HELP! Arctic Sun and Cryoamputation issues

RoxanRN · Jul 10, 2006

I'm not sure what P/P you are looking for. To my knowledge, ours falls under the P/P of cooling blankets. We (Neuro Critical Care) use it (or a cooling blanket or an Aleisus Icy Cooling Cath) for some subarachnoid hemorrages and sometimes neuro temps.

Cynthia_S · Jul 10, 2006

I think we are onto something here! Do you use your cooling blankets for the neuro pt to cool them down to a temp of 91. ?

There are specific physiological aspects that you want to watch out for and for example you do not treat a low k unless it is below 3.2... because it's a false low and if you would treat a 3.5 you could cause much harm to them. normally, we would be calling the dr immediately to treat a 3.3 but in this case you dont. This would be a procedural issue that would need to be address when cooling someone and doing the reverse.

I have read that this procedure has worked for the neuro patient also. It is very interesting material... thank you so much for the info.. whatever you can tell me and send to me even via email would be great !!!

RoxanRN · Jul 10, 2006

Yes, we 'hibernate' the more severe cases. We also have electrolyte replacement protocols (Mg, Phos, K) - K is replaced at 3.6 and below. We (through MD orders) have as of yet to rescind replacement protocols for cooled patients and we have never (to my knowledge) had high Ks when the patient is allowed to rewarm (1 degree per 12 to 24 hours).

Cynthia_S · Jul 10, 2006

Thanks for the replies... Does your hospital have a formal procedure to follow when you hibernate patients or do you have standing orders or what instructions do you follow when you do the procedure? Do these instructions have tidbits of information on what to look for?

We have nothing and what is really scary is that if something should happen, we have nothing to back us up on why we did what we did and no education on the matter. They just expect us just to follow orders- which is BS in my opinion. If I do not know why I am doing something and what to expect and such, I will not to the procedure. I think this is a huge liability. I can see someone on the stand sitting there in front of the jury saying, oh sir, I just did what they told me to do.:trout: :lol2:

ccrnjen · Jul 10, 2006

Try doing a search on google - hypothermia cardiac arrest. you can also add protocol or policy to get more detailed info instead of just the research. There seem to be several that are available online. Hope this helps!

Renee_RN · Jul 11, 2006

We are actually in the process of using the Arctic Sun machine for intentional post-resuscitation hypothermia. This is what we are supposted to do. We have policy in place that defines criteria for usage (adult, v-fib witnessed arrest, 5-15 min emergency response team, 60 min or less until return of spontaneous circulation, coma post-resuscitation), cooling procedure, rewarming procedure, equipment and monitoring. We have strict documentation guidelines as well. We cool to 33 degrees C within 6 hrs of event. All patients are intubated, sedated (propofol, versed), a-line, good iv access, paralytics on board for shivering. We use BIS monitoring with a goal of 40 for monitoring sedation, bladder catheter with thermistor, train of four, and the cooling device. We draw BMP's q8h including Mg levels, with ABG's, lactate, and CBC as ordered, Q1hour BGM, outputs. Fluid boluses for diuresis. K and Mg boluses for deficiencies.We have to chart the temp of the patient via two methods (oral and bladder probe) and the water temerature hourly as well. After 24 hours, we begin the rewarming process. This is over 6-8 hrs (slow). Once the patient is 35 deg C, we turn off the paralytic. Sedation is off when temp is 37 and the paralytic has worn off. We are also watching the K levels during this time for major increases. Hope this helps.

Renee

dorimar, BSN, RN · Jul 11, 2006

amazing! Where have I been? Greek to me. I will be researching this.

Cynthia_S · Jul 21, 2006

Thanks for the replies!

HyperTension · Nov 2, 2006

We are just initiating mild hypothermia therapy for CVA / Cardiac Arrest. One of the sites that we have used for reference is a .pdf file from the University of Chicago, among others.

http://hypothermia.uchicago.edu/documents/Hypothermia%20Protocol%20Univ%20of%20Chicago%202004.pdf

As of this moment, from the limited and continued reading that I have done, results appear to be variable. Then again, individuals how have gone through these events aer not in the top 5% of health to begin with, and any little advantage that we can give to them can't make thier current reason for admission any worse.

Renee_RN pretty much hit it on the head for the protocols on our unit. Bear in mind that this is a "new" (tried with minimal success in the late 60's I believe) trend, and protocols will continue to be tweeked as with anything in the CC environment.

Good Luck... It's always nice to try something new :)

Cynthia_S · Nov 3, 2006

Thanks for the info. It was very helpful!

rn2trauma · Nov 5, 2007

hey! I work at the VA in southern california and participated in three cryoamputations in the 7 years i have worked on the ICU. I also have participated in several others at another trauma center in this area, and I have yet to see anything that would resemble policies and/or protocols for the procedure. I have also seen it done wrong, where the tissue death extended far further than was intended, resulting in a rather high AKA versus the BKA that was planned. I am kinda wondering what specifically you were asking for regarding the cryoamputation. I just happened to finish setting one up when i went on a search for pretty much what you are asking for, i.e., policies and protocols. Not sure if i answered anything close to what you are asking for, but maybe we all can help each other.