Autonomic Dysreflexia (AD) is characterised by a sudden rise in blood pressure which may lead onto a cerebral haemorrhage (stroke) and even death. It must always be treated as a medical emergency. Those that are at risk of AD are individuals with a spinal cord injury above T6.
Within a normal functioning nervous system, blood pressure rises when the body encounters a harmful stimulus. The nervous system responds via the autonomic nervous system, which results in dilation of the blood vessels, this in turn lowers the blood pressure and the body circulation remains in a safe and static state.
Patients with a spinal cord injury located at or above Thoracic spinal level 6 (T6), the ability of the autonomic nervous system to respond normally is affected. As a result the autonomic system cannot lower the blood pressure in response to the pain or discomfort below the level of the spinal cord injury. Blood pressure will continue to rise until the stimulus is removed. This can place the patient at risk of cerebral haemorrhage if not managed appropriately.
For patients with spinal cord injuries it is essential their bladder and bowel routine are not interrupted, regardless of the setting in which care is provided (RCN, 2012), to reduce their risks of AD. Patients with a spinal cord injury or neurological conditions may have a neurogenic bladder or bowel dysfunction, which often means they need to have routine interventional bladder and bowel care such as, using an anal irrigation system, procedures such as Digital Removal of Faeces (DRF), clean intermittent self-catheterisation (CISC) or having an indwelling catheter. Such interventions may stimulate the response so it is vital that all clinical staff have an awareness of AD and the actions required to manage the situation as described in this procedure. Staff must be competent in undertaking bladder and bowel management.
Baseline blood pressure must be obtained and recorded in clinical care records and a reminder (alert) also documented to ensure all staff are aware of the potential risk.
A clear, individualised care plan should be in place for safe management of bladder and bowel care.
Non-adherence to a patient’s usual bladder and bowel care regime can cause an onset of AD. Therefore it is vital that bladder and bowel care is a priority for all these patients to ensure that their health and dignity are maintained.
|Compiled by:||Andrea Lewis, Interim Chief Nurse|
|Date Ratified:||January 2020|
|Date Issued:||January 2020|
|Review Date:||January 2022|
|Target Audience:||All healthcare staff|
|Contact name:||Andrea Lewis, Interim Chief Nurse|