We are revising our policy on extravasations, I am also working on a pre printed order set to include reversal agents, as well as application of warm or cold compresses.
I am wanting to list some common drugs where we use warm with the order and list common drugs where we apply cold compress after that order line.
Problem is.......I am finding much conflicting data, and then another one that says to not use either. INS makes mention of thermal therapy but no further.
Any new and improved data anyone has? I have pulled up everything I can find and trying to get 2 or more resources that agree is difficult. For the sake of the nurses who will be dealing with this order set I want to make it user friendly so they will be able to , with the physician, select the appropriate therapy.
Thanks, Gina
There are no studies to support the use of cold or warm with many drugs. I think you will have to look at the basic work from the 1990's by Yucha on hypertonic and hypotonic solutions and how they reacted to the application of cold and heat, then work with an internal committee to make the decision that is the best for your patients. Yes, there are conflicts and there are no concrete statements in standards and guidelines. For instance, the Manual on Contrast from ACR says application of heat or cold for contrast extravasation is controversial and they do not recommend one over the other. However, there are about 6 studies that have reported positive results with cold. These are all hypertonic solutions, so cold makes a lot of sense and they is what I would use. For infiltration of plain fluids you could use either depending upon what feels better to the patient. So you must use critical thinking and make your own decisions about many of these. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861