Infiltrate treatment question

  1. 0 Hello everyone,
    I'm hoping some of you have experience with treating Dopamine Infiltrates. New literature I found indicates that when injecting Regitine into the infiltrate site, the needle must be changed each time you inject at a new spot in the area. Our staff are questioning if this is actually necessary since this is not the practice when infiltrating a site with xylocaine, for example. Can anyone help me with rationale?

    How do you all treat a dopamine infiltrate? I'm trying to compare practice with current literature in the pharmacy world...
    Last edit by suebird3 on Jul 26, '06
  2. Visit  butofcourse profile page

    About butofcourse

    From 'Florida'; Joined Jul '06; Posts: 11.

    17 Comments so far...

  3. Visit  TennRN2004 profile page
    0
    Quote from butofcourse
    How do you all treat a dopamine infiltrate? I'm trying to compare practice with current literature in the pharmacy world...
    Regitine given in 10 SQ injections around the infiltration site.
  4. Visit  jmgrn65 profile page
    0
    Quote from TennRN2004
    Regitine given in 10 SQ injections around the infiltration site.














    :yeahthat:
  5. Visit  dorimar profile page
    0
    Yes, but i have never changed the needle with each SQ poke. Did the lieterature give a rationale for this? I really am interseted, because i want to be using best practice.
  6. Visit  dorimar profile page
    0
    Can you please place a link to the research?
  7. Visit  TennRN2004 profile page
    0
    I don't know the actual hard scientific rational, but from a common sense standpoint, I think the reasoning for switching needles before each injection is to ensure you have a clean needle with just the regitine and no reminants from the dopamine you could be injected into tissue, this making the infiltration over a larger area. The way I think about it is you have the dopamine in the tissues you're wanting to treat with the regitine. If you use the same needle, on the 10th injection you've been penetrating skin that has dopamine then moving to a different site on the skin taking more dopamine there. If you change needles, you have regitine and only regitine you're injected each time with the "clean" needle. The pictures of dopamine infiltration are very ugly, and patient's can end up needing skin grafts, even amputation when an infiltration is not assessed/intervened quickly. I know in my own practice, I always cringe when we have a patient on dopamine with a PIV, I would prefer a central line for that type of infusion. If a PIV is all I have, I document that my PIV has good blood return and is infusing with no s/s infiltration and assess my IV site much more frequently than I would if I just had NS at KVO.
  8. Visit  Otessa profile page
    0
    I've given Regitine and had a new SQ needle for each injection...............
  9. Visit  butofcourse profile page
    0
    Thank you so much, TennRN! You put into words what I was having trouble wrapping my arms around!
    For the rest of you, I will make a more concerted effort to retrieve the exact reference.
    Thanks for all your responses!!!
  10. Visit  Renee_RN profile page
    0
    I have administered Regitine into a Dopamine infiltrate on several occasions. I use aseptic technique and do not change the needle.

    Renee
  11. Visit  TennRN2004 profile page
    0
    Quote from Renee_RN
    I have administered Regitine into a Dopamine infiltrate on several occasions. I use aseptic technique and do not change the needle.

    Renee
    Like I say, I don't know the hard evidence to support doing it. However, it is our hospital policy when administering it to change the needle. My response above was based on why it makes sense to me to do it. I probably would not have given it a thought if the hospital policy didn't state for us to do it.
  12. Visit  mmutk profile page
    0
    Actually saw this done for the first time last month, although with a little resistance from the rn with the infiltrate...
  13. Visit  butofcourse profile page
    0
    Here are the references that specifically state to change the needle between each skin entry:
    Lexi-Comp's Drug Information Handbook, 13th edition, p 1192-1193, Lexi-Comp, Inc, 2005.
    Cancer Chemotherapy Manual: Summary of Extravasation Management for Non-antineoplastic Agents, Walters Kluwer Health, Inc, 2005
    I also found it online in the Extravasation Policy at Overlake Hospital Medical Center. Actually, they have a reference which I am about to check out- "The National Extravasation Information Service" http://www.nexis.org.uk/treating.htm
    Hope these help you all!
    I'm convinced this is Best Practice, and will be recommending we change our policy and practice.
  14. Visit  butofcourse profile page
    0
    I now have reached another snag w/ this issue.
    We all are concerned w/ avoiding needle sticks and all of the needles avail. in our hospital have safety covers for the needle after injection. Once covered, the needle CAN'T be changed. How have you guys, that are changing needles, handled this in your institutions?


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