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mary ann ferrannini
No extravasation policy
 I have been pestering nursing at my place of employment to let me write a policy and procedure on how to deal with non-chemotherapy extravastions. I finally gave up at least for awhile!!!!. I decided to make my own chart for the IV team members after an unfortunate incident during an emergency. Even though this patient had a triple lumen PICC in place they opted to start a Levophed drip on a 48 hour old site that had been in place for IV Dilantin and to boot was at the wrist at an area of flexion. Yes... a nightmare is the result... multiple surgeries ,partial amputation,mos of hospitalization and functional losses,so was it the Dilantin or the Levophed was it PGS or a combination of them both. I doubt the site was good at the start of the Levophed or should I say at least as good as a sight like that can be. No one knew to try some Phentolamine. I will make it clear on the document that any treatment orders must come from the MD and and when there is a difference of opinion in the literature I have stated this as well, and anything that is used as an off label use I have also stated. Are there any other instructions I can give my co-workers. There is already a section on assessment nursing actions and documentation
momdogz
Here's a great

Here's a great resource:

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

mary ann ferrannini
Thank you Mari!!!!! I will
Thank you Mari!!!!! I will check it out. My project is looking really good But I am only half way through it.   Thanks again.
momdogz
Sounds like you're doing

Sounds like you're doing great work - what an awful outcome! 

After our extravasation policy was inactive for a year, we rewrote ours.  We decided that since any chart that might contain all potential irritants/vesicants/extravasants would be so big, and changing when new meds introduced, that we would have pharmacy be the first contact after the staff RN noted the infiltration.  Used to be - the staff RN would call the IV team, but then precious time was wasted if we didn't have the most up to date information about meds.  For some meds the antidote includes heat, others - cold, etc.etc - you know the issue well.  How big is your facility?  Would your pharmacy be willing to be a resource like that?

And...would you be willing to "swap" documents with me? 

One thing I do stress because I find that not many nurses know it is that infiltration of any amount of blood product (as well as irritant or vesicant) is a grade IV on the INS Infiltration Scale (can find in the 2006 SOP).

 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

mary ann ferrannini
Mari I would love to
Mari I would love to share,but need more tome to finish it. This summer I am also studying to recert my CRNI. I just take the test every 3 years b/c it is so much cheaper and easier b/c I am a single mom. Our pharmacists are great but they are really not into IV Therapy issues that much. Our hospital nurses are really dependent on the IV Therapy staff to give them direction and want us to evaluate the sites when issues arise. i would be concerned to be left out of the loop and lose the oppurtunity to do a venous evaluation and suggest best treatment and provide advice about further venous access needs. Do you want to give me your e-mail as I anticipate I will be done with it by end of summer if not sooner. 
momdogz
Sure - [email protected]  

Sure - [email protected]          Thanks! 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Peter Marino
http://www.extravasation.org.

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

Heather Nichols
  Mary Ann,       I

  Mary Ann,

      I started on an extravasation policy not to long ago, and I am almost finished.  A lot of my info came from Lynn Hadaway.  You should check out her CE course.  It's great.  I also have heard thru the grape vine that AVA will also be coming out with all of this information soon.  That should be nice to have.  Sorry to hear about your incident.  We had a nurse in the ER push straight Phenergan into a PIV in the brachial vein a couple of months ago. It extravasated and ate into the artery.  The poor woman lost her whole arm within a couple of weeks.  Thinks like that are so sad seeing as they are completely preventable.  Good luck. 

Wendy Erickson RN
Mary Ann, an additional
Mary Ann, an additional concern here is why you are not able to get nursing administration to see the need for such a policy!  I would suspect that if you run it by Risk management or your legal department, they would be a whole lot more interested!  As chair of our nursing Policy/Procedure Committee, I cannot imagine ever saying "no" to someone asking to write a policy/procedure!  Now....  if only I could get all nurses to READ them, I'd be able to die happy!  :)

Wendy Erickson RN
Eau Claire WI

mary ann ferrannini
 Wendy, maybe I am weird
 Wendy, maybe I am weird but I can not image practicing for any employer without reading the Policies and Procedures that I may be using.If the situation arises that I do not know or can not recall I look it up!!!!!. But i must ssay I do know what you are talking about!!! I can not tell you how many policies and procedures I have written over the years and re-written as practice guidelines change and generally they listen to me. I think the nurses are unaware of all the damage that can be done to an individual when these extravasations happen. I am hoping when they see my finished product they will ask for it 
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