Sepsis SIX

As nurses, our first priority will always be our patient’s survival. However, there are instances that make it difficult for us to do so. Things become complicated and the patient’s chances of surviving become weak. Therefore, there should be set standards

The Sepsis Six is a set of interventions which can be delivered by any junior healthcare professional working as part of a team and when performed during the first hour, the patient’s chance of survival may be doubled.

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1. Administer high flow oxygen.

This may be done via non-rebreathe bag. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.Resuscitate the patient, using supportive measures to correct hypoxia, hypotension, and impaired tissue oxygenation (hypoperfusion)

2. Take blood cultures

Blood work for a suspected case of sepsis includes a complete blood count, a platelet count, and a DIC panel (prothrombin time, activated partial thromboplastin time, and the serum concentrations of fibrinogen, D-dimer, antithrombin III, and lactate.Blood cultures should be obtained prior to antibiotic administration. When taking blood cultures, also consider source control. You may obtain two or more Blood Cultures.

3. Give broad spectrum antibiotics

From the time of presentation, broad-spectrum antibiotics to be given within 1 hour. IV antibiotics must be given according to local protocol. Begin IV antibiotics as early as possible, and always within the first hour of recognizing severe sepsis and septic shock.Reassess antimicrobial regimen daily to optimize efficacy, prevent resistance, avoid toxicity and minimize costs.

4. Give intravenous fluid challenges

Start IV fluid resuscitation using Hartmann’s or equivalent. In all cases of septic shock, adequate venous access must be ensured for volume resuscitation. When sepsis is suspected, 2 large-bore (16-gauge) intravenous (IV) lines should be placed if possible to allow administration of aggressive fluid resuscitation and broad-spectrum antibiotics.If an intravascular access device is suspected as the source of severe sepsis or septic shock, alternative vascular access must be obtained, and the suspect device must then be removed.

5. Measure serum lactate and hemoglobin

Serial blood lactate measurement can be an early predictor of shock. Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of trauma or sepsis. In sepsis, the initial treatment goals include maintaining a hematocrit >30% and a hemoglobin concentration >10 g/dl. The septic patient’s hematocrit and hemoglobin concentration will vary as fluids shift between compartments in the body, but over time these red blood cell values will drift lower because red cell production and survival times decrease during sepsis.

6. Measure accurate hourly urine output

You may also consider catheterization. In all patients with sepsis, urine output (UOP), a marker for adequate renal perfusion and cardiac output, should be closely monitored, as should renal function; mortality is greatly increased in patients with urosepsis and severe sepsis or septic shock. Normal urine output usually ranges from 30-50cc/hr for most adults.

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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