Why these 11 interventions?

CCAPG seeks to identify ICU interventions which meet the following 3 criteria: 

1. The intervention is potentially incompatible with one or more of the following common patient goals:

  • To be cured

  • To live longer

  • To improve health

  • To maintain autonomy

  • To maintain health

  • To be comfortable

  • To accomplish a particular personal life goal (such as attending a birth or wedding)*

  • To continue interacting with others in a meaningful way

2. The intervention has the potential to cause physical, emotional or financial harm to patients

3. The intervention can usually be anticipated on a non-emergent basis. 

In the 1st round of the study, 100% of ICU doctors and nurses agreed that the following 4 intervention might meet these criteria: 

  1. Dialysis catheter (permanent)

  2. Suprapubic catheter

  3. Feeding tube (gastric, oral, nasal)

  4. Peritoneal dialysis

In the 2nd round of the study, each possible intervention was rated by the ICU doctors and nurses on the panel on how well it met each of the 3 criteria using a 1-9 Likert scale.  The total score for these interventions was the sum of the median rating on each criteria. 

In the 3rd round survey, all CCAPG panel members will vote on the 4 interventions with 100% agreement from the 1st round and the interventions with a total score greater than 17 and a median score of at least 5 for each criteria in the 2nd round.  Descriptions of these 11 interventions are provided on the CCAPG website. 

 

 In-hospital dialysis

HTTP://BIT.LY/1QCEUBG

HTTP://BIT.LY/1QCEUBG

HTTP://BIT.LY/1OXAZMQ

HTTP://BIT.LY/1OXAZMQ

What is it?

In-hospital dialysis is a form of life support for people whose kidneys don’t work. .

What does it do?

Kidneys normally clean a person’s blood.  If they stop working, the blood becomes full of fluid and dangerous toxins.  During dialysis, blood is removed from the body, cleaned by a machine, and then returned to the body.

How might this intervention cause physical, emotional or financial harm to a patient? 

  • Dialysis requires a large tube (dialysis catheter) to be placed into the patient’s neck or groin in order to remove their blood for cleaning.  Placing this tube can be risky. Risks from the placement of the dialysis catheter include bleeding, and infection. The longer the dialysis catheter is in place, the higher the risk of infection, formation of blood clots around the catheter, or scarring of the vein it is placed in.

  • Regardless of age or income, Medicare covers the cost of dialysis for all patients.

How quickly does this decision need to be made?

It depends. For people whose kidneys stop working suddenly, they may die within hours if their blood is not cleaned.  For people whose kidneys stop working slowly, they may be able to survive for weeks.

Why might some people choose this intervention?

  • Dialysis can keep a person alive until they know if their kidneys will get better or are permanently broken.

  • About ½ of people whose kidneys stop working while they are in the ICU survive if they receive treatment. (Pannu, 2005, Schiffl, 2012)

  • If someone with kidney failure decides not to have dialysis, they will eventually die. As toxins and fluid build up they may feel tired, itchy, nauseous, or short of breath. These symptoms can generally be treated with medications from the doctor.

  • If the kidneys are permanently broken, dialysis is required for if a patient wants to live as long as possible, or live long enough to see an important event.

  • A small number of people whose kidneys are permanently broken qualify for a kidney transplant.

Why might some people choose NOT to have this intervention?

  • Dialysis can keep a person alive until they know if their kidneys will get better or are permanently broken.

  • If a person’s kidneys are permanently broken, they must visit a treatment center 3 times per week for 4 hours for the rest of their life.

  • During dialysis, people may experience light-headedness, nausea, or anxiety which can be uncomfortable.

  • About ½ of people die within 3 years if they survive their ICU stay but their kidneys are permanently broken and they can’t receive a new kidney. (Collins, 2010) 

  • A decision to stop dialysis needs to be made before a patient can die naturally.

Citations:

Collins AJ, Foley RN, Herzog C, et al. Excerpts From the US Renal Data System 2009 Annual Data Report. Am J Kidney Dis. 2010;55(1 Suppl 1):S1-A7.
Davison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. American Journal of Kidney Diseases. 2003;42(6):1239-1247.
Kliger AS, Finkelstein FO. Which patients choose to stop dialysis? Nephrol Dial Transplant. 2003;18(5):869-871.
Murray AM, Arko C, Chen S-C, Gilbertson DT, Moss AH. Use of hospice in the United States dialysis population. Clin J Am Soc Nephrol. 2006;1(6):1248-1255.
Pannu N, Gibney RN. Renal replacement therapy in the intensive care unit. Ther Clin Risk Manag. 2005;1(2):141-150.
Pham P-CT, Toscano E, Pham P-MT, Pham P-AT, Pham SV, Pham P-TT. Pain management in patients with chronic kidney disease. NDT Plus. 2009;2(2):111-118.
Schiffl H, Lang S, Fischer R.  Long term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study. Clin Kidney J 2012;5(4):297-302.


Long-term dialysis catheter

HTTP://WWW.BEAUMONT.IE/KIDNEYCENTRE-FORPATIENTS-AGUIDETODIALYSIS-ACCESSFO

HTTP://WWW.BEAUMONT.IE/KIDNEYCENTRE-FORPATIENTS-AGUIDETODIALYSIS-ACCESSFO

What is it?

A long-term dialysis catheter is a thin flexible tube that is placed into a large vein, usually in the neck or chest. 

What does it do?

  • Kidneys normally clean a person’s blood.  If they stop working, the blood becomes full of fluid and dangerous toxins.  During dialysis, blood is removed from the body, cleaned by a machine, and then returned to the body.

  • With a long term catheter, part of the catheter is hidden under the skin to help prevent infections. A long term dialysis catheter is used when the need for dialysis is expected to be longer than a few weeks. 

How might this intervention cause physical, emotional or financial harm to a patient?

  • Placing the catheter requires minor surgery. The risks from the surgery include bleeding, injuring the lung, and infection.

  •  Long term catheters are intended as a bridge to when either the kidneys starting to work again or to an even more permanent solution. These more permanent options are usually considered only after the patient is well enough to leave the hospital.

  • The longer the dialysis catheter is in place, the more likely it is to get infected or stop working.

  • More than 1/3rd of people with a long-term dialysis catheter develop a serious infection within 3 months.  (Lee, 2005; Sarnak, 2000)

  • Infection is the 2nd most common cause of death among people receiving dialysis. (Lee, 2005; Sarnak, 2000)

  • Between 20-25% of people who require chronic dialysis are depressed. (Kimmel 2006,2007,2008)

  • Regardless of age or income, Medicare covers the cost of hemodialysis for all patients whose kidneys no longer work.

How quickly does this decision need to be made? 

If a long term catheter is replacing a more short-term catheter through which dialysis can still be performed, there may be more time to make the decision.  If a person with kidney failure does not receive dialysis, they will die within days to weeks as the toxins build up in their blood.

Why might some people choose this intervention?

  • Dialysis can keep a person alive until they know if their kidneys will get better or are permanently broken.

  • If someone with kidney failure decides not to have dialysis, they will eventually die. As toxins and fluid build up, they may feel tired, itchy, nauseous, or short of breath. These symptoms can generally be treated with medications.

  • If the kidneys are permanently broken, the person must visit a treatment center 3 times per week for the rest of their life to live as long as possible, or live long enough to see an important event.

  • A small number of people whose kidneys are permanently broken qualify for a kidney transplant.

Why might some people choose NOT to have this intervention?

  • Dialysis will not fix the kidneys or cure the patient. 

  • During dialysis, some people feel light-headed, nauseous, or anxious. 

  • Almost ½ of people whose kidneys stop working for the 1st time in the ICU will die in the hospital. (Schiffl, 2012)  

  • About ½ of people die within 3 years if they survive their ICU stay but their kidneys are permanently broken and they can’t receive a new kidney. (Collins, 2010)  

  • A decision to stop dialysis needs to be made before a patient can die naturally.

Citations

Collins AJ, Foley RN, Herzog C, et al. Excerpts From the US Renal Data System 2009 Annual Data Report. Am J Kidney Dis. 2010;55(1 Suppl 1):S1-A7.
Davison SN. Pain in hemodialysis patients: prevalence, cause, severity, and management. American Journal of Kidney Diseases. 2003;42(6):1239-1247.
Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Semin Nephrol. 2006;26(1):68-79.
Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression in end-stage renal disease patients: a critical review. Adv Chronic Kidney Dis. 2007;14(4):328-334.
Kimmel PL, Cohen SD, Weisbord SD. Quality of life in patients with end-stage renal disease treated with hemodialysis: survival is not enough! J Nephrol. 2008;21 Suppl 13:S54-S58.
Murray AM, Arko C, Chen S-C, Gilbertson DT, Moss AH. Use of hospice in the United States dialysis population. Clin J Am Soc Nephrol. 2006;1(6):1248-1255.
Pham P-CT, Toscano E, Pham P-MT, Pham P-AT, Pham SV, Pham P-TT. Pain management in patients with chronic kidney disease. NDT Plus. 2009;2(2):111-118.
Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000;58(4):1758-1764.

Schiffl H, Lang S, Fischer R.  Long term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study. Clin Kidney J 2012;5(4):297-302.

Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005;46(3)501. 


Suprapubic urinary catheter

HTTP://DXLINE.INFO/DISEASES/SUPRAPUBIC-CATHETER-CARE

HTTP://DXLINE.INFO/DISEASES/SUPRAPUBIC-CATHETER-CARE

What is it?

A suprapubic urinary catheter is a flexible tube inserted through the abdomen (belly) and into the bladder. 

What does it do?

  • If someone cannot urinate normally, their bladder must either be emptied multiple times each day by manual catheterization which involves placing a tube into the urethra (pee hole), or it can be emptied by a suprapubic catheter. 

  • A suprapubic urinary catheter drains urine directly from the bladder into a bag.  

How might this intervention cause physical, emotional or financial harm to a patient?

  • 4 - 20% of people with suprapubic catheters get repeated urinary infections. (Ahluwalia et al., 2006).

  • For every 100 people who have surgery to place a suprapubic catheter, 2 or 3 experience damage to their bladder or bowls. This damage is generally not life threatening. (Ahluwalia et al., 2006).

  • Some patients are embarrassed by the catheter or self-conscious about it leaking.

How quickly does this decision need to be made?

  • In a healthy person, the urethra drains urine from the bladder.  If the urethra is completely blocked, a decision about how to empty the bladder must be made within 1-2 days. 

  • If the urethra is not blocked, decisions about suprapubic catheters can be made over weeks or months.

Why might some people choose this intervention?

  • Long-term manual catheterization can damage the urethra.  A suprapubic catheter prevents this damage.

  • Most people who have been using manual catheterization to empty their bladders report improved quality of life after receiving a suprapubic catheter. (Ahluwalia et al., 2006; Sheriff et al., 1998)

Why might some people choose NOT to have this intervention?

  • The suprapubic catheter will not cure a person or make them able to urinate normally again.

  • Some people with a suprapubic catheter need diapers.

  • Sometimes suprapubic catheters leaking or cause bladder cramping.

  • Some patients get frequent urinary infections or bladder stones.

  • The suprapubic catheter must be changed every 6-8 weeks which may require a trip to the hospital.

 

Citations

Ahluwalia, R. S., Johal, N., Kouriefs, C., Kooiman, G., Montgomery, B. S. I., & Plail, R. O. (2006). The Surgical Risk of Suprapubic Catheter Insertion and Long-Term Sequelae. Annals of The Royal College of Surgeons of England, 88(2), 210-213.

Sheriff, M., Foley, S., McFarlane, J., Nauth-Misir, R., Craggs, M., & Shah, P. (1998). Long-term suprapubic catheters: clinical outcome and satisfaction survey. Spinal Cord, 36(3), 171-176. 


Temporary nasogastric feeding tube

HTTP://BIT.LY/1WGLOFZ

HTTP://BIT.LY/1WGLOFZ

What is it?

A nasogastric feeding tube (NG tube) is a thin, flexible, plastic tube that is passed through the nose and into the stomach.

What does it do?

  • Medications or nutrition can be placed in the tube for patients who cannot swallow or are not awake.

  • NG tubes can also be used to remove fluid or blood from the stomach.

How might this intervention cause physical, emotional or financial harm to a patient?

  • Patients may find an NG tube uncomfortable.

  • An NG tube could injury the nose or throat.  People with an NG tube may be more likely to develop a nasal or sinus infection.

  • When an NG tube is put in, there’s a small risk it will tear the esophagus (the tube between the throat and the stomach) or cause bleeding. This is rare but can be life-threatening. (Isik, Firat, & Soyturk, 2014)

  • Approximately 2% of patients will have a complication from the NG tube being accidentally placed into the lung. This could cause injury to the lung, bleeding, or lung infection. (Pillai, Vegas, & Brister, 2005)

How quickly does this decision need to be made?

If a patient does not receive any nutrition, they may die within weeks.

Why might some people choose this intervention?

  • NG tubes can give medications and nutrition to people who cannot eat safely.

  • Receiving nutrition may help patients maintain their strength while they are recovering from an illness.

  • If something is blocking a person’s bowels, an NG tube can provide significant relief from nausea, vomiting, and pain.

Why might some people choose NOT to have this intervention?

  • Patients who are at the end of their life or have advanced dementia often do not feel hunger. Giving these people nutrition through a feeding tube will not make them more comfortable or cure them.

  • Some patients find NG tubes uncomfortable.

  • A decision to remove the NG tube may need to be made before a patient can die naturally.

 

Citations

Isik, A., Firat, D., & Soyturk, M. (2014). A case report of esophageal perforation: complication of nasogastric tube placemetn. The American Journal of Case Reports, 15, 168-171.

Pillai, J. B., Vegas, A., & Brister, S. (2005). Thoracic complications of nasogastric tube: review of safe practice. Interactive CardioVascular and Thoracic Surgery, 4(5), 429-433. doi:10.1510/icvts.2005.109488


 Permanent or long-term feeding tube

HTTP://WWW.MYPRIMEYEARS.COM/HNC/FEEDINGTUBE.SHTML

HTTP://WWW.MYPRIMEYEARS.COM/HNC/FEEDINGTUBE.SHTML

HTTP://LEMELDER.BLOGSPOT.COM/2012/06/STANDING-AT-CORNER-OF-STUBBORN-AND.HTML

HTTP://LEMELDER.BLOGSPOT.COM/2012/06/STANDING-AT-CORNER-OF-STUBBORN-AND.HTML

What is it?

A long-term feeding tube is a flexible tube that is placed through the abdominal wall and into the stomach.

What does it do?

  • Feeding tubes are used to deliver medications or nutrition to the stomach for patients who cannot swallow safely.

  • Permanent, or long-term, feeding tubes are placed when someone won’t be able to swallow for more than 4 weeks.

How might this intervention cause physical, emotional or financial harm to a patient?

  • The physical risks of getting a permanent feeding tube include pain, bleeding, or injury to the stomach or guts.  

  • In the long term, potential risks include infection around the tube, accidental removal of the tube, bleeding, leakage around the tube, forming an opening between the stomach and skin or between the stomach and abdominal cavity.   The majority of physical complications are minor (not life threatening) but occur in 8-30% of patients. (Schrag et al., 2007)

  • Some patients find a feeding tube uncomfortable or feel self-conscious.

How quickly does this decision need to be made?

If a patient does not receive any nutrition they may die within weeks.  During the time a decision is being made food can be delivered other ways. 

Why might some people choose this intervention?

  • Receiving nutrition helps patients maintain their strength while they recover from an illness.

  • Feeding tubes are not always permanent.  People who recover from long-term illnesses like strokes, head/neck cancer, or head/neck surgery may have their feeding tube removed so they can eat normally again. (Kurien, 2010)

Why might some people choose NOT to have this intervention?

  • Patients who are at the end of their life or have advanced dementia often do not feel hunger. Giving these people nutrition through a feeding tube will not improve their quality of life or prolong their life. (Sampson, 2009)

  • If a long-term feeding tube is placed because someone cannot swallow safely, the patients may not be able to eat food by mouth until their swallowing improves.

  • A decision may need to be made to stop feeding someone via a feeding tube for them to die naturally.

Citations

Kurien, M., McAlindon, M. E., Westaby, D., & Sanders, D. S. (2010). Percutaneous endoscopic gastrostomy (PEG) feeding. BMJ, 340. doi:10.1136/bmj.c2414

Sampson, E., Candy, B., & Jones, L. (2009). Enteral tube feeding for older people with advanced dementia. Cochrane Database of Systematic Reviews(2).

Schrag, S. P., Sharma, R., Jaik, N. P., Seamon, M. J., Lukaszczyk, J. J., Martin, N. D., . . . Stawicki, P. S. (2007). Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. Journal of Gastrointestinal and Liver Disease, 16, 407-418.


Tracheotomy

HTTP://BIT.LY/1QN0ZOL

HTTP://BIT.LY/1QN0ZOL

HTTP://BIT.LY/1NY0SQK

HTTP://BIT.LY/1NY0SQK

What is it?

A tracheostomy tube (trach tube) is a tube that is placed through the front of the neck into the windpipe, or trachea.

What does it do?

  • People who cannot breathe on their own require a breathing machine or ventilator.  At first the ventilator delivers air through a tube that goes into the person’s mouth or nose and then into their lungs.  A trach tube provides a route for air to reach the lungs without going through the nose or mouth.

  • Trach tubes can also be used to remove mucus or saliva from the upper airway.

How might this intervention cause physical, emotional or financial harm to a patient?

  • The area around the trach tube can get infected or blocked by mucus.  3-12% of patients with trach tubes develop a narrowing in the airway that cause them to feel short of breath. Less than 1% develop life-threatening complications, such as a hole between the windpipe and a large blood vessel or esophagus (tube from mouth to stomach).(Epstein, 2005)

  • Many patients cannot eat when the trach tube is first placed. A feeding tube is typically placed at the same time for this reason.

  • Some patients find trach tubes uncomfortable or feel self-conscious about their trach tube.

  • Some patients are upset by the scar a trach tube creates.

How quickly does this decision need to be made?

A decision about a trach tube should be made 1-3 weeks after a patient begins using a breathing machine (ventilator). This time limit may change depending on the reason the trach is being placed.

Why might some people choose this intervention?

  • A trach tube connected to a ventilator can keep a person alive while they receive medical treatment.

  • A trach tube replaces the tube that was in the person’s mouth.  Removing the tube from the mouth lowers their risk of getting pneumonia while on the ventilator.

  • A trach tube may prevent damage to the voicebox and airway. 

  • Some people with trach tubes are able to speak or eat once the tube in the mouth is removed.

  • If a person recovers the ability to breathe normally, the trach tube can be removed.

Why might some people choose NOT to have this intervention?

  • A trach tube may allow people to live longer but it will not cure them. Approximately 30% of patients will die in the hospital from their underlying disease despite receiving a tracheotomy. (Pandian, 2012)

  • Some people may need to be connected to a breathing machine every day to stay alive.  These people may need to live in a residential facility (nursing home) for the rest of their lives.

  • If a patient’s trach tube is connected to a breathing machine, the machine will need to be turned off before they can die naturally.

 

Citations

Epstein, S. K. (2005). Late Complications of Tracheostomy. Respiratory Care, 50(4), 542-549.  Retrieved from http://rc.rcjournal.com/content/50/4/542.abstract

Pandian, V., Gilstrap, D., Mirski, M., Haut, E., Bowman, N., Yarmus, L., Feller-Kopman, D. (2012). Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy. Journal of Critical Care, 27(4), 420.e429-420e.415.


Rectal fecal management system

HTTP://BIT.LY/1QN17O9

HTTP://BIT.LY/1QN17O9

What is it?

A rectal fecal management system (FMS) is a thin plastic tube that is inserted into the rectum to collect stool (poop).

What does it do?

The FMS is used to collect stool and control diarrhea for patients in the hospital who cannot get out of bed to use the toilet. 

How might this intervention cause physical, emotional or financial harm to a patient?

There’s a small risk that the FMS could cause an ulcer in the rectum which may be painful or cause bleeding.

How quickly does this decision need to be made?

There is no time limit.

Why might some people choose this intervention?

  • The FMS may effectively divert stool into the bag which could protect a patient’s wounds from contamination and reduce the risk of infection or of the patient's skin becoming ulcerated.

  • If it is painful for a patient to turn over in bed each time they need to be cleaned, an FMS will make them more comfortable.

  • Collecting stool in an FMS may reduce odor from diarrhea and preserve a patient’s dignity.

Why might some people choose NOT to have this intervention?

Some patients may find the FMS uncomfortable or embarrassing.


Long-term venous catheter

HTTP://BIT.LY/1OXBVPK

HTTP://BIT.LY/1OXBVPK

What is it?

A long-term venous catheter is a thin, flexible tube that is placed into a large vein, usually in the neck or chest.

What does it do?

The catheter can remain in place for weeks to years so that blood can be drawn or medications can be given without repeatedly puncturing the skin.

How might this intervention cause physical, emotional or financial harm to a patient?

  • There is a risk of bleeding, injuring the lung, and infection when the catheter is put in.

  • After the catheter is in, there’s a risk that the catheter could become clotted or cause a skin or bloodstream infection.

  • The longer the catheter is in place, the more likely it is to get infected or stop working.

How quickly does this decision need to be made?

There is no rush.  Most patients use short-term catheters in the arm, hand, or neck until a decision is made regarding a long term catheter.

Why might some people choose this intervention?

  • For people who need to have their blood drawn frequently or need to receive medications for a long time, a long-term catheter makes these treatments simple and painless.

  • This type of catheter may allow patients to receive certain treatments at home rather than staying in the hospital.

  • A long-term venous catheter is easy to remove when it is no longer needed.

Why might some people choose NOT to have this intervention?

  • If a patient is at the end of their life, they may not want to take the risks associated with getting a long-term venous catheter.

  • As long as the patient is still in the hospital they can receive medications through a smaller short-term catheter.

  • Some people may feel self-conscious about the way the catheter looks.


 Endoscopy

HTTP://BIT.LY/1S9PEQR

HTTP://BIT.LY/1S9PEQR

HTTP://BIT.LY/1HAYEJH

HTTP://BIT.LY/1HAYEJH

What is it?

An Upper or Lower Endoscopy, also called EGD (esophago-gastro-duodenoscopy) and colonoscopy, is a procedure that allows a doctor to see the inside of the gastrointestinal (GI) tract, including the stomach, and intestines using a tiny camera.

What does it do?

A long flexible tube with a tiny camera on the end is inserted into a person’s mouth or up their butt.  

How might this intervention cause physical, emotional or financial harm to a patient?

  • The procedure requires sedation.  Bad reactions to the sedating medications are possible.

  • If the patient has eaten recently there is risk of inhaling food or fluid from the stomach into the lungs, which could cause pneumonia.

  • The camera could cause a tear in area of the GI tract being examined. Less than 2% of the time, this will cause bleeding or require surgery. 

How quickly does this decision need to be made?

It depends.  If the patient’s GI tract is bleeding badly a decision may need to be made within hours. 

Why might some people choose this intervention?

  • The most common reason for an upper or lower endoscopy is to find a source of bleeding. Endoscopy can help diagnose where the bleeding is coming from which may save the patient’s life.

  • If a patient has a narrowing in their GI tract, an endoscopy can help stretch out that part of the GI tract and stop nausea, vomiting, or constipation. 

Why might some people choose NOT to have this intervention?

  • If a patient is at the end of their life, an endoscopy may not save their life and may be uncomfortable.

  • The patient might require a breathing tube during or after the procedure.  


Spinal tap

HTTP://BIT.LY/1WK1R6J

HTTP://BIT.LY/1WK1R6J

What is it?

A spinal tap, or lumbar puncture (LP), is a procedure to remove a small amount of fluid from around the spinal cord.

What does it do?

Fluid obtained from a spinal tap may help doctors diagnose infection, bleeding, or cancer in the brain.   

How might this intervention cause physical, emotional or financial harm to a patient?

  • The most common physical risk from the LP is a headache.

  • Very rarely, complications of infection, bleeding, pain and numbness in the back or legs, or paralysis can occur.

  • The procedure can be uncomfortable while it is being performed.

How quickly does this decision need to be made?

The spinal tap is typically done to diagnose problems that need to be treated within hours to days. 

Why might some people choose this intervention?

The LP may provide important information to doctors that could help cure a patient’s disease or help them to live longer. 

Why might some people choose NOT to have this intervention?

The procedure can be uncomfortable.  



Pulmonary artery catheter

HTTPS://VIMEO.COM/19188104

HTTPS://VIMEO.COM/19188104

HTTP://BIT.LY/1M0CJUI

HTTP://BIT.LY/1M0CJUI

What is it?

A pulmonary artery catheter (PA catheter) is a small hollow tube that is placed in a large vein in the neck or chest and guided through the right side of the heart into the main blood vessel carrying blood to the lungs.

What does it do?

The PA catheter measures blood flow in the heart and lungs. This can help doctors to diagnose or manage problems like low blood pressure (shock), or heart failure.

How might this intervention cause physical, emotional or financial harm to a patient?

  • The insertion of the catheter can cause bleeding, injury to the vein or lung, or infection. Approximately 3-5% of patients will experience prolonged irregular heart rhythms, which is usually reversible but could be life-threatening. (Sprung, 1982)

  • Other rare but life-threatening complications include creating a tear in the heart or in the main blood vessel carrying blood to the lungs, as well as forming air or blood clots around the catheter that could prevent blood flow to the lungs.

How quickly does this decision need to be made?

There is no clear time limit.

Why might some people choose this intervention?

 This procedure might help doctors diagnose or manage a patient’s illness.

Why might some people choose NOT to have this intervention?

  • Even with a PA catheter, doctors may not be able to prevent the patient from dying. (Shah, 2005)

  • Patients with PA catheters do not recover faster than patients without PA catheters. (Shah, 2005)

  • A patient will not be able to leave the intensive care unit until the catheter is removed.

 

Citations

1.         Sprung CL, Pozen RG, Rozanski JJ, Pinero JR, Eisler BR, Castellanos A. Advanced ventricular arrhythmias during bedside pulmonary artery catheterization. The American Journal of Medicine. 1982;72(2):203-8.

2.         Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: Meta-analysis of randomized clinical trials. JAMA. 2005;294(13):1664-70.