Nursing interventions related to cerebral perfusion pressure following an aneurysmal subarachnoid haemorrhage

Nursing assessment, decisions and interventions are important in the management of cerebral vasospasm for patients following aneurysmal subarachnoid hemorrhage (aSAH). The nursing role in fluid management is complex, characterised by frequent decisions regarding flow rates of fluids and medications. Whist there is extensive literature outlining the medical care for patients post aSAH, nurses are practising in an environment where the guidelines related to haemodynamic augmentation are varied and the evidence is lacking. A literature review was undertaken to understand the current state of knowledge relating to the role of nurses in hemodynamic augmentation and the management of vasospasm for patients post aSAH. A key word search was conducted of the electronic databases Pubmed, Proquest and Cochrane. A specific search for nursing related research identified a total of 70 articles. From this initial list, 16 articles were identified as being specific to nursing practice and interventions; 14 papers described empirical nursing research, however the articles were descriptive in nature and provided little beyond a clinical overview of the natural history of aSAH. Two studies specifically focused on the role of the nurse when caring for patients post aSAH. Whilst the nursing role is represented in the literature, the complex nature of the role is not acknowledged. Further research is needed on nurses’ understanding of the decisions behind nurses’ choices regarding the amounts and timing of intravenous fluids, as well as the indications for inducing hypertension in patients who have experienced an aSAH.