Acute Limb Ischemic Events Post Pressor Support in the ICU Setting: Identifying a nurse driven protocol for identification and prevention

Abstract

Vasopressor support has become the therapeutic cornerstone in treating shock and maintaining perfusion in critically ill patients in the ICU setting. However, like any treatments there are adverse effects. Vasopressors allow patients experiencing hypotension related to hypovolemic or distributive shock to maintain perfusion of vital organs and preserve cardiac and neurological functioning, however, due to contractility of vessels they can cause a host of downstream problems. Acute limb ischemia is associated with vasopressor support, especially long-term support as well as hypercoagulable states often associated with pathologies seen in the ICU. The paradigm within the medical community has been “life over limb”, positing that perfusion trumps all. While perfusion of vital organs is undoubtedly the most important piece of the clinical picture, we present a paradigm shift to “life and limb”, implementing a nurse driven protocol for vascular checks, dependent padding of limbs as well as unit wide education on the ability to preserve vascular function through early intervention.