Infiltrate treatment question

[butofcourse]

Hello everyone,

I'm hoping some of you have experience with treating Dopamine Infiltrates. New literature I found indicates that when injecting Regitine into the infiltrate site, the needle must be changed each time you inject at a new spot in the area. Our staff are questioning if this is actually necessary since this is not the practice when infiltrating a site with xylocaine, for example. Can anyone help me with rationale?

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

[butofcourse]

I now have reached another snag w/ this issue.

We all are concerned w/ avoiding needle sticks and all of the needles avail. in our hospital have safety covers for the needle after injection. Once covered, the needle CAN'T be changed. How have you guys, that are changing needles, handled this in your institutions?

[TennRN2004]

I now have reached another snag w/ this issue.

We all are concerned w/ avoiding needle sticks and all of the needles avail. in our hospital have safety covers for the needle after injection. Once covered, the needle CAN'T be changed. How have you guys, that are changing needles, handled this in your institutions?

We also have the needles with the safety covers. BUt, ours allow us to choose the length/guage of the needle we want, so we can change ours out. In the situation you are describing, sounds silly, but the only thing I could think to do would be draw portion of the med up into ten different syringes.

[butofcourse]

Yes, after much discussion here's the solution we've come up with:

Pharmacy will support the nursing units by doing the reconstituting and send 10 1cc syringes of diluted Regitine to the unit. As such, it is stable for 24 hours. Regitine will also remain avail. on the units (in pyxis) as a powder needing to be reconstitiuted...just in case. Pharmacy will create reconstitiution instructions to keep w/ the vial.

Thank God, this is a low volume issue as we only use periph. IVs for this when absolutely no other option, and then for as short a time as possible...until PICC or midline or central line can be inserted.

[studentnurserachel]

Interesting to see that so many have policy of only 10 sticks around infiltration site. Our policy is to bleb every cm around site first and then all throughout site every cm, let me tell you, it is a very long process even without changing the needle for every stick and if we did, that would involve literally hundreds of needles and probably well over an hour instead of the 20-30 minutes it typically takes now. I would love to change policy to 10 sticks, even if we had to change out needles each time. I am pretty new to the CCU and have fortunately only had to do this twice so far, but I will say about our methods, I've heard nothing but good things about our results using this method, would be interested to see research on this.

[butofcourse]

Hi all! I'm revisiting a very old thread to add a little info and ask a question:

As far as the 10 sticks, we have had very good results with it, so i wouldn't recommend more unless the infiltrate is extensive. That needs to be assessed on an individual basis.

Recently, there has been a shortage of Regitine. We had only 5 cc avail. in our hospital at the time of a most recent infiltrate. We used what we had, applies Nitropaste (BP was ok) to the site, and prayed. The patient did well, but I was very worried.

How are you all handling the drug shortage?

[IVRUS, BSN, RN]

Well,

This is frustrating for you and your employing institution, for sure... However, you can do some research and perhaps change your antidote. Some people are finding Terbutaline to work well when Regitine isn't available.