Intraoperative Anesthesia Care of Patients with Cardiovascular Implantable Electronic Devices
AuthorNwankwo, Chioma U.
MetadataShow full item record
Other TitlesIntraoperative CIED Anesthesia Care
AbstractProblem and Purpose: Cardiovascular Implantable Electronic Devices (CIED), commonly referred to as pacemakers or implantable cardioverter defibrillators (ICD), are lifesaving devices placed subcutaneously in patients with recurrent life-threatening bradyarrhythmias and tachyarrhythmias (Crossley et al., 2011). In the United States, more than 3 million patients have pacemakers and more than 300,000 patients have ICDs (Ellis et al., 2017). Electromagnetic interference during the intraoperative period is the most significant problem encountered with these patients during surgeries (Crossley et al., 2011). Therefore, anesthesia providers need to understand how to manage these devices perioperatively (Neubauer et al., 2018). The purpose of this scholarly project is to develop a clinical practice guideline (CPG) for consistent intraoperative anesthesia care of the patients with CIEDs at a hospital in Baltimore, Maryland. Methods: Institutional Review Board approvals at the school and the hospital facility were obtained prior to DNP project implementation. An expert panel was assembled: two CRNAs, an Anesthesiologist and a Cardiac Electrophysiologist. The expert panel utilized the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool to evaluate the CPG developed by the student. Revisions were made to the CPG based on feedback from the AGREE II tool. A PowerPoint presentation on the CPG was delivered to the anesthesia staff during ground rounds by the student. Following the presentation, the anesthesia staff completed the Practitioner Feedback Questionnaire (PFQ), an anonymous survey that assessed for clarity of the presentation and ease of CPG adaptability to clinical practice. Results: Domain scores from the AGREE II tool results ranged from the lowest score of 70.8% to the highest score of 97.9%. Of the PFQ distributed, 80% were returned and analyzed. Results indicated that 94% of the providers recommended adoption of the CPG, and 90% indicated they would adapt the CPG recommendations to their practice once approved. Qualitative data on the anesthesia providers’ years of experience and provider type were collected from the PFQ responses, and results indicated that 50% of the providers had less than five years of experience and 47% were CRNAs. A finalized CPG was approved by the chief anesthesiologist, and the CPG became an official policy at this anesthesia department. Conclusion: The cumulative results revealed anesthesia providers’ future intention to use the CPG policy during their care of patients with CIEDs. Adoption of this CPG in daily clinical practice will mean a reduction in electromagnetic interference, and the use of evidence-based care by anesthesia providers during the intraoperative care for this patient population.
Appraisal of Guidelines for Research & Evaluation II
Practice Guidelines as Topic
Surgical Procedures, Operative