Erythropoeitin Administration

[rogue_maverick]

Question:

If the patient comes to the facility and for some reason was not dialyzed, but is scheduled to receive his Epo injection, shall we inject the medication or not?

And why?

Thanks!

[traumaRUs, MSN, APRN]

My understanding is that if the blood doesn't hit the dialyzer, there is no treatment so you can't charge for it, so therefore, you wouldn't administer meds either.

[rogue_maverick]

Yup, I understand that.

But in third world conditions usually patients bring their own epo injections. So if the patient was not dialyzed for some reason, but he brought his injection, should it be administered?

[just keep swimming]

If the patient is carrying their own epo I would assume it is already paid for. The problem would then lie in whether or not you can bill for and are covered for administration of the medication if you are not billing for a treatment. It would depend on the policies you need to follow.

In terms of whether it should be given or not, I would say it is important that they receive their epo on schedule. It takes 4 to 6 weeks to see the results of administration and missed doses can really screw up how you would adjust for future dosing as hgb would come back lower than it should be. This may cause you to increase the dose because it appears the patient needs more when the inadequate rise in hgb is really due to missed doses.

I would consult with the docs you work with and also with your policies. Are you giving the epo IV or subq? If subq, can these patients be trained to administer their own? When in developing countries I would assume you have to be creative with treatment options....just curious, where are you working?

[rogue_maverick]

I'm working in Guyana (but I'm not from here) and here patients bring their epo when it's scheduled for them them to have their injections.

[rogue_maverick]

Follow up question:

In some caribbean countries, they already inject the EPO either IV or SC while dialysis is ongoing. Is this alright? Because i was trained before to administer it AFTER the treatment. But the nurses from Curacao and Aruba that i work with inject it DURING dialysis, and mostly IV. is there any significant difference?

[just keep swimming]

I believe the half life is longer when given sub q. We give ours iv during the treatment. The package insert does not specify anything about beginning or end of treatment

[rogue_maverick]

If given IV during treatment, haven't you encountered patients who had seizures upon EPO administration?

[just keep swimming]

Never

[rogue_maverick]

Thanks Nurse Nessa!

[just keep swimming]

You're welcome