Anesthesia Record Keepine

[Tolti]

I work with a CRNA who feels that recording vital signs every 10-15 minutes is adequate for a stable GETA pediatric (dental) patient. Do those of you out there know of any published standards for intervals for vital signs recorded on the anesthetic record for GA? I have been a CRNA for 28 years and have always done q 5 minute vitals, more often, if needed....as we work in a small hospital without automated records, I would like to know if there is an actual standard, or if we all just do it because we learned it this way....

I would like to know, and am particularly interested in documented references (like your policy and procedure manual, or JAHCO, or AANA or ?

Thanks!

[deepz]

I work with a CRNA who feels that recording vital signs every 10-15 minutes is adequate ..........

Check the last line of this quote from AANA Standards:

http://www.aana.com/crna/prof/scope.asp

"Standard V *

Monitor the patient's physiologic condition as appropriate for the type of anesthesia and specific patient needs.

1. Monitor ventilation continuously. Verify intubation of the trachea by auscultation, chest excursion, and confirmation of carbon dioxide in the expired gas. Continuously monitor end-tidal carbon dioxide during controlled or assisted ventilation including any anesthesia or sedation technique requiring artificial airway support. Use spirometry and ventilatory pressure monitors as indicated.

2. Monitor oxygenation continuously by clinical observation, pulse oximetry, and if indicated, arterial blood gas analysis.

3. Monitor cardiovascular status continuously via electrocardiogram and heart sounds. Record blood pressure and heart rate at least every five minutes"

-----At least every five minutes.-----

Check the AANA's standard suggested anesthesia graphic

http://www.aana.com/crna/pdfs/Anesthesia%20Record%205-2.pdf

and you'll see a form set up to record VS at five minute intervals.

Personally I think we may sometimes confuse recording intervals with intervals between checks. That is to say, my personal feeling is that *checking* VS at five minute intervals is too lax a standard for overall safety. Recording q 5 is fine; checking q 5 is not adequate IMHO. Why? Ask yourself how long it takes for grey matter to begin to die without perfusion. Say four minutes?

Then consider that when we look up at the monitor's BP readout what we see is HISTORY, not the current BP. Unless you're following A-line pressures beat by beat, the pressure you see is what was recorded at the last interval check -- not that moment's BP. History. So why be satisfied with a BP taken up to five minutes ago when that BP could (worst case scenario) mean five minutes with no cerebral perfusion (say an MAP below 50) and, ergo, dying grey cells.

To err on the safe side I keep my BP monitor interval set to 2.5 or 3 minutes normally. And yes, I record VS q 5 min.

Good luck with your colleague.

deepz

[DreamMatrix]

I agree wholeheartedly with deepz. The standard in the industry is to record every 5 minutes and monitoring every 2.5 to 3 minutes. That is what most do, and to deviate from that would probably cost you big time!

DreamMatrix

[Tolti]

Thanks for the great input. It is exactly what I needed to present the need to record q 5 minutes....I do moniter continously, and take BPs q 2.5, while recording q 5. I respect the fact that there are many ways to do things in our field, but even though my colleague does continous monitering, his record doesn't reflect this, and in addition, doesn't reflect the accepted standard.

[An Yogi]

Yep, and if if not recorded, not done (monitored in this case). Be a nightmare to defend in court....