ratio's with induced hypothermia patients

Specialties CCU

Published

Poll: Are your induced hypothermia patients kept 1:1 throughout cooling/maintenance and rewarming?

Thanks in advance :)

Specializes in Critical Care, Med-Surg.

Ours are 1:1, usually the whole time. On a rare occasion, they are paired during maintenance phase.

1:1 until they are re-warmed.

Our TH patients are 1:1 throughout the phase till rewarming unless there is no other alternative for staffing. There is a significant amount of charting, monitoring, labs, and other tasks that are built into the TH protocol in our facility that make them very busy. They do have a research team that studies everyone of them with their outcomes so that does effect how they are managed as well in terms of nursing care needed. Also the shifting of electrolytes across the cell membranes during the cooling and rewarming phases increases the risks with these patients that should be kept in mind as well.

Specializes in ICU.

We never make ours 1:1... just treat them like a regular ICU patient. They're not usually higher acuity than any of the other patients on the floor, so I guess that's why they're not singled. We only single our CRRTs and occasionally a fresh admit on sepsis protocol if staffing allows.

Specializes in Critical Care.

I'm curious what ICU's that keep these patients 1:1 throughout TH staff for other types of patients? They are busy, but once they're cooled they're well within "normal" ICU busy, so are all the ICU patients 1:1?

Never 1:1. In fact no matter the patien my hospital (UPMC Presby) virtually never single assigns a nurse. Only exception is ecmo/vads/fresh hearts in the cticu

Also IMO cooling them isnt the hard part. Its rewarning them. Rewarm too fast and their brain swells

Specializes in ICU.
I'm curious what ICU's that keep these patients 1:1 throughout TH staff for other types of patients? They are busy, but once they're cooled they're well within "normal" ICU busy, so are all the ICU patients 1:1?

Because they're lower acuity ICUs and the TH patients are well and above the normal level of difficulty. My first ICU job was that. Getting a TH patient was something to brag and whisper about, one of those rights of passage kind of things that the first time you got one, you could know that your charge nurse had faith in your abilities and you were finally a trusted part of the team sort of thing.

TH was the only type of patient that was 1:1. We didn't do CRRTs and who knows about the fresh hearts... I didn't work CICU.

Also, we had to chart two temps q15 minutes and our TH machines did not connect to the monitors, so someone literally had to be in the room every 15 minutes to record the q15 minute temps because only one set of temps pulled to the computer. I think having to be in the room every 15 minutes had something to do with the 1:1 staffing.

Specializes in NICU, telemetry.

I work in NICU, and when we cool we do try to have them 1:1 if numbers allow for it. If not, we hope we have an awesome, helpful charge nurse and podmates to help out 😉 it usually ends up being 2:1, or if it was as admit assignment, 3:1 IF a baby cannot be moved to another assignment. That circumstance really sucks, bc our cooling kids are usually a hot mess anyway, even outside of the cooling process.

When we warm, it's usually 2:1.

I thought we were always 1:1...but then I realized all of my hypothermia patients had an IABP! 1:1 during the cooling phase, but usually if we have a hypothermia the other patient is pretty stable.

Specializes in SICU, trauma, neuro.

Ours are 1:2 during maintenance and rewarming; possibly during cooling too, but I can't remember offhand. I'm not in a CVICU though, and we only really use hypothermia for severe TBIs with elevated ICPs not responding to other interventions. I wish they were 1:1; those are some sick people

It's the rewarming phase you need to be worried about!!! To fast and cerebral edema=bad news!!

You really can't cool them fast enough.

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