Clinical practice guideline development to increase use of pleth variability index monitoring to guide fluid management in patients undergoing major abdominal surgery
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McLaughlin, William. Clinical practice guideline development to increase use of pleth variability index monitoring to guide fluid management in patients undergoing major abdominal surgery. Retrieved from https://doi.org/doi:10.7282/t3-jk8r-6e58
TitleClinical practice guideline development to increase use of pleth variability index monitoring to guide fluid management in patients undergoing major abdominal surgery
DescriptionPurpose of the Project: Current intraoperative fluid management techniques for patients undergoing abdominal surgery are subjective in nature. Pleth Variability Index monitoring (PVI) as part of goal directed therapy (GDT) has shown to improve outcomes of abdominal surgery when compared to traditional techniques. The purpose of this project was to increase the use of PVI monitoring for patients undergoing abdominal surgery at an affiliated clinical site by creating and implementing a readily available, point of care accessed clinical practice guideline. Methodology: Anesthesia providers were recruited to participate in a two part session regarding the benefits, limitations and practical application of PVI monitoring and accessing the developed CPG via QR code. Changes in PVI monitor use were indirectly assessed via changes in inventory ordering patterns of disposable, single use PVI probes. Results: A significant increase in PVI monitoring occurred following CPG implementation evidenced by reduced days and weeks between PVI probe inventory ordering (p= 0.004, p=0.002 respectively), as well as a significant increase in average weekly probe use as compared to baseline (p=0.03). Implications for Practice: PVI monitoring has proven benefits as an objective guide for fluid management, with overall reduction sin morbidity, mortality, and length of stay. Now that providers are trained and willing to use PVI monitoring, ERAS protocols can be developed incorporating PVI.