Code Management

Code Management

The goals of any code are to restore the patient’s spontaneous heartbeat and respirations and also to prevent hypoxic damage to the brain and other vital organs. Fulfilling these goals requires a team approach. Ideally, the team should consist of health care workers trained in advanced cardiac life support (ACLS), although health care workers trained in basic life support (BLS) may also be a part of the team. Sponsored by the American Heart Association (AHA), the ACLS course incorporates BLS skills with advanced resuscitation techniques. BLS and ACLS should be performed according to the 2010 AHA guidelines.

In most health care facilities, ACLS-trained nurses provide the first resuscitative efforts to cardiac arrest patients, often administering cardiopulmonary resuscitation (CPR) and performing defibrillation before the doctor’s arrival. Ventricular fibrillation commonly precedes sudden cardiac arrest; initial resuscitative efforts should focus on early CPR, rapid recognition of arrhythmias and, when indicated, defibrillation. If monitoring equipment isn’t available, you should simply perform BLS measures. Of course, the scope of your responsibilities in any situation depends on your facility’s policies and procedures and your state’s nurse practice act.

A code may be called for patients with absent pulse, apnea or inadequate breathing, ventricular fibrillation, ventricular tachycardia, and asystole. Family members may be present during a code if your facility’s policy supports it. The Emergency Nurses Association supports the option of family presence during invasive procedures and CPR in its 2005 position statement.1

According to the 2010 AHA guidelines for CPR and emergency cardiovascular care, ACLS interventions build on the foundation of basic life support, which includes immediate recognition and activation of the emergency response system, early high-quality CPR, and rapid defibrillation to increase the patient’s chance for survival. The recommended priority of the 2010 AHA guidelines is performing high-quality CPR chest compressions of adequate rate and depth that allow complete chest recoil after each compression, with minimal interruptions and avoiding excessive ventilation.

To prevent a delay in chest compressions, the AHA changed the sequence of CPR in the 2010 guidelines from “A-B-C” (airway, breathing, and compressions) to “C-A-B” (compressions, airway, and breathing), which gives the highest priority to chest compressions when resuscitating a patient in cardiac arrest. In addition to high-quality CPR, the only rhythm-specific therapy known to increase survival is defibrillation. As such, defibrillation remains of primary importance in the CPR cycle when a rhythm check reveals ventricular fibrillation or ventricular tachycardia. Establishing vascular access, administering medications, and inserting an advanced airway are important, but they shouldn’t cause significant interruptions in CPR or delay defibrillation.2

Preparation of Equipment

Because effective emergency care depends on reliable and accessible equipment, the equipment, as well as the personnel, must be ready for a code at any time. You also should be familiar with the cardiac drugs you may have to administer. (See Common emergency cardiac drugs, pages 182 and 183.)

Always be aware of your patient’s code status as defined by the doctor’s orders, the patient’s advance directives, and family wishes. If the doctor has ordered a “no code,” make sure the doctor has written and signed the order. If possible, have the patient or a responsible family member cosign the order.

For some patients, you may need to consider whether the family wishes to be present during a code. If they do want to be present, see if another nurse, social worker, or clergy member can remain with them.

Jul 21, 2016 | Posted by in NURSING | Comments Off on Code Management

Full access? Get Clinical Tree

Get Clinical Tree app for offline access