We also did this frequently on the In-Pt. Oncology unit I worked on for many
years. It made it much less intrusive to slip in and hang their multiple ABX
without waking the patients at night. Our oncologist was very big on trying to
let pts sleep. He had no problem giving us an order for tko fluids at night.
Usually they were stopped during the day when they were awake and ambulatory.
Kathy Kennard, CRNI
________________________________
From: [EMAIL PROTECTED] on behalf of Schwaner, Sandra L *HS
Sent: Fri 9/15/2006 10:55 AM
To: Lynn Hadaway; Janousek, Patricia; [EMAIL PROTECTED]
Subject: RE: diluents
But, wouldn't running a maintenance solution at 20ml or so an hour,
piggybacking multiple meds into the primary tubing by use of backflush method,
and connecting the entire apparatus , then disonnecting every 72 hours reduce
number of times that the system is compromised and possible impact infection?
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 Lynn Hadaway
Sent: Thu 9/14/2006 6:30 PM
To: Janousek, Patricia; [EMAIL PROTECTED]
Subject: Re: diluents
I am familiar with hospitals that practice this way, although I have never done
it where I have worked. This would not be for the purpose of actually diluting
anything, but it would be used as fluid to keep the catheter and vein open in
between med doses. The issues with this are:
1. KVO is not a valid order since there is no patient-specific rate prescribed.
So the physicians will need to prescribe a rate.
2. Risk of fluid overload
3. Limitations on patient's ability to get out of bed and ambulate since they
will always be connected to an infusion.
This works best for those patients that are still receiving other infusions and
are not to the point of ambulation.
I also know there are other facilities that will use a bag of fluids, piggyback
all meds into it, and then allow the saline to infuse after each dose has
finished, then the nurse disconnects the patient after the saline has flushed
the line. This is acceptable and would allow the backpriming procedure to be
used for multiple drugs.
I have recently researched this for one of my manufacturing clients and there
are really no standards about using fluids in this manner. INS standards do not
address it. The other option is to not use this carrier fluid and infuse each
drug directly through the catheter. This means the nurse must be present to
disconnect the tubing immediately when the med is finished. If not, there will
be blood that refluxes into the lumen leading to a lumen occlusion from clotted
blood. So it is a trade-off for nursing time. Also, using this carrier fluid
connected to the catheter with the backpriming process for multiple drugs would
mean the least amount of catheter hub manipulation, and thus decrease the risk
of catheter related bloodstream infection. Again, no studies to support that
idea either.
Hope this helps, Lynn
At 2:48 PM -0500 9/14/06, Janousek, Patricia wrote:
Hello everyone, I have been asked to check on the practice of hanging a
diluent on a patient who has multiple IVABs scheduled frequently (Q 4, Q6 hours
etc.). I'd like to know if anyone does this, and if so, is there set criteria,
specific solution, rate etc. Also, are there references I could refer to? INS
Standards? Thanks so much.
Patty
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Lynn Hadaway Associates, Inc.
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