Hypertension during Angio Procedures

  1. Our radiologist do not pay any attention to my warnings of increased Hypertension. When exceeding 200/? I get a little concerned. They do not. - I take the pt to recovery after the proceedure and get unpleasantly attacked. My question is do you have standing orders to use in time like this or do you just alert and hold your breath? I asked RR to give me thieir protocol orders and I will pursure trying to get similar standing orders to use as a guide. Then I can have meds on hand without waiting for a crisis and using the crash cart meds.... Help! I would like some imput of others in similar situations.: eek:
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  2. 8 Comments

  3. by   dianah
    If the pt is otherwise stable (no s/sx hypertensive emergency or urgency), treatment to control the BP really is in the best interest of both the pt AND the Rad: no bleeding from angio site, overall DECREASED COMPLICATIONS if BP is controlled! IMHO Rads do tend to be exclusively procedure-focussed; however, they are not the pt's primary MD (and don't wanna be!). I agree with you: that BP must be relatively controlled during and after the case. See if you can get some parameters, meds and dosages from the Anesthesiologists/CRNAs - THEY are OUR wellspring of wisdom! I too have been chewed by the PACU for pt with high BP; and if the PACU nurse calls the Rad, he'll just refer them to the primary MD, who, by the way, is not always the referring MD for the procedure/angio, so you play guessing games for whom to call, and then play phone and beeper tag. Meanwhile, the pt's BP continues . . . As you probably have seen, the elevated BP can be directly related to anxiety R/T procedure; Versed etc help sometimes, not all the time. I've had anesthesiologists say they'd cancel a case if the BP was XXX/XXX. However, a lot of our cases are slightly more urgent than just an elective surgery, and benefit VS risk must be weighed when considering whether to postpone a case . . .
    How would this work: Gather your info then write a proposed policy and present it to the Rads (all or just the Chief Rad), with the pt's well-being and the potential for complication prevention as the primary focus. Our Rads seem to respond well if we do all the groundwork/writing, the policy is sensible, and they have only to OK a it (and it's been developed in conjunction with their "peers", the Anesthesiologists).

    Re: "meds on hand"; do you use a Pyxis system or have to get the meds from the Pharmacy each time? Before Pyxis we had a supply of emergency meds we kept in the angio room: Priscoline, Tridil, antiemetics, antihypertensives, steroids, Epi and Benadryl for contrast reactions, as well as Lidocaine, Atropine, Dextrose 50%, and others that we could access quickly in a Radiologic or ANY emergency (as well as a crash cart nearby). Each X-ray room in the dept where contrast is injected still has a small locked box (checked and maintained by the Pharmacy personnel) with emergency drugs for severe contrast reactions. NO DELAYS IN TREATMENT = IMPROVED OUTCOMES. (not to mention the nurses breathe easier knowing the meds are at hand)

    Good luck to you! I'm interested to know what you do and what happens. -- D
  4. by   dianah
    Have you been to www.arna.net? Radiology nurse's ass'n site. Might give more info/contacts for this particular issue.
  5. by   Spirit A-glow
    Thank you for your imput. The beginnign or your comments match my experience so far (rads do not handle BP, refer to their referring service.. so I tell PACU this, but still bump heads. They want me to provide them with the numbers to call. - now look - there are 5 of them to 1 of me.... go figure....I did not give them much satisfaction but referred them to their phone list...
  6. by   Spirit A-glow
    Sorry, wasn't done - hit the return key and it submitted my reply a little early....
    I do not have the pix system, must use crash cart if needed urgently. I have a few drugs on hand.. Benedryl, Eppi, Atropine, Lido - but anything else - no. This is why I would like to get a protocol going so I can respond rapidly and have what I need - when I want it. PACU said they would write up what they do, havn't seen it yet. But I like your suggestion to involve anesthesia. - do you have a policy you can fax to me? I'd like to have a sample to work from when I present my idea. if you do: fax# 216-421-3068 attn: Sandy RN - it will get to me.
  7. by   Spirit A-glow
    Sorry, wasn't done - hit the return key and it submitted my reply a little early....
    I do not have the pix system, must use crash cart if needed urgently. I have a few drugs on hand.. Benedryl, Eppi, Atropine, Lido - but anything else - no. This is why I would like to get a protocol going so I can respond rapidly and have what I need - when I want it. PACU said they would write up what they do, havn't seen it yet. But I like your suggestion to involve anesthesia. - do you have a policy you can fax to me? I'd like to have a sample to work from when I present my idea. if you do: fax# 216-421-3068 attn: Sandy RN - it will get to me.
    I recently found the arna site - wrote to Pam Meyers conserning membership. She contacted me today. I obtained the name of my chapter president. - I still have to search the site a bit. - havn't gotten past enquirery.
    Thanks again for your help... all is well in angio land for now.
    What do you know about a WADA study? we have one Tuesday - havn't done one of these yet......
  8. by   dianah
    Hmmm, would have to ask one of my Interventional Rads or go online to find out. Did you do a search? Now you have me curious: gotta look up WADA.

    You know, we really don't have a policy re: htn during procedures. We kind of take it one case at a time, assessing each pt to sift (or sniff, whatever) out who is just anxious VS who has chronic htn (renal pts!!!) etc.

    Glad you have an ARNA chapter in your area. We formed one a few years ago, but it's not well-membered nor well-attended, for the amount of hospitals in the area. I have family issues and find it hard to attend meetings, but I still belong and really enjoy the yearly meetings (held in conjunction with SCVIR), when I can go.

    Best regards!! -- D
  9. by   Spirit A-glow
    I havn't done a search on the WADA - but waiting for the pt now - my understanding is that we use Amatol injected into the cerebral branches and Neuro does some studies before some elective surgical procedure. - I'll fill you in when I know more.
    My issue with wanting a protocol is that when you determine if pt condition is not due to anxiety (Versed & fentanyl helps with this) - I want some orders I can act on since the Rad's don't want to order anything then I show up with a severly hypertensive pt to Recovery and that is when I have problems. isssues that staff doesn't understand...
  10. by   CATHYW
    When I worked Cath Lab, we would put all of the potentially needed meds on the counter at the foot of the stretcher, with sterile syringes and needles standing next to them. If a Nipride gtt was needed, it was a matter of opening the cabinet above the meds, snatching it and the tubing out, spiking it, setting it up on the extra IV pump in the room, and voila! BP within limits. We had standing orders, but NEVER did this without asking the doc performing the procedure, first. Most of them said, "do whatever you have to to keep the distolic under 90 (meaning-use the nipride gtt protocols). We had one doc, though, who was the most incompetent of all of them, and was continually requesting gtt rate changes, and BP's even before they had a chance to be affected by the change in meds!

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