POLL: Do you still use trendelenburg?

Specialties MICU

Published

  1. Do you use trendelenburg position for hypotension (of any nature) at your current job

    • 12
      Yes, my facility requires trendelenburg for all hypotensive pts
    • 8
      NO, my facility has banned the use of trendelenberg
    • 89
      There is no specific policy, use of trendelenburg is at the discretion of the RN

109 members have participated

Hi all. I am currently switching jobs. At my old job, using trendelenberg was a complete no-no because of the evidence-based studies. At my new job, however, when I mention this I get weird looks and nurses tell me that of course they've used it everywhere they've worked. So, do you?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Interesting. Like Marla, I'm old school, but open to new evidence-based practices. :)

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Well, have definately used or seen used the ice packs inthe groin/axilla... one guy had a 106F temp that just wasn't going down...and it was when I was working med surg....he got transported to another hospital. They thought there were other things at play making that guy so hot.

Where I work now, they have cooling blankets, but I have still seen the ice packs when someone had temps that just wouldn't go down so well.

Missy (sounds chilly to me!)

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Specializes in ICU, Education.

Supine with knee gatch is the new evidenced based practice-- For the same reasons as earlier voiced: venous back pressure causing a lack in body's compensatory mechanisms for hypotension ( you fool the body in to thinking it is not hypovolemic & there by it doesn't respond to hypovolemia by increasing HR and vasocontstiriction and & increased contractility, etc. like it is suppose to) Body loses it's natrual compensatory mechanisms. Also all that pressure on diaghragm doesn't help either i suppose. That being said... we used trendelenburg for years with positive results shown by INCREASING BLOOD PRESSURE. So i don't know, it seems to me that if the body could have compensated for the hypotension in the first place, it would have done so, NO? I see it as us stepping in where the body failed. Is that not our jobs? But still , playing devil's advocate again, I find the supine knee gatch thing is effective as well.

I too still lavage my ET tube when needed to clear secretions. And ice packs to the gorin and axilla have proven very effetive for refractory thermoregulation. maybe evidence practice just doesn't have our documentation.

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Specializes in ICU, CCU & PCCU/TELEMETRY.

:idea: The reasons I have heard for not using trendelenberg is that it stops the patient's compensatory mechanisms. Specifically, as also taught in nursing school, there are baro receptors in the carotid arteries and aortic arch that detect pressure. They cause the body to release catecholamines to constrict the vessels in light of pressures that are too low, to help raise the blood pressure, and they cause the body to release adrenaline to make the heart beat faster, also for compensation. The reverse is also true. When the baroreceptors detect pressures that are too high in this area, the body may release chemicals to make the vessels relax. Putting the patient into trendelenberg increases the pressure of the blood in the carotids and aortic arch, via gravitated volume, which, as mentioned before stops the body from using its own compensatory mechanisms. The CV surgeon I've worked with most will raise the patient's legs until we can get the vasopressors ready and infusing to raise blood pressure. Just to expand on what dorimar stated.

millkay;)

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A PAC told me the same thing the other day. Here I was feeling all proud of myself for 'dumping him on his head'. The last hospital I came from that was what I was taught.

If I ever have a raging fever please not the ice in the groin thing. Armpits okay. I'd rather stew.

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Specializes in Hemodialysis, Home Health.

Interesting....

All dialysis clinics still use trendelenburg religiously for BP crashes. Works everytime. But then, we also bolus NS as well.

Don't know.. even without the NS, though, we have always found the T'burg position to assist maintain a managable BP on dialysis patients who have a tendency to drop their pressure. Have never heard any nephrologosts say to not use it. And all dialysis chairs have the T'burg position built in.

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Specializes in Emergency, Trauma.

I use trendeleberg, but typically only for the few minutes that it takes to get the vasopressors/IVF bolus/PRBCs up; once I've got those going, then I put the pt back to normal position. Only time I can think of where I would use it as the only treatment is with those pts that drop their pressure for a few minutes after getting a NTG SL, and all they need is a min or 2 of trendelenberg.

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Does anyone wanna expand the original title here and contribute a few. I have another one--ice-bags in the groin and axillae for a fever. Anyone still do that?

Papaw John

Hey Papaw John, funny enough I did just that on my shift last night. Had an immediate post op CAB on admit temp was 97.8 range, couple of hours later, it was 102.9, treated with tylenol, which didn't change the temp much it came down to 102.4, packed axilla and groin with ice and temp was 100.2 when I left this morning.

About lavaging the ETTs, we are told nurses don't do it, but respiratory therapists can (? makes no sense to me), but anyway, we all know if you have a pt with junky lungs and real thick secretions, they're not coming out unless you thin them a little with a lavage. I don't routinely do it, but if I feel the pt needs it, I will.

My ICU also does not do trendelenberg anymore, we do elevate the lower extremities for more venous return as you explained so well in your previous post. One of our more experienced nurses hooked another nurse up to the external cardiac output set up one night, and elevated her legs to demonstrate how and why a fluid bolus works, pretty interesting to see the numbers change, even on someone healthy.

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while i drew up albumin for a bolus. (yet another sore subject with me... the albumin bolus thing

we routinely use albumisol to bolus our post op cabs (adults) why do you not like it? and, are you talking about an spa (50cc) bolus or albumisol (250cc) bolus. i've never worked with the kids, but i wouldn't think they would need to volume our adult hearts do, so albumin would make sense to me.

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a patient with hypotension (my first cv admission) while i drew up albumin for a bolus. (yet another sore subject with me... the albumin bolus thing

we routinely use albumisol bolus on our post op cabs (adults). why do you not like it? and, are you talking an spa (50cc) bolus or albumisol (250cc) bolus. i've never taken care of kids, but i wouldn't think they would need as much volume as our adult hearts. the albumin bolus makes sense to me, even in the kids.

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