A heightened level of care.
Sepsis is estimated to strike up to 3.1 million people in the United States each year, and in 2014 resulted in over 182,000 deaths. Patients who develop sepsis are subjected to an onslaught of procedures and interventions, from cardiac monitoring and transfer to the ICU to frequent blood sampling and insertion of central lines and urinary catheters. It is a frightening experience and requires attention to the patient’s experience and interventions to mitigate stress.
According to a clinical feature article in our October issue, “Assessing Patients During Septic Shock Resuscitation,” the revised six-hour bundle from the Surviving Sepsis Campaign includes a recommendation that, after initial fluid resuscitation, patients’ perfusion and volume status should be reassessed.
Noninvasive bedside indicators of perfusion and volume status.
This article focuses on measuring capillary refill time (CRT) and the skin mottling score (SMS; see figure at right) and details the evidence underlying the correct way to perform these assessments and how to incorporate findings into the overall plan of care.
One of the key advantages of these two measurements is that they are noninvasive and require no equipment—just the eyes and touch of an astute nurse—yet they are highly valuable in the overall indication of whether resuscitation is working. As author Elizabeth Bridges points out:
“CRT and SMS should not be used as the sole indicators of perfusion. However, poor outcomes are associated with the failure of CRT and SMS to improve and with continued abnormal peripheral perfusion following normalization of systemic hemodynamic indicators.”
Integrating these measures into general patient care.
A nurse’s presence at the bedside allows for frequent assessment of these parameters and they can be done in concert with general care and “checking in” with the patient—something many of these ill patients might find comforting.
The article is free to read and offers 1.5 hours of CE. You can also listen to an interview with the author by clicking on the podcast icon on the article home page or visiting our Behind the Article podcast series page.