Penicillin desentiziation

[Peaches N L&D]

Does anyone out there have a protocol for Penicillin desentiziation?, We hardly ever do it, but occasionally there are pregnant women with syphillis who need PCN and are so called allergic to it. We usually call pharmacy and get their protocol and use it (which is all about dosage strength) , but what about the specifics for our maternity unit?, what if she has an anaphylactic reaction? our patients are not admitted (they are out patients), no labs, what if they code?(we do it in our recovery room where the crash cart is near), But I just feel unsafe doing PCN desentiziation, and when I voiced this to my director she said why don't you make a protocol? How rude!!!!! :angryfire

[suzanne4, RN]

Thank you............ :)

[grannynurse FNP student]

I am an OB-GYN NP and I have never desensitized any woman unless she was in the ICU with the proper staff, equipment, etc. This is a very fractious issue and deserves the utmost respect from our OB physicians. It can be a most frightening scene in the absence of pregnancy. Although it is true, "cowboy" OB IS practiced, it is this attitude that will lose the mother and/or baby if densensitization is not properly managed.

Couldn't agree with you more. The term cowboy is clearly deserved. And the risks totally unwarrented.

Grannynurse :balloons:

[Peaches N L&D]

I have participated in 3 desentiziations and have never lost a patient, I have heard of the facility doing more than that, not to be little the risks, but If the pt needs to be treated for a disease she must be treated for her welfare and the welfare of her unborn child, we have had many emergencies and have always done our best and followed protocol, I am concerned that if something were to go wrong while desentizing we would not have a leg to stand on without a protocol for our maternity department. I have never heard of "cowboy" obstetrics (feel free to enlighten me), but for the most part we do what is best for our pt's to avoid any litigations and life threatning complications. Many doctors and units are afraid to participate in the care of a pregnant woman, this why we are left holding the bag....

[suzanne4, RN]

Anaphylactic shock is too dangerous for most facilities to attempt to handle on an elective basis. You are quite fortunate that you have never had to deal with this, but I am sure if you have seen it, your thoughts may differ.

You are actually jeoparizing the lives of two with doing this. And attempting this without a protocol in place in your facility really puts you at risk. Does this even have approval of administration in your facility?

Sorry, but these are my thoughts on the subject.

[Peaches N L&D]

Anaphylactic shock is too dangerous for most facilities to attempt to handle on an elective basis. You are quite fortunate that you have never had to deal with this, but I am sure if you have seen it, your thoughts may differ.

You are actually jeoparizing the lives of two with doing this. And attempting this without a protocol in place in your facility really puts you at risk. Does this even have approval of administration in your facility?

Sorry, but these are my thoughts on the subject.

Yes administration is aware, nothing is done without administration's approval, whom I will include which I am not sure if they are aware is Risk Management. The process starts off with giving a skin test of a minute dose of PCN which if proves to be + we do not continue with the process of desentiziation.... The community I work in is predominately hispanic and they are mostly known to say they are allergic to PCN, the physicians are trying to determine most of all is if this pt is indeed allergic to PCN...

[suzanne4, RN]

That is not desensitation then, especially if there is no positive response to the test dose. But if they are positive, even with an extremely minute dose, you run the risk of anaphylactic shock. Somehting that I would not care to chance.

I work in a very high acuity PICU and asked around today about it, and not one person here would even consider attempting it.

[Peaches N L&D]

That is not desensitation then, especially if there is no positive response to the test dose. But if they are positive, even with an extremely minute dose, you run the risk of anaphylactic shock. Somehting that I would not care to chance.

I work in a very high acuity PICU and asked around today about it, and not one person here would even consider attempting it.

We maybe using it in the wrong context , but the Dr's order reads PCN desentiziation, with the protocol we get from pharamacy if we have a +skin test then we do not proceed and if we get -skin test we continue with smaller to larger doses of PCN.

[sgent]

If you get a -, it means the patient may not be allergic to PCN. Also, performing the skintest in this context is considered a medical procedure -- it has a billible CPT and everything -- meaning in most states it cannot be legally delegated anymore than say suturing a wound. Additionally, Medicare rules require that it be done by a MD or NP/PA.

"Cowboy OB" is a phrase I made up. It means (to me) a OB/GYN performing the role of a very different specialist, well outside his field, only having read the book or asking the nurses what to do. Unless your OB is trained at desentization, I would again state that the proper protocol consists of a consult to the allergist. If you don't have one, then to either the pulmonologist or ENT (although ENT may back out of this, many do a lot of desentization in their practice).

Although there are generic "protocols" available from the CDC, they cannot be used w/o physician supervision because every patient is different -- sometimes very different. The procedure itself, when properly supervised with adequate staff, is safe. Most allergists (who routinely do this type of thing) usually only have 1-2 general reactions a year, and maybe full blown anaphalyxsis every few years. However, they are prepared for it.

Finally, things like insect desen takes place over 6mos to a full year, with shots weekly or monthly. PCN Desen in this context means 24-48 hours.

[Peaches N L&D]

If you get a -, it means the patient may not be allergic to PCN. Also, performing the skintest in this context is considered a medical procedure -- it has a billible CPT and everything -- meaning in most states it cannot be legally delegated anymore than say suturing a wound. Additionally, Medicare rules require that it be done by a MD or NP/PA.

"Cowboy OB" is a phrase I made up. It means (to me) a OB/GYN performing the role of a very different specialist, well outside his field, only having read the book or asking the nurses what to do. Unless your OB is trained at desentization, I would again state that the proper protocol consists of a consult to the allergist. If you don't have one, then to either the pulmonologist or ENT (although ENT may back out of this, many do a lot of desentization in their practice).

Although there are generic "protocols" available from the CDC, they cannot be used w/o physician supervision because every patient is different -- sometimes very different. The procedure itself, when properly supervised with adequate staff, is safe. Most allergists (who routinely do this type of thing) usually only have 1-2 general reactions a year, and maybe full blown anaphalyxsis every few years. However, they are prepared for it.

Finally, things like insect desen takes place over 6mos to a full year, with shots weekly or monthly. PCN Desen in this context means 24-48 hours.

Wow apparently we are using it in the wrong context, this is just another issue I must discuss with the administrative staff at my facility, thank you for the additional knowledge that you have just extended to me....