Nursing Care of the Patient with Aneurysmal Subarachnoid Hemorrhage: A Clinical Practice Guideline (Guideline & Webinar)-SAH CPG 4.29.25

Video Transcription

Video Summary

The American Association of Neuroscience Nurses’ 2025 guideline synthesizes research published from 2013 to 2022 to inform nursing care for aneurysmal subarachnoid hemorrhage (aSAH), a distinct form of stroke with risks including hydrocephalus, seizures, delayed cerebral ischemia, disability, and death.

Nurses should understand the Hunt and Hess, WFNS, Fisher/modified Fisher, and modified Rankin scales, which help assess severity, complications, and outcomes. Palliative care should be considered when appropriate, though evidence about its effects on patient and family satisfaction is limited.

Recommendations for bedside care include routine oral care, clinically indicated chest physiotherapy and short-interval endotracheal suctioning, head-of-bed elevation of 30–45 degrees, and careful monitoring during repositioning when increased ICP is suspected. Maintain <strong>euvolemia</strong>: avoid prophylactic hypervolemia, and monitor fluid balance to support cerebral perfusion.

After aneurysm securement, pharmacological and/or mechanical VTE prophylaxis is recommended. Seizure prophylaxis may be considered before treatment or for patients at high risk; routinely reassess its duration, and monitor for nonconvulsive seizures. Post-endovascular care should include frequent neurological and vital-sign assessments and checks of the access site and distal circulation.

For nutrition, avoid unnecessary interruptions; assess feeding tolerance, and consider small-bowel feeding when appropriate. Use validated pain scales, with acetaminophen for mild pain and short-acting opioids for moderate to severe pain. Monitor temperature and treat fever using protocols.

The guideline highlights substantial evidence gaps, especially regarding nursing interventions, fluid status, seizure prophylaxis, nutrition, pain management, and normothermia.

Keywords

aneurysmal subarachnoid hemorrhage

neuroscience nursing guideline

Hunt and Hess scale

WFNS scale

Fisher scale

modified Rankin scale

euvolemia

venous thromboembolism prophylaxis

seizure prophylaxis

endovascular care

normothermia