care of patient post code

Specialties CCU

Published

question---after a code blue has ended and the patient has expired---what do you do, (1) leave all the tubes in place, all the trash laying where it fell, code cart visible and trashed and bring the family in to see their love one in this state, so they can see how hard you worked to save their life? or (2) clean up the room the best you can,and remove all visible tubes before bringing the family in?

I am told that it is evidenced based practice to have families witness their love one in this state. But--I as an old ICU nurse, who is presently working Med/surg, don't agree. It should be about the patient and the family not about demonstrating how hard we work. I as a family member would not want to have the experience of seeing my love one in that state.

Am I wrong? Does anyone know of articles or research that I can read that would help me.:confused:

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Excellent question as this is a very sensitive situation. Big thing to remember after coding a patient is as a nurse, your focus should automatically switch from the patient to their family members. We must nurture both. Sometimes a family needs to SEE a code in progress so they feel like they have some degree of closure...."they did everything they could to save..."

You are never wrong to simply ASK the family. Of course if there is a desire to have an autopsy or the case will got to the ME, then all lines, tubes, and catheters would have to stay in place. If this be the case, just disconnect the IV's, detach the vent, and try to make them as presentable as possible- to include removing soiled linens and for crying out loud, put a clean gown on them and wipe off their face!

If no autopsy is desired I usually ask the families to give me a few minutes to get them cleaned up. We romove any un-needed equipment, clean up the room as best we can, turn the lights down, and put chairs in the room. It makes the patients look more peaceful and helps to put the families at ease.

People love to be given options, so talk to your families and accomodate them as best as you can.

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Totally agree with Diprivan Diva, except if policy allows, you should invite the family in during the code to see just how hard you are working; not for your satisfaction but for the family. So they feel 100% confident when you tell them, "We did everything we could." Also it's part of family centered care :)

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I do believe in allowing families to be allowed to be present in a code if they wish. I am all about the patient and family. I just could not believe that a nurse would insist that the room remain trashed and the patient left as he was just so the family could see all the work they did. Makes the hair stand up on the back of my neck.

Even years ago when I worked ICU, it was a common practice just like you said, let the family know what happen and ask for a moment to get things straighten up for them. That also allows the family a moment to get themselves togehter.

Do you know of any articles on this subject?

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I would never leave it trashed! Clean up the trash, cover the pt. Make them look presentable. Agree with above posters. I wouldn't worry about the crash cart in room. Lines must be left in until ruled out for coroner's case/autopsy. It's never about proving our hard work.

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Specializes in Critical care.

^^^I disagree. In appropriate circumstances, it most definitely is about proving our hard work. However, absolutely not for the sake of placing the halos securely on our heads, but to aid in closure for the family.

If we can facilitate minimizing those often torturous lingering doubts, then I feel there is a definite utility to letting families see 'all our hard work'.

A quick search provided this thread with a full page of links:Resources for allowing family presence during codes and invasive line placement.... - Nursing for Nurses

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Yes to be present during a code if they wish. No to feeling like you need to leave the room trashed to prove that point. Some people want and need to see it. Others do not. I'm not sure what I'd like it if was me, really. I'd want to be offered.

I guess it would be the reasoning behind it. I think when I read it the first time it sounded like a defensive measure. Like "See.. we DID work hard." Like proving something. I think I get what you mean now though.

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Specializes in CVICU, CCU, Heart Transplant.

The following link is to an AACN Practice Alert pertaining family witnessing a code or invasive procedure. It doesn't exactly speak to allowing families see the aftermath of a code, but does have interesting statistics about the importance for family involvement during a code:

"For family members: Their presence at the bedside helped in removing doubt about the patient's condition by

witnessing that everything possible was being done.8,9,32-35 It decreased their anxiety and fear about what was

happening to their loved one.7,10,29,32,36-37 It facilitated their need to be together8,10 and the need to help and

support their loved one.8-11,33-4,36 They experienced a sense of closure3,8,11,34 and their presence facilitated the

grief process should death occur.3,5,11,32-36

* Studies show that 94 to 100 percent of families involved in family presence events would do so again.3,7,8,9,33,36

* Studies also find that there are no patient care disruptions, no negative outcomes during family presence

events,8,9,29,32-34,38-39 and no adverse psychological effects among family members who participated at the bedside.8-

10,32,40"

http://www.aacn.org/WD/Practice/Docs/PracticeAlerts/Family%20Presence%2004-2010%20final.pdf

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Like so many other situations, it's important to know your facility's policy/procedure and follow that.

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Nothing annoys me more than "what is the policy." Families at the bedside, visitors, etc., let's go my what is best for the patient and family, not run to the policy book and make things so black and white. Use nursing discretion and common sense when appropriate.

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