We don't use pumps here, infact pumps are a big no-no. Our staff are required to utilized pressure bags wide open alone will not cut it on most patients. Patients with a 20g IV or larger can get a 1 liter bolus with a pressure bag in about 20 minutes. We are also in the process of beginning to initiate humeral IO access for the difficult stick patient. The large bore humeral IO access allows 5liters/hour infusion. If you go to EZ IO you can see how using a humeral IO access flows quickly into the subclavian. Great for hydrating patients and working toward a regular IV access and avoiding the risks associated with Central Line placement.
Leslie Mitchell,RN Concurrent Care Intervention Nurse Education/Quality Departments Sutter Solano Medical Center 300 Hospital Drive Vallejo, CA 94590 office: 707-554-5026 cell: 573-825-7656 -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of [email protected] Sent: Wednesday, November 06, 2013 5:51 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 82, Issue 4 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Sepsisgroups Digest, Vol 82, Issue 2 (Mary Draper) 2. Re: Sepsisgroups Digest, Vol 82, Issue 3 (amer raza) ---------------------------------------------------------------------- Message: 1 Date: Tue, 5 Nov 2013 08:38:28 -0800 From: Mary Draper <[email protected]> To: 'Louis Landman' <[email protected]>, "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 2 Message-ID: <[email protected]> Content-Type: text/plain; charset="us-ascii" We don't rely on pumps, the nurse runs the fluids wide open. We have been able to get 2 liters in within 60 mins if we have 2 IV sites. Mary Draper RN BSN CCRN Quality Manager-Best Practice Support Quality Management Supervisor Office (925) 674-2045 Cell (925) 451-8792 Fax (925) 674-2373 [email protected] -----Original Message----- From: [email protected] [mailto:[email protected]] On Behalf Of Louis Landman Sent: Monday, November 04, 2013 2:58 PM To: [email protected] Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 2 I'm glad we're not the only ones with woefully slow pumps! We make up for it by using 2 or 3 infusion sites; for instance, 999 m/hr in each arm and through a central line, so about 1L every 20 minutes. Louis Landman, MD -----Original Message----- From: [email protected] Sent: Monday, November 04, 2013 5:50 PM To: [email protected] Subject: Sepsisgroups Digest, Vol 82, Issue 2 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Initial Fluid Bolus (Hawkins, Denis) ---------------------------------------------------------------------- Message: 1 Date: Mon, 4 Nov 2013 22:50:17 +0000 From: "Hawkins, Denis" <[email protected]> To: "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]> Cc: "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Initial Fluid Bolus Message-ID: <1d03c7f613bcdd4eac466f6a435ddf2b013dc...@smesexcp014031.msnyuhealth.org> Content-Type: text/plain; charset="utf-8" Anyone have a good article to use as evidence for initial fluid bolus? From: Hesham Hassaballa [mailto:[email protected]] Sent: Sunday, November 03, 2013 03:32 PM To: Kramer, George C. <[email protected]> Cc: Mileski, William <[email protected]>; [email protected] <[email protected]>; Tillman, Melinda A. <[email protected]>; Pacheco, Luis D. <[email protected]>; Whitehead, William E. <[email protected]>; Kinsky, Michael P. <[email protected]> Subject: Re: [Sepsis Groups] Initial Fluid Bolus I completely agree with George. 999 mL/hr is WAY too slow. The problem is the pumps can't go any faster, and many times the patients have poor IV lines that can't take pressure bag boluses ( because many times we are putting in the central line) Hesham A. Hassaballa, MD Program Medical Director Critical Care Rush-Copley Medical Center 2000 Ogden Avenue Aurora, IL 60504 Phone: (331) 454-6572 ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. On Nov 3, 2013, at 8:08 AM, "Kramer, George C." <[email protected]<mailto:[email protected]>> wrote: Phil and Terry, Am I off base here? To me, and the clinicians at our institution, it is often not so much the volume, but the rate of infusion and how promptly to deliver the volume that is the controversy. And there is a very active debate at our institution on this. I suggest that 999 ml/kg is largely an inadequate rate. Our surgical intensivists totally support boluses administered by pressure bag and at a minimum wide open going in fast. However, many of our medical intensivists and nurses seem to believe that 999 ml/hr is acceptable and even ideal. It makes sense to me that sometimes 999 is ok, sometimes, but often it is inadequate and puts the patient at risk for remaining in a state of hypo perfusion. And even if fluid overload is a concern rapid bolus, with assessment after each is in order in septic shock and severe sepsis. g George Kramer, PhD UTMB OvidSP Results<message:%[email protected]%3E> From: <Dellinger>, Phil <[email protected]<mailto:[email protected]>> Date: Monday, October 28, 2013 10:54 AM To: Hesham Hassaballa <[email protected]<mailto:[email protected]>>, "[email protected]<mailto:[email protected]>" <[email protected]<mailto:[email protected]>> Subject: Re: [Sepsis Groups] Initial Fluid Bolus Probably the best thing to do. And definitely simpler than trying to figure out a more precise fluid load estimate. I addressed this issue with the primary investigators and research coordinators for the EUPHRATES trial(for which I am the PI for the international trial). We are looking at endotoxin removal with hemoperfusion in patients with septic shock identified to have high endotoxin activity. One of the entry criteria, which also includes a certain level of vasopressor support, is 30 ml/kg actual body weight of crystalloid(or colloid equivalent) fluid resuscitation. ?From a purist standpoint, fluid bolus in obese septic shock patients should be somewhat less per kg than in someone who is normal body habitus since the intravascular volume expands at a somewhat lower % as body weight increases in the obese patient. However no one has ever used, in septic shock research trials, formulas that are available but not well validated to adjust for blood volume in the obese patient..? From: [email protected]<mailto:[email protected]> [mailto:[email protected]] On Behalf Of Hesham Hassaballa Sent: Friday, October 25, 2013 9:33 AM To: [email protected]<mailto:[email protected]> Subject: [Sepsis Groups] Initial Fluid Bolus I'm using actual body weight, and it works out very well. I think if we use ideal body weight, it will under resuscitate the patient. Hesham A. Hassaballa, MD Program Medical Director Critical Care Rush-Copley Medical Center 2000 Ogden Avenue Aurora, IL 60504 Phone: (331) 454-6572 ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]<mailto:[email protected]>. ?? **************************************************************** This communication, including attachments, may contain information that is confidential. It constitutes non-public information intended to be conveyed only to the designated recipient(s). If the reader or recipient of this communication is not the intended recipient, employee, or agent of the intended recipient who is responsible for delivering it to the intended recipient, or you believe that you have received this communication in error, please notify the sender immediately by return e-mail or telephone and promptly delete this e-mail, including attachments without reading them or saving them in any manner. The unauthorized use, dissemination, distribution, or reproduction of this e-mail, including attachments, is prohibited and may be unlawful. ### CONFIDENTIALITY NOTICE ### This message and any included attachments are from Cogent HMG and are intended only for the addressee. The contents in this message contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or contact the Cogent HMG Privacy Officer at [email protected]. ?? -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20131104/af628d2f/attachment.htm> ------------------------------ _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org End of Sepsisgroups Digest, Vol 82, Issue 2 ******************************************* _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ------------------------------ Message: 2 Date: Tue, 5 Nov 2013 20:32:33 +0000 From: amer raza <[email protected]> To: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 3 Message-ID: <[email protected]> Content-Type: text/plain; charset="iso-8859-1" Is there any guidance on what percent Albumin should be used for Resuscitation, ? Amer Raza, MD Pulmonary/Critical Care Mercy Health Systems [email protected] > From: [email protected] > Subject: Sepsisgroups Digest, Vol 82, Issue 3 > To: [email protected] > Date: Tue, 5 Nov 2013 12:07:22 -0800 > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg > > or, via email, send a message with subject or body 'help' to > [email protected] > > You can reach the person managing the list at > [email protected] > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Re: Sepsisgroups Digest, Vol 82, Issue 2 (Louis Landman) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Mon, 4 Nov 2013 17:57:44 -0500 > From: "Louis Landman" <[email protected]> > To: <[email protected]> > Subject: Re: [Sepsis Groups] Sepsisgroups Digest, Vol 82, Issue 2 > Message-ID: <FCDF60BCD6554B10A15D91779512EF3A@Sony> > Content-Type: text/plain; format=flowed; charset="iso-8859-1"; > reply-type=original > > I'm glad we're not the only ones with woefully slow pumps! We make up > for it by using 2 or 3 infusion sites; for instance, 999 m/hr in each > arm and through a central line, so about 1L every 20 minutes. > > Louis Landman, MD > > -----Original Message----- > From: [email protected] > Sent: Monday, November 04, 2013 5:50 PM > To: [email protected] > Subject: Sepsisgroups Digest, Vol 82, Issue 2 > > Send Sepsisgroups mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg > > or, via email, send a message with subject or body 'help' to > [email protected] > > You can reach the person managing the list at > [email protected] > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of Sepsisgroups digest..." > > > Today's Topics: > > 1. Re: Initial Fluid Bolus (Hawkins, Denis) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Mon, 4 Nov 2013 22:50:17 +0000 > From: "Hawkins, Denis" <[email protected]> > To: "'[email protected]'" > <[email protected]>, "'[email protected]'" > <[email protected]> > Cc: "'[email protected]'" <[email protected]>, "'[email protected]'" > <[email protected]>, "'[email protected]'" > <[email protected]>, "'[email protected]'" > <[email protected]>, "'[email protected]'" <[email protected]>, > "'[email protected]'" <[email protected]> > Subject: Re: [Sepsis Groups] Initial Fluid Bolus > Message-ID: > <1D03C7F613BCDD4EAC466F6A435DDF2B013DCC83@SMESEXCP014031.msnyuhealth.o > rg> > > Content-Type: text/plain; charset="utf-8" > > Anyone have a good article to use as evidence for initial fluid bolus? > > From: Hesham Hassaballa [mailto:[email protected]] > Sent: Sunday, November 03, 2013 03:32 PM > To: Kramer, George C. <[email protected]> > Cc: Mileski, William <[email protected]>; > [email protected] > <[email protected]>; > Tillman, Melinda A. <[email protected]>; Pacheco, Luis D. > <[email protected]>; Whitehead, William E. <[email protected]>; > Kinsky, Michael P. <[email protected]> > Subject: Re: [Sepsis Groups] Initial Fluid Bolus > > I completely agree with George. 999 mL/hr is WAY too slow. The problem > is the pumps can't go any faster, and many times the patients have > poor IV lines that can't take pressure bag boluses ( because many > times we are putting in the central line) > > > > Hesham A. Hassaballa, MD > Program Medical Director > Critical Care > Rush-Copley Medical Center > 2000 Ogden Avenue > Aurora, IL 60504 > Phone: (331) 454-6572 > > ### CONFIDENTIALITY NOTICE ### > This message and any included attachments are from Cogent HMG and are > intended only for the addressee. The contents in this message contain > confidential information belonging to the sender that is legally protected. > Unauthorized forwarding, printing, copying, distribution, or use of > such information is strictly prohibited and may be unlawful. If you > are not the addressee, please promptly delete this message and notify > the sender of the delivery error by e-mail or contact the Cogent HMG > Privacy Officer at > [email protected]<mailto:[email protected]>. > > On Nov 3, 2013, at 8:08 AM, "Kramer, George C." > <[email protected]<mailto:[email protected]>> wrote: > > Phil and Terry, > > Am I off base here? > > To me, and the clinicians at our institution, it is often not so much > the volume, but the rate of infusion and how promptly to deliver the > volume that is the controversy. And there is a very active debate at > our institution on this. > > I suggest that 999 ml/kg is largely an inadequate rate. Our surgical > intensivists totally support boluses administered by pressure bag and > at a minimum wide open going in fast. > > However, many of our medical intensivists and nurses seem to believe > that > 999 ml/hr is acceptable and even ideal. It makes sense to me that > sometimes > 999 is ok, sometimes, > > but often it is inadequate and puts the patient at risk for remaining > in a state of hypo perfusion. And even if fluid overload is a concern > rapid bolus, with assessment after each is in order in septic shock > and severe sepsis. > > g > > George Kramer, PhD > UTMB > > OvidSP > Results<message:%[email protected]% > 3E> > From: <Dellinger>, Phil > <[email protected]<mailto:[email protected] > u>> > Date: Monday, October 28, 2013 10:54 AM > To: Hesham Hassaballa > <[email protected]<mailto:[email protected] > m>>, > "[email protected]<mailto:[email protected]>" > <[email protected]<mailto:[email protected] > roups.org>> > Subject: Re: [Sepsis Groups] Initial Fluid Bolus > > Probably the best thing to do. And definitely simpler than trying to > figure out a more precise fluid load estimate. I addressed this issue > with the primary investigators and research coordinators for the > EUPHRATES trial(for which I am the PI for the international trial). We > are looking at endotoxin removal with hemoperfusion in patients with > septic shock identified to have high endotoxin activity. One of the > entry criteria, which also includes a certain level of vasopressor > support, is 30 ml/kg actual body weight of crystalloid(or colloid equivalent) > fluid resuscitation. > > ?From a purist standpoint, fluid bolus in obese septic shock patients > should be somewhat less per kg than in someone who is normal body > habitus since the intravascular volume expands at a somewhat lower % > as body weight increases in the obese patient. However no one has ever > used, in septic shock research trials, formulas that are available but > not well validated to adjust for blood volume in the obese patient..? > > > From: > [email protected]<mailto:sepsisgroups-bounce > [email protected]> > [mailto:[email protected]] On Behalf Of > Hesham Hassaballa > Sent: Friday, October 25, 2013 9:33 AM > To: > [email protected]<mailto:[email protected] > oups.org> > Subject: [Sepsis Groups] Initial Fluid Bolus > > I'm using actual body weight, and it works out very well. I think if > we use ideal body weight, it will under resuscitate the patient. > > Hesham A. Hassaballa, MD > Program Medical Director > Critical Care > Rush-Copley Medical Center > 2000 Ogden Avenue > Aurora, IL 60504 > Phone: (331) 454-6572 > > ### CONFIDENTIALITY NOTICE ### > This message and any included attachments are from Cogent HMG and are > intended only for the addressee. The contents in this message contain > confidential information belonging to the sender that is legally protected. > Unauthorized forwarding, printing, copying, distribution, or use of > such information is strictly prohibited and may be unlawful. If you > are not the addressee, please promptly delete this message and notify > the sender of the delivery error by e-mail or contact the Cogent HMG > Privacy Officer at > [email protected]<mailto:[email protected]>. > > ### CONFIDENTIALITY NOTICE ### > > This message and any included attachments are from Cogent HMG and are > intended only for the addressee. The contents in this message contain > confidential information belonging to the sender that is legally protected. > Unauthorized forwarding, printing, copying, distribution, or use of > such information is strictly prohibited and may be unlawful. If you > are not the addressee, please promptly delete this message and notify > the sender of the delivery error by e-mail or contact the Cogent HMG > Privacy Officer at > [email protected]<mailto:[email protected]>. ?? > > **************************************************************** This > communication, including attachments, may contain information that is > confidential. It constitutes non-public information intended to be > conveyed only to the designated recipient(s). If the reader or > recipient of this communication is not the intended recipient, > employee, or agent of the intended recipient who is responsible for > delivering it to the intended recipient, or you believe that you have > received this communication in error, please notify the sender > immediately by return e-mail or telephone and promptly delete this > e-mail, including attachments without reading them or saving them in > any manner. The unauthorized use, dissemination, distribution, or > reproduction of this e-mail, including attachments, is prohibited and may be > unlawful. > > ### CONFIDENTIALITY NOTICE ### > > This message and any included attachments are from Cogent HMG and are > intended only for the addressee. The contents in this message contain > confidential information belonging to the sender that is legally protected. > Unauthorized forwarding, printing, copying, distribution, or use of > such information is strictly prohibited and may be unlawful. If you > are not the addressee, please promptly delete this message and notify > the sender of the delivery error by e-mail or contact the Cogent HMG > Privacy Officer at [email protected]. ?? > -------------- next part -------------- An HTML attachment was > scrubbed... > URL: > <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org > /attachments/20131104/af628d2f/attachment.htm> > > ------------------------------ > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg > > > End of Sepsisgroups Digest, Vol 82, Issue 2 > ******************************************* > > > > ------------------------------ > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.o > rg > > > End of Sepsisgroups Digest, Vol 82, Issue 3 > ******************************************* -------------- next part -------------- An HTML attachment was scrubbed... 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