This is a medication that would either require a set of standing orders or established protocol OR a physician order for the patient. If you have a standing order or protocol, it could be written so that the infusion nurse could determine when it was appropriate to use this protocol. I would not leave this to the discretion of primary care nurses however. Lynn
so all nurses on our dept can instill tPA at their own discretion. There is a document to follow with what to check first. If in doubt we will contact the physician on call for discussion. Most of the time we will not do radiology before first try with tPA.
to our PICC order sets. The provider has the option to opt out of ordering it (the default, if they sign the order, is to order cathflo prn every time they order a PICC). I presented at the Med Exec committee, with support of the Medical Director of IR - approved easily.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
but can't figure out how to upload to this post. I'll send to Sarah for the gallery for now.
We also have comprehensive order sets for care/maintenance of any catheter we place at our facility, and most catheters that arrive from outside. These order sets include orders for flushing (pedi, adult, different types of VADs), dressing changes, needleless connector disinfection (!!), cxr upon admission for patients admitted with CVAD, etc.
Let me know if the pdf is helpful - if not, I can share the original paper document that the PICC insertion order set was created from.
Mari
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
This is a medication that would either require a set of standing orders or established protocol OR a physician order for the patient. If you have a standing order or protocol, it could be written so that the infusion nurse could determine when it was appropriate to use this protocol. I would not leave this to the discretion of primary care nurses however. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
so all nurses on our dept can instill tPA at their own discretion. There is a document to follow with what to check first. If in doubt we will contact the physician on call for discussion. Most of the time we will not do radiology before first try with tPA.
Mats in Stockholm
to our PICC order sets. The provider has the option to opt out of ordering it (the default, if they sign the order, is to order cathflo prn every time they order a PICC). I presented at the Med Exec committee, with support of the Medical Director of IR - approved easily.
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Mari, cold you share your PICC order set with us.
Darla Tarvin RN VA-BC
Mercy Clermont Hospital
but can't figure out how to upload to this post. I'll send to Sarah for the gallery for now.
We also have comprehensive order sets for care/maintenance of any catheter we place at our facility, and most catheters that arrive from outside. These order sets include orders for flushing (pedi, adult, different types of VADs), dressing changes, needleless connector disinfection (!!), cxr upon admission for patients admitted with CVAD, etc.
Let me know if the pdf is helpful - if not, I can share the original paper document that the PICC insertion order set was created from.
Mari
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center