelenburg it is for such a short time, and it appears that it can't hurt, even if it doesn't help. What do your studies say? Do you have a link?
  5. by   pricklypear
    I'd be interested, too, in seeing something about using trendelenburg. We use it when we need to, and I've never heard anybody say not to. We only use it for short periods of time, also.
  6. by   SouthernLPN2RN
    I've used it and had it work every time.
  7. by   papawjohn
    Hey Y'all

    I've stopped using T-berg myself and not noticed any more problems than I had before. I do elevate the LowerExtrems. And if the previous nurse has the Pt "on his head"---I don't change him quickly to Supine with LEs up.

    There're lots of non-evidence practices that virtually all of us use. My favorite is saline lavage thru the EETube. Reseach says not to do it. I've found its very helpful, even essential.

    Any other 'questionable' practices that we "all" do?

    Papaw John
  8. by   FNimuaeMae
    It's very helpful to put those very LARGE patients into trendelenburg and let gravity assist when you need to boost them up in bed... we do that all the time at work. The docs Trend patients when they are putting central lines in the IJ or SC... But we usually just have elevated the lower extremities, and thats very rarely...

    Missy
  9. by   papawjohn
    Hey FNimuaemae

    Wow---I'd assumed that the Original Post was regarding putting a Pt in T-berg whose BP had crashed. I hope I was correct in that--cause otherwise my reference to putting the Pt's LowerExtrems up must look pretty weird!!

    Obviously putting someone's calves up on pillows doesn't help you put in a Central Line. Or move someone to the head of the bed.

    Some authorities decided a few years ago that the ancient practice of tilting a Pt's head down and feet up did not help resuscitate them. Apparently the venous filling of the neck veins leads to pressure on the carotid bodies and can slow the heart rate. Which is counter productive to the business of resuscitation, we all agree? (Never mind that generations of MDs and RNs had resuscitated people in T-berg. Someone's thesis took a different approach so STYLES CHANGE!!!!!)

    (The original purpose of tilting the bed was to 'pour' venous blood from the Lower Extrems into the CVP--like a 'transfusion'. Now it's too much pressure and can slow the heartbeat---like no one would have noticed that in the previous decades?)

    Well---old people hang onto old ideas. But I have listened to the new ideas, like I said--and do not use T-berg myself now-a-days. And do not notice a major 'die-off' of critical patients. So maybe there's something to this.

    But there are other non-experimental practices that we've used for decades (lavaging an ETT or Trache with saline) that really work. Even though they're 'unscientific' they have the stature of many years experience.

    Does anyone wanna expand the original title here and contribute a few. I have another one--ice-bags in the groin and axillae for a fever. Anyone still do that?

    Papaw John
  10. by   SouthernLPN2RN
    I must clarify that I've only used it in fairly stable pts who have a low bp. I've never used it in a critical situation.
  11. by   pricklypear
    Quote from papawjohn

    Does anyone wanna expand the original title here and contribute a few. I have another one--ice-bags in the groin and axillae for a fever. Anyone still do that?

    Papaw John
    Done that one a few times - didn't seem to work, but that's what the doc wanted.
  12. by   NotReady4PrimeTime
    [quote=papawjohn]

    but there are other non-experimental practices that we've used for decades (lavaging an ett or trache with saline) that really work. even though they're 'unscientific' they have the stature of many years experience.


    i most defininitely do. there are times when "dry suctioning" just doesn't cut it. and for those who believe that the resulting dramatic increase in substances sucked up simply reflects the volume of saline used, i say... "saline doesn't have chunks." in our unit, where many of the patients are so sedate as to be anaesthetized (a separate issue that burns my butt), whatever helps get the gunk moving is good.

    does anyone wanna expand the original title here and contribute a few. i have another one--ice-bags in the groin and axillae for a fever. anyone still do that?

    we surely do that too. we're primarily a peds cv surgical unit and when our kiddies go into jet after having their sa nodes poked and sliced, we often use icepacks to get them back into a sinus tach while the cooling blanket gets itself going. we've used them recently on a child with a temp of 41c (105.4f), poor kid!

    as for the original question, our pre-eminent cv surgeon has been seen manually t-berging a patient with hypotension (my first cv admission) while i drew up albumin for a bolus. (yet another sore subject with me... the albumin bolus thing, not the surgeon helping out.:bowingpur ) we don't use it often, but it's pretty effective in the short term to raise a kid's legs into the knee-chest position. or to lean on their liver for a few seconds. whatever gets you through the crisis!!
  13. by   adawg67
    I'm in nursing school n they r teaching us trendelenburg (sp?).
  14. by   VivaLasViejas
    We don't have a specific policy for this, but recently when my patient's BP went south, I put her in T-burg as I'd done many times before, only to be corrected by one of our hospitalists, who said "Just have her lie supine and elevate her legs above her heart". Now, these particular MDs are up on the latest practices, so I take their advice seriously and incorporate it into my own practice; sure enough, the BP came up, although I'm sure the Atropine I gave her had something to do with it as well.

    See, we learn something new every day........I precept nursing students a lot, and I hope that nursing schools are beginning to teach about evidence-based practice so that nurses will graduate PREPARED for change and knowing that we don't always have to do something one way because 'that's how we've ALWAYS done it'.
  15. by   Tweety
    Interesting. Like Marla, I'm old school, but open to new evidence-based practices.

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