Haemodynamic optimisation protocols

The core of the perioperative pathways at York Teaching Hospital is the implementation of post-operative haemodynamic optimisation protocols.

There are numerous haemodynamic or fluid optimisation protocols described in the literature that have been shown to improve patient outcomes. Although. no single protocol has been shown to be superior, the underlying principles remain the same. For further reading on goal-directed fluid strategies please see our summary sheet.

Patients are allocated to a post-operative haemodynamic protocol according to their cardio-pulmonary exercise testing results, more detail on that can be found here.

The Enhanced Protocol

The enhanced perioperative protocol is currently used in both the Nurse Enhanced Unit (level 1 care) and High Dependancy Unit (level 2 care). Patients deemed at medium or high risk will be allocated to this protocol.

The protocol requires use of advanced cardiac monitoring and an arterial line. Patients will:

Be cared for by a nurse trained in critical care or who has been trained in the perioperative pathways and the use of cardiac monitoring.
Have hourly observations taken.
As a minimum have six hourly ABG's taken.
Have fluid boluses and metermaniol pre-prescribed to be given as per the protocol.
Be known to critical care if being nursed in the level 1, nurse enhanced unit.
Have full post-operative review on the first day post-operatively.
Be reviewed by the perioperative specialist nurse until discharge.

The Standard Protocol

The standard perioperative protocol is currently used in both the regular surgical ward and the Nurse Enhanced Unit (level 1 care).

The protocol requires no addition monitoring. Patients will:

Have hourly observations for the first four hours on the ward and then four hourly thereafter.
Have fluid boluses pre-prescribed to be given as per the protocol.
Have full post-operative review on the first day post-operatively.
Be reviewed by the perioperative specialist nurse until discharge.