gms | German Medical Science

Objective: Severe vasospasm is a feared complication after subarachnoid hemorrhage (SAH) and causative treatment is difficult. The continuous intraarterial application of the calcium antagonist Nimodipine is a possible option and we use it in our clinic regularly. This method is elaborate and involves a variety of problems in patient and catheter handling. We were interested to find out if standard operating procedures (SOP) are helpful to establish patient safety as well acceptance and security of use in the ICU staff.

Method: Patients with suspected vasospasm in transcranial doppler underwent cerebral angiography. If vasospasm was confirmed, intraarterial nimodipine application was started. IN the beginning, complication rate was high due to catheter handling problems and flocculation of nimodipine during application. Therefore catheters clotted or needed to be changed often. After a starting period we developed a SOP for continuous nimodipine application and evaluated the contentedness and handling safety of the ICU personnel as well as frequency of catheter clotting, patient transport and complication rate. The SOP also included implantation of extended neuromonitoring.

Results: Using extended neuromonitoring we could show that intraarterial continuous nimodipine application was feasible and safe to use. But the first patients underwent catheter changes due to mishandling or flocculation regularly. Despite the fact that there were no life threatening complications during the transports and catheter application the continuous running time of nimodipine was short and the personnel didn’t like to be in charge of those patients due to insecurities in handling of patients and catheters and due to the higher transportation rate. After implementing a SOP for monitoring, handling of catheters, application of nimodipine in bypass with NaCl the number of clotted catheters and the need to replace catheters was significantly lower. Also the contentedness of the ICU personnel as well as the safeness in handling those patients improved significantly after SOP installment.

Conclusions: Our data clearly demonstrate that installment of SOP for complex treatment processes improves patient safety as well as staff well being and security of handling and is therefore an important tool to optimize patient treatment.