Hi guys,
The other day I was going to do a 6mwt with a patient with congestive heart failure at arrox 10am. On the day of the test the patient had her IDC out in the am and hadn't been producing much urine since it got taken out. She described it as only a few trickles. You must keep in mind that this patient is on a fluid restriction and the day before she had diarohhea. After talking with her I found out that she was feeling fine and better then the day before. I reported this to my CCT and said that the pt is feeling good and that we can go ahead with the test. My CCT found this to be inappropriate and unsafe. She felt that the pt might be retaining water again and as a result stressing her and putting more stress on her heart might be unsafe. I spoke to my clinical supervisor later on that day about it and she feels that its borderline and that it is not an absolute contraindication. How do you guys feel about it? would you have went on and did the test?
What if I tell you that later on that day she did use the urinate and that the doctors discharged her. She didn't get a 6mwt done and she didn't get a HEP due to that.
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2 comments:
Oh! This is a hard one Shadi, and I suspect different people would call it differently. Neither would be wrong because each position is justifiable.
I am pretty conservative and would've erred on the side of caution and not taken her for the 6mwt in those circumstances.
However - did any of the physios consult other medical staff...nursing staff, doctors? If they were satisfied there was no fluid compromising the heart, a 6mwt could've been managed well.
It's disappointing that she was discharged without the 6mwt and follow-up HEP!
Trudi
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