If a bag of a pain medication is administered to a pediatric patient at a rate of 0.2ml/hour is this going to be a high enough rate to keep a port from clotting? Should the pain medication be mixed with a larger amount of fliud so that a a higher rate can be used? If the pain medication is stopped to administer for example, ativan what is the best way to flush to avoid flushing in too much pain medication. Could a carrier fluid be used and would this be done by connecting the carrier fluid administration set into the lower y-site on the pain medication administration set. When a carrier fluid is used isn't that going to disrupt how quickly they are receiving the pain medication?
Thank you,
Peds encompasses 0 to 21 years and policies vary depending on age. What pain med are you asking about - a strong narcotic or something else. Are you using a large volume electronic pump, a syringe pump or something else. Flow rate alone is not the only factor that contributes to lumen patency and there is no established rate that will automatically ensure the lumen remains patent. Look at the volume of fluid held by the infusion system which includes the catheter. Figure out the length of time required for the system volume to be infused. A carrier fluid should always be the primary fluid with any medications given as a secondary piggyback. The carrier fluid requires a provider order or an established policy. Depending on the mechanism of your pump, you might be able to infuse the carrier and the pain med simulataneously but other pumps would require sequential infusion as with intermittent meds. From the point where the piggyback set is attached to the end of the catheter - what is that volume? You can use 2 pumps, one for the carrier fluid and one for the pain med, piggybacked a close to the VAD hub as possible. If the pain med and the addition med is confirmed to be compatible, you could give it by push through the carrier fluid but remember the small volume you inject into the set will take a long time to reach the patient, depends on the volume of the med, the flow rate of the carrier fluid and the volume of the system. If not compatible, you must stop the infusion and pain med use saline to clear the lumen of all the pain med by flushing but it must be flushed at the same rate as the infusing dose. Any faster means you are giving the med way too fast. No way to flush out part of the pain med except for what is above the injection port for the secondary med. After you give the second med and you resume the carrier fluid rate and the pain med rate of infusion, calculate how long it will take for the med to reach the bloodstream. What will this do to the patient pain control. If there are multiple secondary meds, you will probably need a second VAD depending on t he documented compatiblity of these meds.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861