is this correct? input please:)

[sweetieann]

I am a nursing student and I was wondering what the seasoned nurses would do in this situation.

My friend just got her tonsils out and shared a room with another patient. The other patient complained to her nurses that her antibiotic IV infusion felt like it was burning as it was infusing. The nurse turned down the infusion rate to "remedy" this situation.

Now, without actually having been there, I can't say for sure...but *I* would think that you would first check the sit for swelling, erythema, etc (signs of infiltration) and notify the doctor because burning isn't a "normal" sensation from an IV infusion, right?

My questions are:

-if there was NO swelling (obviously if there was, you'd suspect infiltration), etc...but the site still was burny or the pt felt the infusion burning as it entered their vein, what would you have done? (don't think you can just knock down the infusion rate w/o an MD order, right?) Basically what I am saying is, if there were no s&s of infiltration but there was still discomfort to the patient, what would you do?

-actually, come to think of it, isn't there actually some ATB that burn a bit while infusing normally? can't normal saline even burn?

Thanks so much for your input!

[TazziRN, RN]

you can slow down the infusion rate, yes. what that nurse did was appropriate, assuming s/he did check for infiltration and found no signs of this. many meds can burn on infusion.

[NurseCard, ADN]

Yes, if a patient starts complaining that their IV site is hurting or burning, my first instinct is to visualize it to see if it looks red or swollen, and then feel of the skin above the site to see if it feels tight or swollen. Also I might stop whatever is infusing and flush the site and see what happens. If the site flushes well without the skin above the site puffing up, and blood returns back into the tubing... you've got a good site.

And yes, some antbx, and also potassium infusion, can burn like a &*^%$!!

We've had patients in my hospital complain about their Vancomycin infusion, and yes it does help to turn the rate of the infusion down.

[rnmi2004]

I agree with what the other posters said. Also, MD orders for IV abx (the ones I've seen, anyhow) do not include the rate. The bags come up with a rate on them from pharmacy but it is not an MD order.

[TazziRN, RN]

there are only a few abx that HAVE to be infused at a certain rate or skower. there are a few that i have dumped in pre-op on major traumas.

[banditrn]

What the others have said about checking the site, and the burning that some meds will cause some people is very correct.

Vancomycin, especially, is bad on veins, and is actually best given thru some type of central or picc line.

We used to apply a small ice pack to some people's hands to help the burning.

[Altra, BSN, RN]

Now, without actually having been there, I can't say for sure...but *I* would think that you would first check the sit for swelling, erythema, etc (signs of infiltration) and notify the doctor because burning isn't a "normal" sensation from an IV infusion, right?

I would be willing to bet that the nurse did visually inspect the site, whether or not your friend remembers this or was even aware of it.

Many meds can be uncomfortable infusing - a number of antibiotics (Vancomycin, Gentamycin), KCl, etc. This is a common occurrence, and it's one of those situations where you correct the problem and then talk to the doc. You can slow the infusion or run the med through a bag of NSS to try to reduce discomfort - depends on the patient's circumstances.

These problem-solving skills come with a little experience.

[Haunted]

Some facilities I have worked at add lidocaine to the bag before infusing it, if it is compatible with the solution, MD orders, ya da ya da doo etc.

[Antikigirl, ASN, RN]

Yep, check IV site and slow rate...if no s/sx of probelms at site call MD and tell them what is occuring. If the probelm is very bad and beyond just a small complaint...turn it off (yes you may get flack..but stick to your guns!) and wait for further orders!

Vanco does this, and I see this often..heck I see this on a NS push! Know your pt, and gauge their responses accordingly to tell the MD! If someone that never complains says this..I am on red alert, if they have been on this med before and all the sudden...I am perplexed and will need MD intervention anyway...if this is a person that I touch lightly and they freak...well, I will still slow the rate, talk to the pt, and call the MD.

Veins are tricky and sensitive in certain patients...so use your assessment skills and trust your judgement...well that an call the MD! LOL!!!!!!!

Heck..I have seen MD's change the IVF and all is fine....or use a slower rate....