Those situations put a greater responsibility on the nurses to put a
small catheter in a large vein, avoid veins in areas of joint
flexion, use a handboard if joint veins must be used, adequate
stabilization,always check for a blood return and all other
assessments to ascertain vein patency. Those are the major
interventions to prevent an extravasation injury. Also nurses must
know that if there is pain on infusion or injection, this should
means there is a problem and should not be explained away. Almost
every case of extravasation injury had the patient complaining of
severe pain yet this was ignored by the nursing staff. One the other
hand, infiltration usually only causes a small amount of discomfort
within the first few minutes of the infiltration. Lynn
At 8:54 PM -0400 8/17/06, Nicastro, Margaret wrote:
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
CONFIDENTIALITY NOTICE:
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--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
