Drips and such

Nurses General Nursing

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Hi,

I'm not sure of the right thing to do here. I know every nurse and hospital has it's own policies, but here goes:

Had a pt come to me in recovery room yesturday. The anesthesiologist had one IV site with both a heparin drip and Dopamine drip and normal saline (both dpips on pumps). I told him we needed another line because I was sure I had learned that Heparin goes in alone. He was great and started another line. My question is, he then ordered Albumin 250 cc's stat IV. Where would you run this? Do we need 3 lines? Also, does the Heparin need a "base" solution to be run with it, or can heparin run by itself(pump in use of course). No one here seemed to know. Our anticoag protocol did not address the issue.

Many thanks,

ME

Specializes in Everything except surgery.
Originally posted by batmik

. We once had dopamine infilitrate in mediport( the kind that is under the skin and is accessed with a huber needle., I think that is a mediport),, the nurse didn't access the implantable device properly and it cause major extravasation in the patients chest.

Are you talking about a portacath??

Specializes in Everything except surgery.
Originally posted by sharann

Thanks all. 3rdshift, I think you are right about nurse myths. There are too many of those. Thanks for the links!

I think the reason heparin has been run by it's self is to prevent the mistakes that have been made waaaay too many times, by nurses not making sure they re-set the dosage amount, or not making sure the heparin has been turned back on.

I realize there are pumps where you can run a secondary, and when it has infused the set amount, it will switch back to the primary line, but I wouldn't want to have to trust a pump to do that. Especially when you have drips on floors with the pt./nurse ratio the way there are now. Just my .02cents here.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Originally posted by Brownms46

I think the reason heparin has been run by it's self is to prevent the mistakes that have been made waaaay too many times, by nurses not making sure they re-set the dosage amount, or not making sure the heparin has been turned back on.

I realize there are pumps where you can run a secondary, and when it has infused the set amount, it will switch back to the primary line, but I wouldn't want to have to trust a pump to do that. Especially when you have drips on floors with the pt./nurse ratio the way there are now. Just my .02cents here.

Good point. I try to run heparin in an IV all alone. If I can't because of poor access, I always use a multiline pump with the drip on a separate line which is like having two pumps, or to actually use two pumps. Never as a piggyback.

Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

I have heard from my co-workers about heparin and dopamine being infused together in a code situation...we do NOT do dopamine or dobutamine on our floor-they have to be in the unit.

Our hospital has a policy that you start a primary line of 1/2 NS or NS at KVO and you connect heparin at the proximal y-site-I can't tell you how many times I have found heparin running without a primary line...it is written up if you do not do this. If it is a CHF patient, they still have a primary line-usually runs at 10 cc/hr.

Specializes in CCU/CVU/ICU.

I would make sure i had a DARN good blood return before giving dopamine peripherally.

Have any of you given regimine?(sp?)...as an antidote?

Recently, an unfortunate nurse on our med/onc. unit pushed an amp of D50% on a hypoglycemic patient... The site had infiltrated and the pt probably got (at least!) 1/2 of the amp SQ. 12 hours later her forearm was purple,blistered...and so swollen she developed compartment syndrome...requiring a fasciotomy...and nearly lost her arm/hand as a result. In the hospital for WEEKS....

What a crappy mess...for everyone involved!

Specializes in ICU.

I too have seen dopamine infiltrate - long story but it ended as a 3rd degree burn and needed grafting.

Originally posted by gwenith

I too have seen dopamine infiltrate - long story but it ended as a 3rd degree burn and needed grafting.

Me too.. it didn't third degree burns but it did cause the patient alot of unnecessary pain and suffering. I refuse to hang it without a central line... I just tell that docs I have seen one too many complications with it going peripherally and they can verify that with pharmacy if they;d like to. :) (Unless of course it is a code)

We use periphreal sites for dopamine and levophed in an emergency and then place a central line. Just called the other nite to give regitine for a levophed infiltrate. It looked ugly but the patient did okay. PEARL>>>>>>>>>>if you have a periphreal dopa or levo infiltrate leave the iv in. It will be through the IV that the regitine is given (although it can be injected right into surrounding tissue).

Specializes in ICU.

I go back a ways before we had the regitine (different name here??)

That's really interesting about the regitine, particularly about giving it through the infiltrated IV. Have heard about the drug of course, but have never given it. Otherwise, you just inject it subq?

What does it (the regitine) do to the drug (the dopamine) and the site? I have never seen a dopamine infiltrate. What does the site look like after the regitine?

I realize these may be considered stupid questions by some, but it helps to try to visualize, if it's something never seen or done.

Thanks.

I just found a small blurb about the regitine, it is given IV or SC. SC diluted in normal saline.

It also said can add to dopamine or norepinephrine solutions.

Does that mean it is sometimes added to the dopamine drip as a prophylaxis in case it does infiltrate?

I don't like having to deal with dangerous things like that, and if it does infiltrate and messes up the arm, it's the nurse that they are going to come after, not the doctor who didn't or wouldn't put in a central line or order a PICC.

The two infiltrates i have seen were different. One had a marked 'cord', similar to a KCL infiltrate. It was beefy looking. The other was benign but conincidentally the patients hand was cool and pt. had a negative Allens test. Vascular came in but as it turns out this was the baseline (thank goodness). So PEARL: check for pulses distal/proxima to infiltrate.

You have 12 hours to treat such an event and i guess as others have indicated...untreated it can have quite severe consequences.

It works by blocking the alpha effects of the medication, so it vasodilates. Also used for erectile dysfunction and some other uses including controversial organ donation.

There is a slew of info out there on it. Guess it has been around a while. In our facility it has to be administered by medical staff.

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