I had an instance at work where a pt. came by ambulance from the nursing home with a lower GI bleed about an hour before the end of my shift. The PT was approx. 40, H/H were about 9 and 27. Pt. has stable VS, good pressure and is responsive and at baseline orientation, but skin is pale and has slightly dry membranes. ED doc ordered Vitamin K 10mg IV. I placed the order to pharmacy, and 20 min. later received bag mixed by pharmacy of 10mg Vitamin K in 100ml NS with instructions to deliver IVPB over 30 min. I was hanging the bag as the nurse taking over for me came to get report. When I told her I had hung the IVPB, her eyes got really wide and said, "You're giving it IV?" We asked another ED doc (first one's shift ended when mine was supposed to), who gave me a verbal order to change it to 10mg SQ. When I called pharmacy to change and verify the new order, they stated that "we have just started giving it IV. We had an inservice, and they said you can give it IV now." Although, same pharmacist told me that giving it PO or SQ is just as effective as the IV route. I also had orders for 2 units FFP, which were being prepped by the blood bank as this was going on. Has anyone had any experience giving it IVPB before? Is SQ as effective? I know if the pt. isn't actively bleeding, then IV isn't necessary, but what if the pt. is massively bleeding and is heading towards unstable?
Pts can have frequent and severe reactions to giving it IV, even slowly. This is one of those pt okay --- then suddenly code for no other reason- sort of situations. The other issue, is prior studies showed that there was not really all that much advantage to giving it IV vs by injection into tissue, especially given the potential for problems.
A lot depends on where you work . If you are in CC with an excellent nurse/pt ratio and rapid critical response it is one thing, if you are on M/S with slow response and an poorly staffed unit, this could be a big problem.
Pts can have frequent and severe reactions to giving it IV, even slowly. This is one of those pt okay --- then suddenly code for no other reason- sort of situations. The other issue, is prior studies showed that there was not really all that much advantage to giving it IV vs by injection into tissue, especially given the potential for problems.
A lot depends on where you work . If you are in CC with an excellent nurse/pt ratio and rapid critical response it is one thing, if you are on M/S with slow response and an poorly staffed unit, this could be a big problem.
since i have never worked critical care....i have no clue of the possible mechanism of action here....so what causes the issue...?
caroladybelle, BSN, RN
5,486 Posts
Pts can have frequent and severe reactions to giving it IV, even slowly. This is one of those pt okay --- then suddenly code for no other reason- sort of situations. The other issue, is prior studies showed that there was not really all that much advantage to giving it IV vs by injection into tissue, especially given the potential for problems.
A lot depends on where you work . If you are in CC with an excellent nurse/pt ratio and rapid critical response it is one thing, if you are on M/S with slow response and an poorly staffed unit, this could be a big problem.