We have this problem also. I attempted to change the policies to state that
these medications could be started via a peripheral line and that a central
line was to be inserted ASAP but our docs would not approve. They said the
same thing it would only be for a day or two. Even though we had had a few
infiltrates they didn't want to hear me.
Margaret
Margaret M Nicastro, CRNI, OCN
Coorordinator IV Therapy/Oncology
Gettysburg Hospital
PO Box 3786
147 Gettys Street
Gettysburg, PA 17325
Phone: 717-337-4312 option 2
Fax: 717-337-4485
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________________________________
From: [EMAIL PROTECTED] on behalf of Susan Fullana
Sent: Wed 8/16/2006 1:10 PM
To: Nadine Nakazawa; [EMAIL PROTECTED]
Subject: RE: question abt outpt infusions
Nadine,
Sounds like these patients may have post-infusion phlebitis. At our
hospital we are seeing many medications like amiodorone, KCl replacements,
dobutamine and many others given peripherally. Drs refuse to place central
lines because "it's only going to be a few days". Currently, we do an incident
report for every amiodorone infiltrate and or phlebitis we find. We can build
a data base to pull from to create policies for certain meds to be given only
via central route.
Nadine Nakazawa <[EMAIL PROTECTED]> wrote:
Somehow clinicians think that if the PIV is in only for a few hours,
there is a lesser risk of infection. The risk occurs at the TIME OF INSERTION.
Therefore any less stringent adherence to recommended practices, eg,
inappropriate antiseptic application on the skin, use of non-sterile tape, etc
can lead to peripheral site infections. The procedural folks don't see it, but
it might be seen by the patient at home a few days later as a reddened tender
site, or in the clinics.
The reason I say this is from two sources, although both are anecdotal,
from nurse managers in my institution. One was the CNS on the CCU. He told me
that the cardiologists were questioning what was happening with PIVs in CCU as
they had a number of patients with "infected" PIV sites a week later in clinic.
It may be a combination of the wrong drugs being infused peripherally and this
was chemical phlebitis or poor insertion technique and true exit site
infections. It was problematic enough for the docs to notice, report it to
the CNS, and for him to ask me about it. I told him to try to see what drugs
were infused through those PIVs, and th culprits might be irritating infusions.
I also told him to review the PIV Procedure with the nursing staff and to
remind them to use the PIV start kits which have the Chloraprep sepp for 30
seconds, let it dry and to NOT touch the site with nonsterile gloves unless
they cleaned the glove tip with extra chloraprep. The kits also!
have in it sterile tape, and a sterile transparent dressing. I told him to
remind the staff to apply the sepp
The second report I got was from the Nurse Manager of Radiology. In
the CT and MRI areas, they receive the inpatients with supposedly "patent"
PIVs. A lot of those PIVs are dislodged or don't give blood return, but some
of them also have "nasty" infections" at the exit site (her words, not mine).
She is appalled that nurses allow that to happen and persist. In other words
we have a LOT of work to do, because clinicians think "it's only a PIV," and
become very cavalier with their insertion technique because they "don't see the
infections."
Even a few infections every year on every nursing unit in a hospital
are too many.
Nadine Nakazawa, RN, BS, OCN
PICC Program Coordinator
Stanford University Hospital and Clinics
Stanford University Medical Center
________________________________
From: "Schwaner, Sandra L *HS" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: question abt outpt infusions
Date: Tue, 15 Aug 2006 15:03:13 -0400
>Listservers:
>I've just worked extensively with the practice council,
procedure committee, procurement, center for organizational development and
representatives of numerous pt care areas to develop a comprehensive IV care
package. One of the procedures was on dressing IVs and specified that no
unsterile tape was to be used, and that a sterile dressing needed to be
applied. When this was questioned by the outpatient areas (Iv is only left in
for 10 ments for photovoltaic therapy or ct or whatever), I reiterated the need
for infection control, and for consistency....when you go to UVA and have your
IV started, you can expect it to be started this way and dressed this way. I am
now being asked for studies on infection rates in outpatient areas with
nonsterile dressing practices......any suggestions?
>
>I believe strongly in evidence based practice, and try to
practice what I preach.....but I'm feeling that common sense has left the
building....
>
>
>Sandra L. Schwaner MSN, RN, ACNP
>P.O. Box 800377
>Angiography/ Interventional Radiology
>University of Vriginia
>Office: 434-924-9401 - 434-243-7081
>Fax: 434-982-6468
>Pager # 6180
>
>
Susan J. Fullana
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