Family Presence during a Code Blue
Submitted by Lacy Kusy, MSN, APRN-C
Tags: Code Blue Family Presence RRT RRT Nurse
I have been a nurse in the Cardiac Intensive Care Unit for over five years now, and have participated in many code blues. Some of these situations are appropriate for family to attend and some are not. Each situation is assessed individually to determine the appropriateness of family presence.
I had been caring for a young lady, Ms. R.V., who was an 18 year old that had received a heart transplant for a congenital heart defect when she was 13 years old. She was admitted to TGH to be placed on the heart transplant list again, as her transplanted heart had been failing for months. Due to the failing heart, other organs began to also fail. R.V. had gone into heart and kidney failure and required continuous renal replacement therapy (CRRT) for continuous dialysis treatment since her blood pressure was continuously low.
I had cared for R.V. for three days so far and had gotten to know her and her mother very well. R.V. and her mother were extremely close. Her mother brought her in dinner as often as she could and visited on her days off. Because her daughter had been in the hospital for so long, the patient’s mother had to return to work. She would work during the day and visit in the evening. This particular day, R.V. was stating how excited she was to see her mom that evening, and her mom was going to bring her a salad from Panera Bread. I could sense her excitement in her voice and facial expressions, although she had very little energy to spare.
Around shift change, my patient began to feel “different”, and state that “something isn’t right”. I immediately took her vital signs, laid her back down in bed, and called her doctors. I also called her mother to see how close she was to the hospital. Not long after R.V. stated she felt “different”, her oxygen saturations plummeted, she turned blue, stopped breathing, and a code blue was called.
With many doctors and nurses at the bedside, CPR was performed for at least 15 minutes before R.V.’s mom arrived. She was very distressed and anxious to see her daughter. One of the doctors felt that she should not be around to witness the CPR on her daughter. I, on the other hand, stated that R.V. and her mom are very close and that she should be allowed to stand in the back to be with her daughter, an 18 year old child. This particular doctor was one that strictly attends code blue situations and had no previous relationship with this patient or her mother. I calmly expressed that in this situation, the mother of R.V. should be at the bedside of her daughter if she wants to because her daughter looked as though she would not survive the code situation.
R.V.’s mother was not in the way, and she stood at the head of her daughter and whispered into her ear. Once R.V.’s primary doctors arrived, they agreed that the mother should stay in the room if she wanted to be with her daughter. R.V. did not survive the code. Her mom, however, was able to be with her daughter as she passed and held her hand as she took her last breath. As heartbreaking as this scenario was, the patient’s mother thanked me for allowing her the privilege of being with her daughter as she finally got peace and can “rest now”. Although not all code blue situations are deemed appropriate for family presence, the nurse and care providers should assess each family and patient separately to determine what is best for the patient and the family.