butofcourse

Good access and anticoagulation are the keys to success w/ the machine. The large bore dual lumen cathaters that CHF Solutions has work best. We have our Interventional Radiology place the lines to ensure successful placement. The reason this therapy works is because it pulls off both water and sodium. As a result the pt is less likely to re-accumulate the fluid for a longer period of time. great for frequent flyer, end-stage CHF pts. The pts I've seen with this treatment show a very dramatic improvement in symptoms. We've had pt's gurgling on a Non-rebreather turn around in a few hours, and continue to improve until a total of 6 liters was removed. Stick w/ it. It's cumbersome, but a valuable therapy for the right pt.

Qx Calculate is great if you're looking for risk scores, etc.

I'm trying to collect info on how many practice line pulls are considered adequate to consider someone competent to do them on their own. Our cath Recovery requires 10 but this is not possible for our new ICU staff based on pt volume and staffing I'm wondering what other hospitals are doing.

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?

holly27, a code once a week sounds excessive for any type of unit. why don't you take a peak at the code review sheet listed at the link from siri. it may help you pinpoint opportunities for improvement in pt care. at our hospital we have dramatically decreased the # of codes by using rapid response teams to support non-icu units when they have concerns or just "a funny feeling" about a pt. the med-surg or pcu nurse calls on an icu who intervenes for earlier staff support, pt assessment and treatment and avoid deterioration to an actual code. this translates to a huge improvement in outcomes as the mortality rate for codes is about 50% at best. check it out. and, good luck!

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.

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?

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.

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!!!

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...