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Kathleen Mazza
Administration of multiple first doses in the home

For Home Care providers -
Looking for input on what you do if you receive an order to start a patient on double antibiotics at home and the patient has not previously had either one. We have an RN monitor any first doses with an anaphylaxis kit on hand - we have some staff that request that the first doses be administered on separate days (for example start one on Monday and the other on Tuesday) - and others who want to administer them during the same visit while monitoring each infusion. Can you please let me know what your policies are - Or if you have heard of this staggered first dose before? My understanding is that anaphylactic reaction to intravenous meds is usually experienced during the infusion - not delayed. Want to do what's best for our patients - but don't want to require additional RN visits without evidence that it is best practice. Thanks for any feedback!

Evidence based conundrum!

As clinicians we need to realize that evidence based practice is ideal, but not always possible, or even desirable! In these scenarios good clinical judgment and pt. centered practice must be priority. For instance, if I wanted evidence based practice on the efficacy of administering vesicant drugs through large bore peripheral IV's in very small hand veins. Clearly that study would hurt pt's. and no one would attempt it. Though not as drastic, your scenario is the same. If both IV's are first dosed on the same visit what parameters are set to ensure the team will know which drug is causing a reaction? How much time between dosing, would a delayed reaction from the first drug cause confusion with the second? Or would it just be safer and easier to give the doses on separate days or a early and late visit? While I certainly appreciate the difficulty in capturing reimbursement for this, pt. safety is always the priority.

Stephen Harris RN, CRNI, VA-BC
Chief Clinical Officer
Carolina Vascular Wellness

 Anaphlylaxis can occur at

 Anaphlylaxis can occur at any time and the route does not make any difference. We can see immediate and delayed reactions with the IV route.  The very first exposure to an agent is NOT when the anaphylaxis will occur. The antigen must stimulate the formation of antibioties and this takes time. So it would always be the 2nd or 3rd exposure when the anaphylaxis or milder allergic reaction will occur. I hope you are leaving that anaphylactic kit in the patient's home for the entire course of therapy. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Kathleen Mazza
Thanks Lynn - Yes, the ana

Thanks Lynn - Yes, the ana kit remains in the patient's home. I agree that we should always remember that anaphylaxis is a possibility - even with meds that have been previously tolerated. I was just wondering if other agencies stagger first-doses for different days or administer them in one visit. I appreciate your input!

Kathleen Mazza, RN, MBA

Chief Operating Officer

Advanced Care, Inc.

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