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Sepsis is a leading cause of morbidity and mortality among in-hospital patients and remains the most expensive condition treated in U.S. hospitals.^1,2 Approximately 20%-30% of sepsis patients have an infection originating in the urinary tract.³ Of those patients presenting with symptoms of severe septic shock, 78% have a urinary tract obstruction.⁴

Early fluid resuscitation is a vital intervention for patients with hypotension caused by septic shock, and studies show that two-thirds have a positive response to an initial fluid bolus.⁵ Moreover, initiating fluid resuscitation within the first 30 minutes has been shown to lower mortality and shorten ICU stays in patients with severe sepsis, with delays negatively impacting outcomes.^6,7

The following case from the WakeMed North Emergency Department illustrates the effectiveness of a novel handheld rapid infuser for fluid resuscitation of a patient with septic shock caused by a blocked ureteral stent.

Case Presentation

A 65-year-old female patient presented to the WakeMed North ED with altered mental status. Upon assessment, the patient was found to be in severe septic shock and appeared pale and diaphoretic. Her blood pressure was 80/40, and her heart rate was 125.

Further diagnostic tests revealed a blockage in the patient’s pre-existing ureteral stent caused by a kidney stone. The team determined the need for emergency surgery to remove the blockage and began preparing the patient for the procedure. Nurses obtained a 20g peripheral IV and administered 1 L of normal saline. However, the patient remained hypotensive with a blood pressure of 90/50.

Management

Due to the patient’s continued hypotension, additional intervention was needed to prepare her for surgery. With the OR team en route, the ER nurse caring for the patient used the LifeFlow rapid infuser to deliver an additional 1 L bolus of normal saline in just a few minutes. Almost immediately, the patient’s blood pressure improved to 120/60.

Following this resuscitation a norepinephrine drip was started and the patient was transported to the operating room to have the ureteral blockage removed.

Discussion

Restoring adequate perfusion to the brain and vital organs is an immediate priority for hypotensive patients with septic shock. Current evidence supports rapid fluid resuscitation as an effective intervention that decreases mortality and improves patient outcomes.⁸

However, traditional methods of rapid fluid delivery often prove too slow to meet clinical recommendations. It can take over 20 minutes to administer a liter of fluid with a pressure bag, and this method demands the nurse’s constant attention to ensure the bag remains inflated. Accurately measuring the exact amount of fluid delivered with a pressure bag can also be difficult. By contrast, LifeFlow users can give a life-saving bolus in precise 10 mL intervals up to four times faster.⁹

Thanks to LifeFlow, this patient received an additional liter of fluid in the short time it took for the OR team to arrive. This intervention significantly increased her blood pressure, improving perfusion to the brain and vital organs, and helped stabilize her for surgery.

Despite being in the first weeks of orientation, the ER nurse caring for this patient found LifeFlow easy to set up and use and saw its immediate impact on the patient. Following this case, the nurse said, “It was incredible, and I will absolutely be using this device again and advocating for it in my practice.”

LifeFlow is a practical, effective tool for rapid fluid resuscitation in septic shock patients. When minutes matter, LifeFlow reduces the time-to-first-bolus and gives the provider precise control over how much fluid is administered. With LifeFlow, providers can quickly deliver fluids to reverse shock symptoms and prevent life-threatening complications, while also reassessing patients sooner and determining the most appropriate follow-up interventions.