Infiltrate treatment question

TennRN2004 · Jul 26, 2006

How do you all treat a dopamine infiltrate? I'm trying to compare practice with current literature in the pharmacy world...

Regitine given in 10 SQ injections around the infiltration site.

jmgrn65, RN · Jul 26, 2006

Regitine given in 10 SQ injections around the infiltration site.

:yeahthat:

dorimar, BSN, RN · Jul 27, 2006

Yes, but i have never changed the needle with each SQ poke. Did the lieterature give a rationale for this? I really am interseted, because i want to be using best practice.

dorimar, BSN, RN · Jul 27, 2006

Can you please place a link to the research?

TennRN2004 · Jul 27, 2006

I don't know the actual hard scientific rational, but from a common sense standpoint, I think the reasoning for switching needles before each injection is to ensure you have a clean needle with just the regitine and no reminants from the dopamine you could be injected into tissue, this making the infiltration over a larger area. The way I think about it is you have the dopamine in the tissues you're wanting to treat with the regitine. If you use the same needle, on the 10th injection you've been penetrating skin that has dopamine then moving to a different site on the skin taking more dopamine there. If you change needles, you have regitine and only regitine you're injected each time with the "clean" needle. The pictures of dopamine infiltration are very ugly, and patient's can end up needing skin grafts, even amputation when an infiltration is not assessed/intervened quickly. I know in my own practice, I always cringe when we have a patient on dopamine with a PIV, I would prefer a central line for that type of infusion. If a PIV is all I have, I document that my PIV has good blood return and is infusing with no s/s infiltration and assess my IV site much more frequently than I would if I just had NS at KVO.

Otessa, BSN, RN · Jul 27, 2006

I've given Regitine and had a new SQ needle for each injection...............

butofcourse · Jul 28, 2006

Thank you so much, TennRN! You put into words what I was having trouble wrapping my arms around!

For the rest of you, I will make a more concerted effort to retrieve the exact reference.

Thanks for all your responses!!!

Renee_RN · Jul 29, 2006

I have administered Regitine into a Dopamine infiltrate on several occasions. I use aseptic technique and do not change the needle.

Renee

TennRN2004 · Jul 30, 2006

I have administered Regitine into a Dopamine infiltrate on several occasions. I use aseptic technique and do not change the needle.
Renee

Like I say, I don't know the hard evidence to support doing it. However, it is our hospital policy when administering it to change the needle. My response above was based on why it makes sense to me to do it. I probably would not have given it a thought if the hospital policy didn't state for us to do it.

mmutk, BSN, RN, EMT-I · Jul 31, 2006

Actually saw this done for the first time last month, although with a little resistance from the rn with the infiltrate...

butofcourse · Aug 9, 2006

Here are the references that specifically state to change the needle between each skin entry:

Lexi-Comp's Drug Information Handbook, 13th edition, p 1192-1193, Lexi-Comp, Inc, 2005.

Cancer Chemotherapy Manual: Summary of Extravasation Management for Non-antineoplastic Agents, Walters Kluwer Health, Inc, 2005

I also found it online in the Extravasation Policy at Overlake Hospital Medical Center. Actually, they have a reference which I am about to check out- "The National Extravasation Information Service" http://www.nexis.org.uk/treating.htm

Hope these help you all!

I'm convinced this is Best Practice, and will be recommending we change our policy and practice.