Our faciliity has decided we need  a policy to cover our patients on Flolan.  This medication is used to treat pulmonary hypertension and pt's usually on this drug for the rest of their life.   I understand that Mayo Clinic has a nice policy that incorporates catheter lumen priming volumes.  Do any of you have a policy or procedure you can share with me?  Perhaps Sarah would like to  add it to her great list of other policys. Â
If you want to email it  to me privately please do so at [email protected] Â
If there are policies and procedures out there that folks are willing to share maybe they could be posted to the Policies and Procedures section of the website.
Helen Lazeration, CRNI
Fairbanks Memorial Hospital
Fairbanks, Alaska
Margy, I didn't see the P & P in the downloads so am adding my two cents for your policy regarding Flolan infusions, some of which may be old news to you by now. (Guess I am behind in my reading . . . )
Needs a dedicated central line; no mixing with other medications. Short half-life so should not be infused peripherally -- this will change the patient's response to the medication and they will feel the difference, although this may happen if the central line comes out accidentally. It would be imperitive to get another line in as soon as possible. No abrupt cessation of infusion. Keep cold packs readily available with some in the freezer, and change minimally every 12 hours, may need to change every 6 hours depending on conditions (room temp, patient temp, location of pouch/pump in bed or ambulatory). Mix concentration is dependent upon the patient's specific prescription, may be 1-2-or higher number of vials with the 100ml diluent and this is dependent usually on the length of time the patient has been receiving the medication and their individual response to the medication. Note that diluent is supplied by the company and not to use saline or sterile water for mixing. Medication is measured in nanograms per kg and not milligrams or micrograms per kg. Always keep back up pump and fresh batteries readily available. Do NOT flush the line with Flolan infusing -- patient would receive a bolus of medication. Do not use the Flolan line to draw blood unless specifically trained and competent in the technique due to potential of inadvertent bolus to patient. Short half-life so have the next cassette ready to go. Change cassettes every 24 hours. May mix 24 hours in advance and keep in refrigerator. This helps patients to make their medication only every 48 hours instead of daily. However, must be used within the 48-hours. Sterile technique regarding line care, of course. Change tubing and caps every 72 hours or as per your hospital policy. A frequent visible side-effect is facial flushing. Be aware of medication interactions with other cardiac and antihypertensive medications. Priming volume will depend on the type of pump/cassette and the patient's specific line (PICC, Hickman, Broviac, Mediport, etc.) Patient and family teaching should include all the above along with importance of line safety; staying out of hot tubs and pools (breeding ground for bacteria infections); maintaining continuous infusions; what to do if the line comes out (call physician or nurse, get a peripheral IV inserted right away until central line can be restarted); how to take showers while protecting line and pump; proper line care; how to change tubing and caps. Site care.
I'm sure I am forgetting some things. Hope this helps.
Carole
Artie Hansford, BSN, CRNI
You may want to contact Accredo Therapeutics at accredotx.com or look for a branch near your area. I used to work for this company back when it was Quantum Health Resources (and when it was Accredo) and it was the first and only infusion company for many years that provided Flolan therapy, beginning in 1994. The cllinical staff is exceptionally competent with this therapy and would be instrumental in providing information to assist with P & P development.
Artie Hansford, BSN, CRNI, VA-BC