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Sutter employs new procedure to treat sepsis

Condition claims more lives than lung and breast cancer combined
By: Sena Christian, The Press Tribune
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For decades, when doctors needed to insert a central line into the jugular of a patient they would poke and prod, using landmarks on the body to find the vein.

But there’s a large variance in the normal anatomy of the human body. So doctors might poke a dozen times to see blood to know they’d found the right place.

If they missed, they could hit an artery or puncture a lung.

“A lot of physicians shied away because the treatment can be worse than the disease,” said Wayne Moore, a registered nurse and trainer with Medical Simulation Corporation.

Moore drove his SimSuite mobile training unit into town Oct. 5 and parked in a lot at Sutter Roseville Medical Center for a two-day program to teach hospital physicians how to effectively and efficiently insert central lines to combat sepsis.

A central line is used to administer medications or fluids, obtain blood tests, take cardiovascular measurements and continually monitor resuscitation parameters.

Ultrasound-guided access to the central line greatly reduces the risk of a procedure that doesn’t leave much room for error, Moore said.

Moore uses a mannequin to train physicians, showing them how to use a new ultrasound unit — like when an obstetrician locates a fetus in the womb — to locate the jugular.

“Now it’s easy to see where the needle is going,” said Dr. Imran Aurangzeb, director of the intensive care unit at Sutter Roseville and regional director for severe sepsis and septic shock for Sutter Health Sacramento Sierra Region.

Aurangzeb said while some doctors rarely have to insert a central line, those in intensive care do so often, and he wants all physicians to feel comfortable and confident in their ability to perform the procedure.

Sepsis is a potentially life-threatening complication from an infection. The condition occurs when chemicals released into the bloodstream to fight the infection cause inflammation throughout the body, which creates microscopic blood clots that block nutrients and oxygen from reaching organs.

The condition can progress to septic shock, when blood pressure drops dramatically, which can lead to failure of the brain, intestines, liver, kidneys and lungs.

People of all ages can be affected by sepsis, but the disease is more likely to develop in babies or the elderly, or those with a weakened immune system. Thirty years ago, septic shock had a 60 percent to 80 percent mortality rate.

Early last year, Sutter Health Sacramento Sierra Region received a $3.5 million grant from the Gordon and Betty Moore Foundation to attack sepsis in their hospitals and share best practices.

The hospital implemented a new protocol to identify patients with sepsis early on and initiate treatment before they become critical. As a result, the local hospital achieved a 10 percent reduction in severe sepsis mortality in 2010, according to a Sutter news release. This year, doctors hope to reach a 15 percent drop.

Physicians are using aggressive management to treat sepsis, and inserting a central line is part of this process.

The timely insertion of a central venous catheter is the fifth step out of seven in the care for patients in septic shock.

“This is one component in the full constellation of aggressive management,” Moore said.

Aurangzeb said Sutter Roseville has been transitioning to using the ultrasound equipment for the past decade — changing clinical practice typically takes from eight to 17 years.

“What we’re trying to do here at Sutter is help our physicians obtain the tools they need to better change practice as the evidence comes along,” he said.

Sena Christian can be reached at senac@goldcountrymedia.com. Follow her on Twitter at SenaC_RsvPT.

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Facts about sepsis

• Sepsis claims more lives than lung and breast cancer combined
• Severe sepsis accounts for one in five admissions to intensive care units
• A person is 60 percent more likely to develop sepsis than to be diagnosed with breast cancer
• Young people with something as simple as a urinary tract infection can become very sick, develop sepsis and die
• Sepsis accounts for an estimated 40 percent of all ICU expenditures, totaling $16.7 billion in the United States alone

Source: Surviving Sepsis Campaign, www.survivingsepsis.org.