Desmopressin for epistaxis

[weirdRN, RN]

Hi All,

I need a little help. I am a little confused. I have an order for desmopressin 4 mcg IV, for a resident who has frequent nose bleeds.

I checked with our pharmacist. She said the resident could have up to 23 mcg/daily and that the route could be IV, or SC.

The other day, I sent this resident out b/c I could not get an IV in her. The ER called me back and said that their pharmacist had said that 4mcg was over kill on a 94 yo.

This resident is a really hard stick on a good day. I am thinking of asking her Doc for an SC order. Does anyone else have any experience with this kind of situtation? Specifically the severe epistaxis and the desmopressin?

Any advice would be helpful. Thanks!

[weirdRN, RN]

No takers?

[EricJRN, MSN, RN]

I found this article which mentions the use of desmopressin in epistaxis for patients with bleeding disorders, but they suggest DDAVP nasal spray.

http://www.aafp.org/afp/20050115/305.html

[IVRN72]

Hello,

Please do not get offended by this but I feel strongly about this just coming from LTC.

First of all, why would you send a 94y/o resident to the ER for an IV?

Second, why did you not get an order for SC in the first place?

Third, Do you know how long people have to wait in the ER to be seen and have you ever laid on an ER bed/stretcher. They are not comfortable and have severely damaged elderly peoples skin from the amount of pressure.

Lastly, Did you know that every time a resident goes to the ER or for any outpatient visit the cost is incurred by the facility and/or taken out of their medicare/medicaid reimbursement. So next time you want to send someone to the ER for an IV!?!? Maybe reconsider.

[weirdRN, RN]

Hello,

Please do not get offended by this but I feel strongly about this just coming from LTC.

First of all, why would you send a 94y/o resident to the ER for an IV?

Second, why did you not get an order for SC in the first place?

Third, Do you know how long people have to wait in the ER to be seen and have you ever laid on an ER bed/stretcher. They are not comfortable and have severely damaged elderly peoples skin from the amount of pressure.

Lastly, Did you know that every time a resident goes to the ER or for any outpatient visit the cost is incurred by the facility and/or taken out of their medicare/medicaid reimbursement. So next time you want to send someone to the ER for an IV!?!? Maybe reconsider.

Not offended, but if you can't get an IV started and six people have tried at two sticks a person, what would you have done differently?

As for the order IV vs SC... That was this way before I ever came to this facility. This is a new situation for me. I asked about the nasal spray and the SC route as soon as I read that the oder was for IV. I also followed up to see if I could get the order changed to SC. Her reg Doc refused b/c the order came from her hematologist. So now I have to consult with the hematologist on Tuesday (b/c he took a long weekend) to get her order changed, IF the Doc will even change the route.

I am completely with you on ER wait times. Fortunately, our community hospital doesn't usually have a long wait time. I think the longest wait time is about fifteen minutes from front door to doc.

I am completely aware of what pressure can do to old, fragile skin. I deal with that on a day to day basis.

Why should I care where the reimbursement comes from? I don't mean that is a mean way. It is a valid question. The woman needed to go out to a hospital where she could be evaluated for possible placement of a central line if that was needed and possibly nasal packing. Which she has had done a number of times previously. I could give a rat's behind where the reimbursement comes from as long as the resident is taken care of appropriately.