Thanks for your input Lynn. Margaret Margaret Nicastro, CRNI,OCN 147 Gettys Street P.O. Box 3786 Gettysburg, PA 17325-0786 717-337-4312 option 2 717-337-4485 Fax [EMAIL PROTECTED] [EMAIL PROTECTED] www.wellspan.org
-----Original Message----- From: Lynn Hadaway [mailto:[EMAIL PROTECTED] Sent: Friday, August 18, 2006 9:34 AM To: Nicastro, Margaret; Susan Fullana; Nadine Nakazawa; [EMAIL PROTECTED] Subject: RE: question abt outpt infusions 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 > >Confidentiality Notice: This e-mail may contain confidential health >information that is legally privileged. This information is intended >for the use of the named recipient(s). The authorized recipient of this >information is prohibited from disclosing this information to any party >unless required to do so by law or regulation and is required to >destroy the information after its stated need has been fulfilled. If >you are not the intended recipient, you are hereby notified that any >disclosure, copying, distribution, or action taken in reliance on the >contents of this e-mail is strictly prohibited. >If you receive this e-mail message in error, please notify the sender >immediately to arrange disposition of the information. > > >________________________________ > >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: > >This email may contain confidential health information that is >legally privileged. This information is intended for the use of the >named recipient(s). The authorized recipient of this information is >prohibited from disclosing this information to any party unless >required to do so by law or regulation and is required to destroy >the information after its stated need has been fulfilled. If you >are not the intended recipient, you are hereby notified that any >disclosure, copying, distribution, or action taken in reliance on >the contents of this email is strictly prohibited. If you receive >this e-mail message in error, please notify the sender immediately >to arrange disposition of the information. -- 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 CONFIDENTIALITY NOTICE: This email may contain confidential health information that is legally privileged. This information is intended for the use of the named recipient(s). The authorized recipient of this information is prohibited from disclosing this information to any party unless required to do so by law or regulation and is required to destroy the information after its stated need has been fulfilled. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this email is strictly prohibited. If you receive this e-mail message in error, please notify the sender immediately to arrange disposition of the information.
