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ladena rhoden
Regitine administration for extravasation

Anybody have a precise order set for treating vasopressor extravasations they would be willing to share?  I have an ICU director that wants to initiate an order set.  I cannot find precise instructions, only general. 

It's not that I doubt her resources, I'd just like to verify a couple of statements.

lynncrni
I don't have an order set to

I don't have an order set to share but think this is a great idea. I also might be able to answer your questions if you post them. 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

ladena rhoden
It took me a few minutes to

It took me a few minutes to cogitate, but I have to agree with the unit director that it might increase compliance with treating some of these extravasations - make it less a mystery to the nursing staff.  It is apparently too much trouble to look up policies.

I will write the point here and very much appreciate your feedback.  My questions are pretty minor-I'd just like another pair of eyes that I trust looking at it.

1. If extravasation is suspected, stop infusion immediately. (Huh.  Sad that we need this.)

2. Leave the catheter in place.

3. Notify the physician.

4. Slowly attempt to aspirate as much of the drug as possible.

5. Do not apply pressure to the area.

6. Prepare Regitine (Phentolamine).

7. Take (2) 5mg/1ml vials and dilute with 10ml 0.9% normal saline, in 20ml syringe.

8. Inject 6ml through the indwelling IV catheter at the site. (Some resources indicate this  may not be indicated)

9. Inject the remaining 6ml in 0.5ml increments SQ around the extravasation site.

10. Cleanse the area with chloraprep prior to injections.

11. Each injection should be done with a new 25 or 26 ga needles (27 or 30?)

12. The injections should be done in a star pattern around the infiltrate at the peripheral margin of the infiltrate (I'm used to clock, but this sounds fine, too.)

13. Apply cold packs prn to affected area.

14.Apply guaze dressing and secure loosely (I'd rec telfa and secure with netting).

15. Elevate extremity. (for patient comfort)

16. Blanching should reverse immediately (why is this on an order sheet)

17. If blanching returns, additional doses may be required. (Not familiar with repeat doses.)

18. Continue to monitor for pain, induration, and necrosis.

19. Notify physician for additional orders.

If we're going to do this, I'd like something about a consult for plastics.

Again, appreciate any input.

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

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

lynncrni
I definitely think that

I definitely think that ***all*** facilities administering infusion therapy must have a written policy and procedure to manage both extravasations and infiltrations. You used the word "extravasation" and are listing Regitine as the only antidote. Extravastion is used when there is leakage of any vesciant medications from the vein. Regitine is the antidote for only vasopressors (e.g. dopamine) and is not indicated for all vesicants. The concept of injecting antidote through the short peripheral catheter is controvesial and is never done with a CVC. Many are concerned about some of the antidote being given IV rather than SC. But the additional injections cause skin breaks that could lead to infection. Your procedure already calls for skin injections, so I would not do the injection through the catheter. Smallest needles are better. For vasopressors, cold is not indicated. The vasopressors are causing vasoconstriction and so is the cold. This could lead to increased risk of tissue damage. Cold is indicated for most everything else except vinca alkaloids and epipodophylotoxins. You need to include notification of risk management through an unusual occurrence report. INS standards now call for extravasation injuries to require a sentinel event. Also you need to take a photo of the site. Plus you will need to address the many other vesicants and infiltration also. Surgical consults may be necessary. For instances, severe infiltrations can cause compartment syndrome. If not surgicall relieved within 12 hours the patient can loose the entire extremity. 

 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

ladena rhoden
We have policies that deal

We have policies that deal with infiltration and extravasation with the recommended antidotes for specific solutions/drugs.  Since it is not readily available enough to them, the unit director wants to have an order set for vasopressor extravasation.  The names are listed across the top of the sheet.

I can make the suggestion to clarify injecting thru the catheter - peripheral only.  I have never been able to inject more than 0.5ml this way and question where she got the 6ml.  She tells me this order set was rigorously researched by the education people in Hawaii and includes best practice.  I review these things at least yearly.  Guess I'm missing something.

Can you give me your favorite references?  You are one of mine.

lynncrni
I also do not know what she

I also do not know what she is referring to from Hawaii. I put up my online course on infiltration and extravasation earlier this year and there are more than 90 references. Also I have been working on another project about this topic over the past year and don't recall any "rigorously researched" article. In fact this seems highly unlikely given the nature of this issue. 

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

www.hadawayassociates.com

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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