Neo in the RV port

  1. The facility I work at has an unwritten rule that Neo gtt's will not go through the RV port on a PAC (SGC). When someone "breaks" the rule the claws come out. I have asked 6 cardiologist, 2 CT surgeons, 1 APRN, 5 CCRNs, 1 intensivist, and the educator about literature to support this rule. Every MD/DO says it BS, the CCRN's agree, and the APRN looked like a stunned mullet. The educator, who is the rule proponent, says it has always been that way. Someone...anyone.....direct me to evidence based research that supports/rejects this notion. I have tested this theory with no adverse effects as there is no policy to support it and the RV port was the only one left.

    FYI....I do not intend to gloat either way but my unit is antiquated in its approach to critical care nursing and will never get it until the boat is rocked. :angel2:
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  2. 4 Comments

  3. by   ICU_floater
    no evidenced based except to say that our policy, consistent with the universal IV therapy guidelines runs all pressers together through the side port of the swan. The space of the holes on the swan are so short that when you add in blood flow, cardiac output.... what are we talking a second delay of reaching the RV? We separate a line for TPN,lipids and diprovan and use a manifold approach for multi drug therapy when blood, albumin and all the others start to get added.....

    I know of no specific research for or against, only the pathologic process of blood flow and the swan set up.... and this seems... unnecessary. Chime in anyone who can help prove this, can only offer our current practice.
  4. by   Summitk2
    Even EBP aside, what's their rationale against it? Do they have the same rule for all pressors? It's so sad to hear an educator give the reasoning, "it's always been done that way."
  5. by   ICU_floater
    I've asked around, many of our CCRN's have gone on to anesthesia school, I asked three of them, no literature or taught theory that states a contraindication, and I received quite a lecture on cardiac output flow and the short swan with real time blood mixing for your pressers in multi-ports and minimal effect from multi-second flow... to the point my head spun. Basically, alpha, beta 1 or beta2 will work as absorbed and the inotropic cascade begins, it occurs through flow and absorption through the carrier molecules and is NOT differentiated by a lumen or port as once the drug enters the great vessels flow is a constant.

    Now, could they quote research... well the look I got said enough for me, I hope this helps.
  6. by   BAMACCRN
    Thanks for the replies. To answer the question about the SOP on pressors.....there is no SOP. I believe the educator ( who is "educated" with a MSN) had a pulmonary vasospasm occur years ago and that has been her rule since she has been around for so long. I again asked her, after showing her this thread, and she still could not come up anything better than "that is the rule." I politely told her until it was approved by the multiple committees to have the "rule" made into the SOP I would continue to put the Neo in the available port. And then........her reply....." you are going to CRNA school, what do you care?"
    I believe she should extinguish her lamp of knowledge and put it on the shelf.
    Last edit by BAMACCRN on Mar 6, '07

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