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daylily
Fentanyl (dedicated line or not)

Our hospital has a statement in which when Fentanyl is given as a controlled PCA the patient must have a dedicated IV access for this drug only. It also reads "Do not flush the IV line or use of any other purpose (this is to prevent accidental bolus of fentanyl)".

This has come into question by the PACU nurses that IVP Fentanyl.

What is the current practice?

lynncrni
Many incompatibilities listed

Many incompatibilities listed for fentanyl. That could be the primary reason. This policy is probably related to the concern for adverse events if the patient should get an unplanned bolus of the drug on a med-surg unit without close monitoring. My best guess, but I would go directly to the people responsible for this policy to learn their rationale for it.

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

jillstarkey
dedicated line

 There has been discussion @ our hospital about dedicated lines. I know it is prefered with TPN . How about Insulin and heparin ?  Could use some help thanks

lynncrni
You will need to locate a

You will need to locate a pharmacists in your facility that has a good knowledge of drug compatibility literature, and has an interest in proper interpretation of this data. Each drug must be assessed separately based on how it is being given. One textbook reports on compatibility mixed in a large fluid container, mixed in a syringe, and given through a Y injection site. This all makes a difference. 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

WadeBoggs26
I'm not sure if you mean

I'm not sure if you mean PCA's shouldn't run with any fluids at all, or just with other infusions.  I'm not sure why compatibility would be an issue since it's one of the most compatible medicaitons we give.

  PCA medication should never run all by itself and when set-up correctly there's no reason why it can't run with other compatible infusions.  PCA's should always run with a carrier fluid, even if it's the only thing running in that IV, otherwise you risk giving unsafe boluses.  An IV with only a PCA running in it is likely to become at least partially occluded at some point with only a few mls running though it every hour, the Nurse is then left with the choice starting a new IV, or flushing it, which will bolus the patient.  There will also be times when the patient will be bolused unkowngily; if the line occludes due to a positional occlusion (bent arm) and the patient continues to hit the button (which they likely will since the med isn't infusing) when they straighten their arm they'll get a few doses at once.  PCA's do have an occlusion sensor but it won't alarm until the pressure builds up from at least a few mls, which accounts for a few typical PCA doses.  Without a carrier fluid, you also have the problems of accurately priming the line and getting rid of the concentrated med in the line when the PCA is D/C'd but the line is still needed.

With a carrier fluid, all these problems are solved.  The line is primed without risk of accidently bolusing or causing a delay in when the medication finally reaches the patient.  The important thing is to make sure the PCA line Y's close to the patient, how close depends on how fast the carrier fluid is running.  We typically do 25cc/hr for a patient without a Hx of HF or RF.  Obviously you wouldn't to Y the PCA in so far up the line that there is 10 cc of line between the Y'd in PCA and the patient if the carrier fluid is running at 10cc/hr, since it would then take an hour for a PCA dose to hit the patient after the patient hits the button.  Even at 25cc/hour or 100cc/hr for that matter you want the PCA Y'd in very close so that each PCA dose hits the patient before the lockout period has ended, otherwise the patient will be hitting the button for additional doses before the last dose has even entered their system which can contribute to oversedation.  As long as the rate and and proximitly to the patient are sufficient to insure that each dose infuses before then next dose is available, you will never have more than one dose in the line, which makes both flushing of the line and variable rate infusions in a shared line inconsequential.  The occlusion problem is also addressed since you're more likely to get an occlusion alarm after just one dose, not 3 or 4, avoiding an unintentional bolus when the occlusion resolves, plus, you can flush it if necessary and never flush more than a single dose.

  In terms of IVP I'm not clear why you would need an IV dedicated for that purpose. 

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