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Discussion

How do I chart this one?

I have a HH pt with a port-a-cath. When changing the needle the pt has been perfectly fine until this week. I always remove the needle without flushing because has narcotics in the line, prime the new line with NS and then flush with NS. No problems. Cool. This time the second I started the NS flush the pt jumped up, got on the floor and was writhing around saying he'd/she'd been overdosed with narcotics yet that was impossible beside the pt was acting anything but sedated. Claimed he/she was burning and itching all over, nauseated the whole gammet. The spouse just looked at him/her, didn't seem overly concerned. The spouse said that's exactly what happened at the ER this past weekend when they gave him/her IV Demerol. The doctor said to the spouse well no more Demerol for this pt ever again. The infusion at home is not Demerol.

I feel like this was some sort of put on or some sort of psych reaction or a combination of the two. I don't know what to think or what to chart. Once I assured the patient that there was not any overdose of medication only a NS flush, that didn't seem to change any of the over inflated reaction. Any thoughts?

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I guess I would chart what happened ("blow-by-blow") in as dispassionate terms as possible. Including what was said and by whom.

Be factual from a 3rd party perspective:

Example:

12:00 PM: pt became [Adjective here]. Spouse reports similar occurence

from previous weekend involving intravenous administration of demerol;

after said reactions, physician [Physician Name here] ordered a halt

on all future administration of demerol.

As important as what to chart is what to do the next time you need to change the needle set. What exactly is the infusion? The reaction sounded a little odd,but maybe it was real. Next time when you change needle sets,aspirate for blood return (which needs to be done,anyway) discard the aspirate and then flush. That way you are sure not to bolus whatever is in the port and catheter,you've confirmed needle placement and device patency all in one.

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