Hypertensive emergency with discrepancy between arterial line and sphygmomanometer

Background: Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. Methods: We describe a multidisciplinary vascular access team’s development to improve frontline providers’ workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. Results and conclusions: Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.

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Epidemiology and Management of Children with Hypertensive Crisis: A Single-Center Experience

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1698759 ◽

2019 ◽

Vol 09 (01) ◽

pp. 045-050

Author(s):

Alicia May Lim ◽

Siew Le Chong ◽

Yong Hong Ng ◽

Yoke Hwee Chan ◽

Jan Hau Lee

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hypertensive Crisis ◽

Hypertensive Emergency ◽

Renal Pathology ◽

Pediatric Hospital ◽

Single Center ◽

Single Center Experience ◽

Effective Treatments

AbstractMost children who present with hypertensive crisis have a secondary cause for hypertension. This study describes the epidemiology and management of children with hypertensive crisis. A retrospective cohort study was done in a tertiary pediatric hospital from 2009 to 2015. Thirty-seven patients were treated for hypertensive crisis. Twelve (32.4%) patients were treated for hypertensive emergency. The majority of our patients (33 [89.1%]) had a secondary cause of hypertension. The most common identifiable cause of hypertension was a renal pathology (18/37 [48.6%]). Oral nifedipine (23 [62.1%]) was the most frequently used antihypertensive, followed by intravenous labetalol (8 [21.6%]). There were no mortalities or morbidities. Hypertensive crisis in children is likely secondary in nature. Oral nifedipine and intravenous labetalol are both effective treatments.

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Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method

The Journal of Vascular Access ◽

10.1177/1129729820904872 ◽

2020 ◽

Vol 21 (5) ◽

pp. 715-722

Author(s):

Jessica Baez ◽

Elizabeth Powell ◽

Megan Leo ◽

Uwe Stolz ◽

Lori Stolz

Keyword(s):

Delphi Method ◽

Competency Assessment ◽

Arterial Line ◽

Ultrasound Guided ◽

Arterial Access ◽

Modified Delphi Method ◽

Modified Delphi ◽

Item Checklist ◽

Standard Quality ◽

Femoral Arterial Access

Background: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. Methods: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

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905: Improving the Treatment of Obstetric Hypertensive Emergency

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.11.492 ◽

2018 ◽

Vol 218 (1) ◽

pp. S537-S538

Author(s):

Rosemary J. Froehlich ◽

Lindsay Maggio ◽

Phinnara Has ◽

Roxanne Vrees ◽

Brenna L. Hughes

Keyword(s):

Hypertensive Emergency

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Prevalence, Determinants, and Clinical Significance of Cardiac Troponin-I Elevation in Individuals Admitted for a Hypertensive Emergency

Journal of Clinical Hypertension ◽

10.1111/j.1751-7176.2011.00476.x ◽

2011 ◽

Vol 13 (8) ◽

pp. 551-556 ◽

Cited By ~ 18

Author(s):

Luis Afonso ◽

Himabindu Bandaru ◽

Ankit Rathod ◽

Apurva Badheka ◽

Mohammad Ali Kizilbash ◽

...

Keyword(s):

Clinical Significance ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Hypertensive Emergency

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The Use of Topical Nitroglycerin Ointment to Treat Peripheral Tissue Ischemia Secondary to Arterial Line Complications in Neonates

Journal of Perinatology ◽

10.1038/sj.jp.7210713 ◽

2002 ◽

Vol 22 (5) ◽

pp. 416-419 ◽

Cited By ~ 28

Author(s):

Mariana C Baserga ◽

Asha Puri ◽

Augusto Sola

Keyword(s):

Peripheral Tissue ◽

Arterial Line ◽

Tissue Ischemia ◽

Nitroglycerin Ointment ◽

Topical Nitroglycerin

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Arterial Line Placement Pitfalls Can Be Demonstrated and Visualized With an Inexpensive, Wearable Trainer

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2021.10.017 ◽

2022 ◽

Author(s):

Olivia Paradis ◽

Lauren Bitterman ◽

Kimberly H. Park ◽

Stacey Ernest ◽

Amy Russell ◽

...

Keyword(s):

Arterial Line ◽

Line Placement

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