Flolan

[heart queen]

how many of you are using flolan? Does your policy not only require the back up, but a spiked bag back up, with a back up pump pre set at the infusion rate? Are you keeping your (I'm assuming) 8 hour bag chilled, via cadd pump?

After researching literature, I'm fully aware of the instability with light, room temp. and NS. yet I'm pretty sure we're a bit beyond over the edge here. without having to go through all that policy junk, can you just share basically how you deal with Flolan? Aware of titrating, vs. all that stuff.

Just looking for stability practices and back up practices. I know you have 2-3 minutes, but pre-spiking bags? It seems like if you just call pharmacy the two hrs. ahead, plus you have a back up... our norms seem abnormal. Did I mention the spare tubbing and batteries?

It seems like 4 times the needed work, because some idiot may let the line go dry.

Understanding the quick rebound pulm. HTN. but isn't this a bit much??

thanks

Thanks soooo much

[traumaRUs, MSN, APRN]

I know (as an ER RN) we have several people on it in the community and they do carry back-up infusion to include extra IV tubing and access equipment. However, in the hospital, having it at bedside seems enough to me.

[zambezi, BSN, RN]

We don't use this at my hospital. In fact, I have never even heard of it. What is it? Thanks.

[heart queen]

http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?documentid=7169

this link, falsely leads you to think its anticoagulation. We use it for it's prostiglandin vasodilator effects, esp. refractory pulmonary HTN in our pre and esp. post heart transplant patients. Even more esp. those who were borderline both lung and heart transplant, where we elected just a heart due to instability and lack of lung donor. We also use it, rare, on our hearts. Due to the vasodilation at the arterioles, we have decreased venous congestion, increased venous return which in theory equals higher RV filling, more filling to the coronary sinus, decreased afterload, decreased wedge pressures.

The pure pulmonary Htn use can decrease RV filling pressures and allows a "normal" RA/RV pressure, giving time for O2/C02 exchange, with less barrotrauma to the pulmonary vasculature, all with the anticoagulation princpals due to not irritating, yet facilitating the clotting casscade.

All this assuming your RA/RV pressures are not through the roof, independent of your wedge. you drop them with this drug and there goes your starling's law, you need to have the volume, especially with an independent dilated RA/RV to give you high enough filling pressures. Vasodilating the arterioles at this point is detromental, when this presents a different problem, not fixed by flolan.. fixed by fluid like in you fresh RV infarcts

luckily, for efficacy of the drug, pure right sided heart failure is RARE, wich makes this a wonder drug, if used in a select population

this drugs use though, is a bugger for nursing

[nexus]

We use it as an anticoagulant during cvvhf when patients have HIT.

I didn't know it had vasodilatory effects and we certainly don't take all the precautions you mention. What doses are you giving?

Dee P

[traumaRUs, MSN, APRN]

We use it as a last ditch effort for pulmonary hypertension. The few people on it in our community are from the fen-fen disaster!