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
Here's a great resource:
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
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
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Sure - [email protected] Thanks!
Mari Cordes, BS RN
Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
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
Eau Claire WI