Ditto and Ditto agaiin!!!!!!! Reasonable, Prudent actions by a nurse include using his/her brain! 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
________________________________ From: [EMAIL PROTECTED] on behalf of Heather Nichols Sent: Sat 8/26/2006 7:52 AM To: Lynn Hadaway; [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: [vascular] ammonul extravasation Lynn, You stay on your soap box as long as you like when it comes to this issue. I feel like it is not preached on half enough. Sometimes I think that if the doc wrote an order to jump off the second street bridge, there would be nurses down there doing it. Heather Nichols RN BSN CRNI Infusion Services University of Louisville Trauma Institute 530 S. Jackson St. Lou. Ky. 40202 (502)562-3530 >>> "Lynn Hadaway" <[EMAIL PROTECTED]> 8/20/2006 3:44 PM >>> I am working on my infiltration and extravasation presentation for AVA and received your message. I found this drug online but it must be very new as it is not in the 2006 edition of Intravenous Medications. Here is the statement on the home page online http://www.ammonul.com/: Administration must be through a central line; use of a peripheral line may cause burns. Do not administer undilluted product. I could not find the pH or osmolarity in the prescribing information, but the above sentence is in bold letters. Based on the other information, I would strongly recommend a surgical consultation immediately. The treatment would depend upon the total volume of the infiltrated solution and the osmolarity of it. If this is hyper-osmolar do NOT use heat as this will exacerbate the problem. Use cold instead and the prescribing information recommends cold. If this drug is a vesicant or if the volume is great enough to compromise the neurorvascular function of the extremity, a surgical consultation is needed sooner rather than later as a decompression and fasciotomy with a washout procedure could prevent further damage. This usually leaves a large scar though but better than a necrotic ulcer. As far as antidotes, I have not seen this drug listed in any of my research. Yes, a nurse can refuse to follow a physician's order if he/she has information or knows that this order is not appropriate. With the drug information I found in about 5 seconds, I would have called the physician and discussed it. If there was no change in the order, I would have informed him that I was going to speak with others and then followed the hospital chain of command for a decision. It is not only the nurses right to refuse to follow a known dangerous order, it is our responsibility. I previously taught every nurse I oriented that they needed to follow through on every question with supervisors, pharmacy information, risk management, etc. and make sure they were correct in their assessment and that the chain of command supported them. I have seen this process work in numerous situations. It is time for nurses to accept the accountability for infusion therapy if they are going to be responsible for delivery. If they are unwilling to accept accountability, then they do not need to be performing infusion therapy! We must use a high level of critical thinking and not just blindly follow orders. Sorry, I will get off my soap box now! Lynn At 11:44 AM -0700 8/20/06, Anna Liang wrote: would like to know if your facility have a standard protocol for ammonul administration. this is another example that I would like to beat my head (or somebody else's) on the wall. I don't understand why the team didn't order a picc -- maybe because they didn't make the decision/diagnosis to start the med until Friday afternoon. and it was too late to attempt a picc (not enough time of NPO for sedation for that 2 y.o.). maybe they think a picc procedure is invasive? or maybe they think, ' oh, there only gonna be 3 doses.' I don't think anybody talked to parents that ammonul extravasation can lead to necrosis. the drug reference says ammonul should be given through central line. but there is another line: if given through peripheral IV, dilute the med. can nurses refuse to give it through piv???? __________________________________________________ Do You Yahoo!?< BR>Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com MedComp Proud Sponsor of the Vascular List Serve. Yahoo! Groups Links <*> To visit your group on the web, go to: http://groups.yahoo.com/group/vascular/ <*> To unsubscribe from this group, send an email to: [EMAIL PROTECTED] <*> Your use of Yahoo! Groups is subject to: http://docs.yahoo.com/info/terms/ -- 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 Disclaimer This message, including any attachments, is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law, including PHI (Protected Health Information) covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you are not the intended recipient(s), you are notified that the dissemination, distribution, or copying of this message is strictly prohibited. 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