Procedure for Inotrope Administration in the home

Size: px
Start display at page:

Download "Procedure for Inotrope Administration in the home"

Transcription

1 Procedure for Inotrope Administration in the home Purpose This purpose of this procedure is to define the care used when administering inotropic agents intravenously in the home This includes: A. Practice and support the following guidelines for administration of inotropic therapy at home. B. Facilitate the hospital discharge of patients with end-stage CHF who: Have not responded to standard oral drug therapy Cannot be weaned off of Inotropic therapy and need continuous intravenous Inotropic therapy. May be on a waiting list for a heart transplant. Have a significant response to intermittent Inotropic therapy. C. Provide a safe and effective use of Dobutamine, Dopamine and Milrinone in the home. BACKGROUND The goal of inotropic agents is to enhance cardiac output by reducing preload and afterload. Patients who cannot be weaned from intravenous to oral therapy may require continuous infusion of inotropic agent such as dobutamine and milrinone. The decision to continue intravenous infusions at home should not be made until all attempts to achieve stability have failed. Dobutamine and Milrinone are the agents used in DHCH Home Health Program. They are positive inotropic agents used for the management of patients with stage III and IV congestive heart failure who have not responded adequately to Digoxin, diuretics, ACE inhibitors, and/or oral vasodilators. Inotropic agents have also found application in the treatment of acute hypotensive and low cardiac output conditions. PROCEDURES: Nursing staff may expect that it is the primary physician's responsibility to determine/order the best maintenance dose that increases cardiac contractility and output and relieves symptoms. Additionally an order for nitropatch should be obtained and placed in the home for use in case of infiltration/extravasation. The maintenance dose will be established and patient stabilized on maintenance dose before first home infusion. Titration of the maintenance dose should not be done in the home setting. Safe doses for the drugs should be fall within the ranges noted below. Dobutamine Milrinone 2.5 mcg minimum to 15 mcg maximum minimum to 0.5mcg maximum Any doses falling outside of these ranges should be double checked with the DHCH Pharmacist. Specific physician s orders for inotropic agents must be obtained prior to beginning infusion in the home. Dosing will be adjusted only under the direction of a physician based upon the patient s response. 1

2 Clinicians should review all of the patient s medications and consult with the pharmacist about the existence of incompatibilities prior to administration of other medications. Clinicians should be aware of the following incompatibilities Inotrope Dobutamine Incompatibilities Heparin Alkaline solutions such as sodium bicarbonate Home Health Nursing Responsibilities All nursing staff caring for patients receiving IV inotropes at home will have successfully completed the online competency module on administers inotropes in the home. Documentation of successful completion of the module will be kept in the nurse s personnel file. Nurses will be aware of and monitor for the common side effects of inotropic therapy include: Hypotension, palpitation, headache, syncope, chest pain. Home health Nursing staff will: Evaluate home environment for safe infusion (i.e., functioning telephone). Provide education and patient teaching Maintain central venous access site according to policy Assess patient/caregiver's ability to understand, accept and demonstrate appropriate catheter and pump procedures; and drug administration procedures Educate patient and caregiver on their responsibilities with care Evaluate patient outcomes Identify and document patient s code status Inotrope infusion in the home will only be done via a long term venous access device (PICC, Hickman, or Portacath preferred.) The patient's residence will have a functioning telephone and safe storage area for supplies Patient should have knowledgeable and willing caregiver in the home. If patient is independent and does not require caregiver, then patient will maintain daily monitoring logs and be in close communication with pharmacist and RN between visits. The physician will be aware that there will be no caregiver and will write an order to this effect. Patient/caregiver will demonstrate a willingness and ability to understand, accept and demonstrate appropriate catheter and infusion pump care and monitoring parameters during the infusion for continuous or intermittent therapy. When patient is receiving continuous infusion of Dobutamine or Milrinone, B/P, heart rate will be monitored by caregiver every AM. Complete cardiac assessment should be completed and documented at each visit to include but not limited to: heart sounds abdominal girth (if applicable) presence and degree of edema cardiac episodes lung sounds (angina/palpitations) fluid intake and output (if ordered presence of dyspnea by physician) Orthopnea/n# of pillows 2

3 weight gain, or loss pulse oximeter reading) B/P, TPR Document the baseline findings in the clinical note. Vital signs taken by RN should be documented in clinical note and on Home Inotropic Therapy Flow sheet In the event that the patient has experienced medication changed, and increase in weight and/or missed dose, the nurse should contact the DHCH pharmacist immediately. Physician ordered labs may include: BUN, K+, CREATININE, NA, CO2. Physician may order additional labs to be drawn. The RN caring for the patient should record available lab results in the handheld computer and report all alert values per DHCH policy. If infiltration/extravasation at central line site occurs, the Home Care/Hospice RN should notify the physician immediately and follow physician's orders for treatment. Symptomatic control would include warm soaks at site (and extending up the patient's arm if a PICC line is being utilized), and use of a low dose Nitropatch placed near the insertion site to dilate blood vessels and increase blood flow. Physician order required for nitropatch placement. Physician may order low dose Nitroglycerine. Line changing procedure For Home Inotrope infusion a patients Do not use the SASH (Saline, Administer, saline, heparin) method when doing a bag or PICC line dressing change. Never flush a line that is infusing inotropes. 1. Explain the procedure to the patient/caregiver. 2. Wash hands. 3. Assemble all equipment (i.e., Inotropic Drug, Alcohol Wipes, 3.0 cc NS, and other supplies as needed). 4. Obtain pre-infusion change assessment: Heart rate (apical & radial), edema, assess peripheral pulses, B/P, respirations, temperature, 5. Attach new tubing to the inotropic therapy bag and prime the new tubing. 6. Attach inotropic therapy medication to the insertion site. 7. Start infusion. lung sounds, pulse oximeter reading, skin color, abdominal girth capillary refill Patients should be disconnected from the infusion for only the amount of time it takes to remove the catheter cap and to unhook and hook up the new tubing. Care should be taken to not have the patient disconnected for any longer than 4 hours for any reason. In the event that the pump alarm goes off and indicates line occlusion, the nurse should instruct the patient to perform routine maneuvers to make sure there are no kinks in the line of other obvious obstructions. If the alarm still sounds, the patient should call 911 immediately. The nurse should phone the DHCH pharmacist and physician immediately, notifying them of the situation and follow the orders received. 3

4 Thorough educational instruction to patient and caregiver will be provided during admission process. RNs will reinforce teaching with each visit. Teaching will include importance of pt./caregiver's ability to discontinue therapy if pump infiltration occurs and notifying Home Care/Hospice charge nurse or on-call nurse immediately if the occlusion alarms sound. The patient/caregiver will be instructed to weigh patients prior to breakfast every morning and document weights on the Inotropic Therapy Flow sheet (left in patient's home). If the patient is unable to be weighed on bathroom scales in the home, the physician should be notified for further orders. The caregiver is encouraged to also take B/P, heart rate, respirations, pulse oximeter reading as needed, and record findings on same form. For patients on Continuous Inotropic Therapy, vital signs will be taken every eight hours by nurse or caregiver and recorded on the same form. When form is completed, it will be placed on permanent chart. Vital signs taken by pt./caregiver should be documented on Home Inotropic Therapy Flow sheet. A copy of the Home Inotropic Therapy flow sheet may be placed in the RN field chart for reference purposes. (Pulse oximeter readings) RN is to reinforce signs and symptoms of exacerbation of CHF with patient/caregiver and when to call Home Care/Hospice and/or the physician. If the physician has not established parameters, then the following will be used: PARAMETERS OF WHEN THE CAREGIVER IS TO CONTACT PHYSICIAN Weight Increase or decrease Systolic BP <90 or > 150 or change from baseline BP Increase or decrease of 15 mm Hg Heart rate <60 or > 100 and change from baseline Symptoms Dysrythmia s, chest pain, headache, increase ectopy, increased SOB, nausea, vomiting, anxiety A copy of the parameters will be kept in the home for family to follow. Teaching will be documented. Home instructions will be used and copies given to patient/caregiver. 4

5 DHCH Inotropic Therapy Flow sheet Patient Name DATE Weightsdone each AM prior to breakfast Heart rate Blood Pressure Respirations Number of pillows used at night Pulse oximeter reading Shortness of breath 5

6 6

CONGESTIVE HEART FAILURE PATIENT TEACHING

CONGESTIVE HEART FAILURE PATIENT TEACHING CONGESTIVE HEART FAILURE PATIENT TEACHING What is Heart Failure? Congestive Heart Failure occurs when the heart loses its ability to pump enough blood to meet the body s needs. Because the heart is not

More information

Medications or therapeutic solutions may be injected directly into the bloodstream

Medications or therapeutic solutions may be injected directly into the bloodstream Intravenous Therapy Medications or therapeutic solutions may be injected directly into the bloodstream for immediate circulation and use by the body. State practice acts designate which health care professionals

More information

Peripherally Inserted Central Catheter (PICC) for Outpatient

Peripherally Inserted Central Catheter (PICC) for Outpatient Peripherally Inserted Central Catheter (PICC) for Outpatient Introduction A Peripherally Inserted Central Catheter, or PICC line, is a thin, long, soft plastic tube inserted into a vein of the arm. It

More information

Policies & Procedures. ID Number: 1118

Policies & Procedures. ID Number: 1118 Policies & Procedures Title: INTRAVENOUS AND/OR PERIPHERAL SALINE LOCK INSERTION AND MAINTENANCE ID Number: 1118 Authorization [X] SHR Nursing Practice Committee Source: Nursing Date Revised: September

More information

Patient Information Guide Morpheus CT Peripherally Inserted Central Catheter

Patient Information Guide Morpheus CT Peripherally Inserted Central Catheter Patient Information Guide Morpheus CT Peripherally Inserted Central Catheter IC 192 Rev C A measure of flexibility and strength. Table of Contents 1. Introduction 2. What is the Morpheus CT PICC? 3. What

More information

Policy and Procedure Flushing and / or Blood withdrawal Aspiration Procedure For PICC Line and Midline Catheters

Policy and Procedure Flushing and / or Blood withdrawal Aspiration Procedure For PICC Line and Midline Catheters Policy and Procedure Flushing and / or Blood withdrawal Aspiration Procedure For PICC Line and Midline Catheters Purpose: Blood Withdrawal: To obtain blood samples for laboratory evaluation, eliminating

More information

Chapter 16. Learning Objectives. Learning Objectives 9/11/2012. Shock. Explain difference between compensated and uncompensated shock

Chapter 16. Learning Objectives. Learning Objectives 9/11/2012. Shock. Explain difference between compensated and uncompensated shock Chapter 16 Shock Learning Objectives Explain difference between compensated and uncompensated shock Differentiate among 5 causes and types of shock: Hypovolemic Cardiogenic Neurogenic Septic Anaphylactic

More information

All About Your Peripherally Inserted Central Catheter (PICC)

All About Your Peripherally Inserted Central Catheter (PICC) All About Your Peripherally Inserted Central Catheter (PICC) General Information Intravenous (IV) therapy is the delivery of fluid directly into a vein. An intravenous catheter is a hollow tube that is

More information

University Hospitals and Health System Jackson, MS

University Hospitals and Health System Jackson, MS University Hospitals and Health System Jackson, MS Pediatric PICC Line Care Instructions (Peripherally Inserted Central Catheter) PICC line was put in on (date/time): Type: Size: French Number of ports:

More information

Heart Failure Phased Pathway

Heart Failure Phased Pathway UNIVERSITY OF OTTAWA HEART INSTITUTE CLINICAL PATHWAY Heart Failure Phased Pathwa Addressograph/Plaque Acute Phase (Patient moves to transition phase once oral diuretic ordered) Date Initiated: m d Critical

More information

V: Infusion Therapy. College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181

V: Infusion Therapy. College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181 V: Infusion Therapy College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 181 Competency: V-1 Principles of V-1-1 V-1-2 V-1-3 V-1-4 V-1-5 Demonstrate knowledge and ability

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. Diabetic ketoacidosis in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

More information

Within the Scope of Practice/Role of APRN RN _ X_LPN CNA

Within the Scope of Practice/Role of APRN RN _ X_LPN CNA Wyoming State Board of Nursing 130 Hobbs Avenue, Suite B Cheyenne, WY 82002 Phone (307) 777-7601 Fax (307) 777-3519 E-Mail: wsbn-info-licensing@wyo.gov Home Page: https://nursing-online.state.wy.us/ OPINION:

More information

PICCs and Midline Catheters

PICCs and Midline Catheters Patient Education PICCs and Midline Catheters Patient s guide to PICC (peripherally inserted central catheter) and midline catheters What are PICCs and midline catheters used for? Any medicine given over

More information

Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS

Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS 1. Definition -an agent that affects the contractility of the heart -may be positive (increases contractility) or

More information

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY. Guidelines for Use of Intravenous Isoproterenol ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Isoproterenol Major Indications Status Asthmaticus As a last resort for

More information

NORTH CAROLINA BOARD OF NURSING NURSE AIDE II TRAINING MODULE

NORTH CAROLINA BOARD OF NURSING NURSE AIDE II TRAINING MODULE PART A: PREPARING FOR ADMINISTRATION OF IV FLUIDS All four parts of this module, including skills checklists must be successfully completed in order to complete this training module. This activity is a

More information

STAGES OF SHOCK. IRREVERSIBLE SHOCK Heart deteriorates until it can no longer pump and death occurs.

STAGES OF SHOCK. IRREVERSIBLE SHOCK Heart deteriorates until it can no longer pump and death occurs. STAGES OF SHOCK SHOCK : A profound disturbance of circulation and metabolism, which leads to inadequate perfusion of all organs which are needed to maintain life. COMPENSATED NONPROGRESSIVE SHOCK 30 sec

More information

Community Caregivers. Diseases of the Elderly/Vital Signs Test

Community Caregivers. Diseases of the Elderly/Vital Signs Test Community Caregivers Diseases of the Elderly/Vital Signs Test Name: Date: For each question, choose the best response or responses. 1. Care for a client with a stroke involves which of the following? a.

More information

PATIENT GUIDE. Understand and care for your peripherally inserted central venous catheter (PICC). MEDICAL

PATIENT GUIDE. Understand and care for your peripherally inserted central venous catheter (PICC). MEDICAL PATIENT GUIDE Understand and care for your peripherally inserted central venous catheter (PICC). MEDICAL Introduction The following information is presented as a guideline for your reference. The best

More information

Section Two: Arterial Pressure Monitoring

Section Two: Arterial Pressure Monitoring Section Two: Arterial Pressure Monitoring Indications An arterial line is indicated for blood pressure monitoring for the patient with any medical or surgical condition that compromises cardiac output,

More information

Suffolk County Community College School of Nursing NUR 133 ADULT NURSING I

Suffolk County Community College School of Nursing NUR 133 ADULT NURSING I Suffolk County Community College School of Nursing NUR 133 ADULT NURSING I Page # 1 Instructions for students: Case study # 1 For this lab, you are planning to provide care to the following client: CB

More information

PERIPHERAL STEM CELL TRANSPLANT INTRODUCTION

PERIPHERAL STEM CELL TRANSPLANT INTRODUCTION PERIPHERAL STEM CELL TRANSPLANT INTRODUCTION This booklet was designed to help you and the important people in your life understand the treatment of high dose chemotherapy with stem cell support: a procedure

More information

Lynda Richardson, RN, BSN Sepsis/Septic Shock Abstractor. No disclosures

Lynda Richardson, RN, BSN Sepsis/Septic Shock Abstractor. No disclosures Lynda Richardson, RN, BSN Sepsis/Septic Shock Abstractor No disclosures 1 2 3 Discuss data requirements -3 hour bundle -6 hour bundle Challenges and compliance issues Success 4 Based on the Surviving Sepsis

More information

Inpatient Heart Failure Management: Risks & Benefits

Inpatient Heart Failure Management: Risks & Benefits Inpatient Heart Failure Management: Risks & Benefits Dr. Kenneth L. Baughman Professor of Medicine Harvard Medical School Director, Advanced Heart Disease Section Brigham & Women's Hospital Harvard Medical

More information

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary

X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary Introduction A Subclavian Inserted Central Catheter, or subclavian line, is a long thin hollow tube inserted in a vein under the

More information

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND

RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out

More information

Intravenous Therapy. Marjorie Wiltshire, RN

Intravenous Therapy. Marjorie Wiltshire, RN Intravenous Therapy Marjorie Wiltshire, RN :OBJECTIVES Define key terms related to intravenous therapy. Demonstrate the procedure for IV insertion, conversion to a saline lock, administration of IV fluids,

More information

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information)

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information) ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Alteplase (Tissue Plasminogen Activator (t-pa)), Activase in the Treatment

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: infusion_therapy_in_the_home 3/1998 2/2016 2/2017 2/2016 Description of Procedure or Service Home infusion

More information

Nursing Record Documentation

Nursing Record Documentation Nursing Record Documentation 1 Medical records are legal records that must be done in a very careful legal way. They must also be used in a legal way: tell us and all the other members of the health care

More information

FULL-TIME LPN SPINECARE CENTER PERFORMANCE PLANNING

FULL-TIME LPN SPINECARE CENTER PERFORMANCE PLANNING FULL-TIME LPN SPINECARE CENTER PERFORMANCE PLANNING Under the supervision of a Registered Nurse, the LPN administers direct and indirect patient care according to experience, training, certifications,

More information

V: Infusion Therapy. Alberta Licensed Practical Nurses Competency Profile 217

V: Infusion Therapy. Alberta Licensed Practical Nurses Competency Profile 217 V: Infusion Therapy Alberta Licensed Practical Nurses Competency Profile 217 Competency: V-1 Knowledge of Intravenous Therapy V-1-1 V-1-2 V-1-3 V-1-4 V-1-5 Demonstrate knowledge and ability to apply critical

More information

PICC & Midline Catheters Patient Information Guide

PICC & Midline Catheters Patient Information Guide PICC & Midline Catheters Patient Information Guide medcompnet.com 1 table of contents Introduction 4 What is a PICC or Midline Catheter? 4 How is the PICC or Midline Catheter Inserted? 6 Catheter Care

More information

PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC) Fong So Kwan APN, Haematology unit Medical Department, QMH

PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC) Fong So Kwan APN, Haematology unit Medical Department, QMH PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC) Fong So Kwan APN, Haematology unit Medical Department, QMH 1 What is a PICC catheter? Primary vascular access device since their introduction in the mid-1970s,

More information

PICC and Midline Catheters

PICC and Midline Catheters PICC and Midline Catheters Infusion RN s Deb Bucher RN BSN CRNI Dawn Finch RN CRNI Marianne Hansen RN BSN CRNI Karman Youngblood RN BS CRNI Infusion Pharmacist Kathy Cimakasky Pharm D Tamara Migut RPh

More information

Dehydration and Fluid Therapy Guide

Dehydration and Fluid Therapy Guide Dehydration and Fluid Therapy Guide Background: Dehydration occurs when the loss of body fluids (mainly water) exceeds the amount taken in. Fluid loss can be caused by numerous factors such as: fever,

More information

PROCEDURE FOR SUBCUTANEOUS INSERTION, REMOVAL, MEDICATION ADMINISTRATION AND FLUID ADMINISTRATION FOR COMMUNITY PALLIATIVE CARE PATIENTS

PROCEDURE FOR SUBCUTANEOUS INSERTION, REMOVAL, MEDICATION ADMINISTRATION AND FLUID ADMINISTRATION FOR COMMUNITY PALLIATIVE CARE PATIENTS PROCEDURE FOR SUBCUTANEOUS INSERTION, REMOVAL, MEDICATION ADMINISTRATION AND FLUID ADMINISTRATION FOR COMMUNITY PALLIATIVE CARE PATIENTS Approved: February 2010 Date for review: February 2010 1 PROCEDURE

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION REGULATIONS RELATING TO ADMINISTRATION OF INTRAVENOUS THERAPY BY LICENSED NURSES

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION REGULATIONS RELATING TO ADMINISTRATION OF INTRAVENOUS THERAPY BY LICENSED NURSES 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 380 BOARD OF NURSING Chapter 10: REGULATIONS RELATING TO ADMINISTRATION OF INTRAVENOUS THERAPY BY LICENSED NURSES SUMMARY: This chapter identifies

More information

Caring for a Tenckhoff Catheter

Caring for a Tenckhoff Catheter Caring for a Tenckhoff Catheter UHN A Patient s Guide What is a Pleural Effusion? There is a small space between the outside of your lung and the chest wall (ribs). This space is called the pleural space.

More information

Clinician Competency:

Clinician Competency: Thanks to CR Bard Clinician Competency: INS (Intravenous Nursing Society) recommends that an institution create a set criteria to evaluate the competency of nurses learning to place PICC Line / Midline

More information

TOTAL PARENTERAL NUTRITION (TPN) Revised January 2013

TOTAL PARENTERAL NUTRITION (TPN) Revised January 2013 TOTAL PARENTERAL NUTRITION (TPN) Revised January 2013 OBJECTIVES Definition Indications for TPN administration Composition of TPN solutions Access routes for TPN administration Monitoring TPN administration

More information

POSSIBLE NURSING DIAGNOSIS: Pain Potential for Infection / Infection Fluid volume deficit

POSSIBLE NURSING DIAGNOSIS: Pain Potential for Infection / Infection Fluid volume deficit 1 Procedure for Subcutaneous Over-the-needle Cannula Insertion, Removal, Medication Administration, and Fluid Administration for the Individual in the Home PURPOSE: To provide medication via the subcutaneous

More information

Peripherally Inserted Central Catheter (PICC) Benefits Long-term access - dwell time varies (can be > one year) Decreased length of stay in hospital a

Peripherally Inserted Central Catheter (PICC) Benefits Long-term access - dwell time varies (can be > one year) Decreased length of stay in hospital a Nursing Management of Venous Access Devices: Peripherally Inserted Central Catheter (PICC) Mimi Bartholomay, RN, MSN, AOCN Denise Dreher, RN, CRNI, VA-BC Theresa Evans, RN, MSN Susan Finn, RN, MSN, AOCNS

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

Page 1 of 10 MC1482 Peripherally-Inserted Central Catheter. Peripherally-Inserted Central Catheter (PICC)

Page 1 of 10 MC1482 Peripherally-Inserted Central Catheter. Peripherally-Inserted Central Catheter (PICC) Page 1 of 10 MC1482 Peripherally-Inserted Central Catheter Peripherally-Inserted Central Catheter (PICC) Page 2 of 10 MC1482 Peripherally-Inserted Central Catheter Introduction A peripherally-inserted

More information

General PROVIDER INITIALS: PHYSICIAN ORDERS

General PROVIDER INITIALS: PHYSICIAN ORDERS Height Weight Allergies If appropriate for patient condition, please consider the following order sets: Initiate Electrolyte Replcement: Med/Surg, Med/Surg Tele Physician Order #842 General Vital Signs

More information

PARAMEDIC TRAINING CLINICAL OBJECTIVES

PARAMEDIC TRAINING CLINICAL OBJECTIVES Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members

More information

General PROVIDER INITIAL: PHYSICIAN ORDERS. Vital Signs

General PROVIDER INITIAL: PHYSICIAN ORDERS. Vital Signs Height Weight Allergies If appropriate for patient condition, please consider the following order sets: Initiate Electrolyte Replcement: Med/Surg, Med/Surg Tele Physician Order #842 Discontinue all lorazepam

More information

Understanding your Peripherally Inserted Central Catheter (PICC) Patient Information

Understanding your Peripherally Inserted Central Catheter (PICC) Patient Information Understanding your Peripherally Inserted Central Catheter (PICC) Patient Information The Purpose of this Information Sheet This information sheet has been written by patients, members of the public and

More information

VAD Chemotherapy Regimen for Multiple Myeloma Information for Patients

VAD Chemotherapy Regimen for Multiple Myeloma Information for Patients VAD Chemotherapy Regimen for Multiple Myeloma Information for Patients The Regimen contains: V = vincristine (Oncovin ) A = Adriamycin (doxorubicin) D = Decadron (dexamethasone) How Is This Regimen Given?

More information

404 Section 5 Shock and Resuscitation. Scene Size-up. Primary Assessment. History Taking

404 Section 5 Shock and Resuscitation. Scene Size-up. Primary Assessment. History Taking 404 Section 5 and Resuscitation Scene Size-up Scene Safety Mechanism of Injury (MOI)/ Nature of Illness (NOI) Ensure scene safety and address hazards. Standard precautions should include a minimum of gloves

More information

PATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly

PATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly PATIENT GUIDE Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Every drainage Weekly Clinician s Signature: ACCESS SYSTEMS Pleural Space Insertion Site Cuff Exit Site Catheter

More information

A. ADMINISTERING SUBCUTANEOUS MEDICATIONS INTERMITTENTLY/CONTINUOUSLY B. (SUBCUTANEOUS INFUSION) HYDRODERMOCLYSIS

A. ADMINISTERING SUBCUTANEOUS MEDICATIONS INTERMITTENTLY/CONTINUOUSLY B. (SUBCUTANEOUS INFUSION) HYDRODERMOCLYSIS SUBCUTANEOUS THERAPY A. ADMINISTERING SUBCUTANEOUS MEDICATIONS INTERMITTENTLY/CONTINUOUSLY B. (SUBCUTANEOUS INFUSION) HYDRODERMOCLYSIS PARTS I. Purposes II. General Information III. Responsibilities IV.

More information

Title/Description: Nursing Care of the Patient on Continuous Renal Replacement Therapy (CRRT)

Title/Description: Nursing Care of the Patient on Continuous Renal Replacement Therapy (CRRT) University of Kentucky / UK HealthCare Policy and Procedure Policy # NE08-06 Title/Description: Nursing Care of the Patient on Continuous Renal Replacement Therapy (CRRT) Purpose: To provide direction

More information

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS LEVELS I through IV A. OVERRIDING CRITICAL ELEMENTS Violation of an overriding area will result in termination and failure of the particular

More information

Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol

Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol Using a Graseby MS26 Syringe Driver for Continuous Subcutaneous Infusions (CSCI) Protocol Who Division 1 Registered Nursing staff for the purposes of administering and monitoring of infusion Division 2

More information

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE

DISCHARGE CRITERIA FOR PHASE I & II- POST ANESTHESIA CARE REFERENCES: The Joint Commission Accreditation Manual for Hospitals American Society of Post Anesthesia Nurses: Standards of Post Anesthesia Nursing Practice (1991, 2002). RELATED DOCUMENTS: SHC Administrative

More information

Heart Failure Clinical Pathway

Heart Failure Clinical Pathway Patient & Family Guide 2016 Heart Failure Clinical Pathway www.nshealth.ca Heart Failure Clinical Pathway Your hospital stay will follow a written care plan called a Clinical Pathway. The pathway is a

More information

Quiz 5 Heart Failure scores (n=163)

Quiz 5 Heart Failure scores (n=163) Quiz 5 Heart Failure summary statistics The correct answers to questions are indicated by *. Students were awarded 2 points for question #3 for either selecting spironolactone or eplerenone. However, the

More information

Medical Direction and Practices Board WHITE PAPER

Medical Direction and Practices Board WHITE PAPER Medical Direction and Practices Board WHITE PAPER Use of Pressors in Pre-Hospital Medicine: Proper Indication and State of the Science Regarding Proper Choice of Pressor BACKGROUND Shock is caused by a

More information

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 118-28 SAN DIEGO, CA

VA SAN DIEGO HEALTHCARE SYSTEM MEMORANDUM 118-28 SAN DIEGO, CA GUIDELINES FOR PATIENT-CONTROLLED ANALGESIA (PCA) AND PATIENT- CONTROLLED EPIDURAL ANALGESIA (PCEA) FOR ACUTE PAIN MANAGEMENT 1. PURPOSE: To assure the safe and effective use of patient controlled analgesia

More information

ACLS PHARMACOLOGY 2011 Guidelines

ACLS PHARMACOLOGY 2011 Guidelines ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.

More information

Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins)

Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins) Jeopardy Topics: THE CLOT STOPS HERE (anticoagulants) SUGAR, SUGAR, HOW D YOU GET SO HIGH (insulins) I HEAR YA KNOCKING BUT YOU CAN T COME IN (electrolytes) TAKE MY BREATH AWAY (Opiates-morphine) OUT WITH

More information

Administration of Medications & Fluids via a Peripheral Intravenous Cannula

Administration of Medications & Fluids via a Peripheral Intravenous Cannula Administration of Medications & Fluids via a Peripheral Intravenous Cannula Clinical S.O.P. No.: 22.0 Compiled by: Approved by: Review date: November 2016 Administration of Medications & Fluids via S.O.P.

More information

WHAT TO DO WHEN THE URR IS UNDER 65

WHAT TO DO WHEN THE URR IS UNDER 65 Everest Healthcare Services Corporation August 4, 2000 WHAT TO DO WHEN THE URR IS UNDER 65 (See Model: Low URR Checklist adapted from Midwest Kidney Centers, Peoria, IL and presented in an Excel spreadsheet

More information

ADMINISTRATION OF INTRAVENOUS PUSH/DIRECT MEDICATIONS

ADMINISTRATION OF INTRAVENOUS PUSH/DIRECT MEDICATIONS SASKATOON DISTRICT HEALTH Department of Nursing Affairs ADMINISTRATION OF INTRAVENOUS PUSH/DIRECT MEDICATIONS SPECIAL NURSING PROCEDURE LEARNING PACKAGE This package provides the basic information necessary

More information

Medical Surgical Nursing Skills List

Medical Surgical Nursing Skills List Medical Surgical Nursing Skills List Read each of the required clinical skills for a Registered Nurse working on a typical acute medical-surgical unit. Write the number that corresponds to the level of

More information

Date effective: Jan 2005 Date revised: June 2015

Date effective: Jan 2005 Date revised: June 2015 Section H: Administration of Blood Products Page 1 of 8 I. Introduction... 1 II. Intravenous (IV) Access... 2 Peripheral Line:...2 Central Venous Catheter:...2 III. Compatible Solutions with Blood Products...

More information

Adult Drug Reference. Dopamine Drip Chart. Pediatric Drug Reference. Pediatric Drug Dosage Charts DRUG REFERENCES

Adult Drug Reference. Dopamine Drip Chart. Pediatric Drug Reference. Pediatric Drug Dosage Charts DRUG REFERENCES Adult Drug Reference Dopamine Drip Chart Pediatric Drug Reference Pediatric Drug Dosage Charts DRUG REFERENCES ADULT DRUG REFERENCE Drug Indication Adult Dosage Precautions / Comments ADENOSINE Paroxysmal

More information

ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767 Copyright 2010 American Heart Association ACLS Cardiac Arrest Circular Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767

More information

Improve Your Home Health Nursing Documentation

Improve Your Home Health Nursing Documentation Improve Your Home Health Nursing Documentation November 20, 2012 1401_0113 Today s Presenters Sally Rosiello RN, BSN 2 National Government Services, Inc. Disclaimer National Government Services, Inc. has

More information

PATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly

PATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly PATIENT GUIDE Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Every drainage Weekly Clinician s Signature: ACCESS SYSTEMS Pleural Space Insertion Site Cuff Exit Site Catheter

More information

Diabetic Ketoacidosis

Diabetic Ketoacidosis Princess Margaret Hospital for Children PAEDIATRIC ACUTE CARE GUIDELINE Diabetic Ketoacidosis Scope (Staff): Scope (Area): All Emergency Department Clinicians Emergency Department This document should

More information

Vaxcel PICCs Valved and Non-Valved. A Patient s Guide

Vaxcel PICCs Valved and Non-Valved. A Patient s Guide Vaxcel PICCs Valved and Non-Valved A Patient s Guide Information about your Vaxcel PICC is available by calling the Navilyst Medical Vascular Access Information Line 800.513.6876 Vaxcel Peripherally Inserted

More information

HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES

HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES HOSPICE ORIENTATION FOR SKILLED NURSING FACILITIES (2008 Medicare Conditions of Participation for Hospice Care 418.122 (f)) Hospice Philosophy Hospice is a unique concept of care designed to provide comfort

More information

1.4.4 Oxyhemoglobin desaturation

1.4.4 Oxyhemoglobin desaturation Critical Care Therapy and Respiratory Care Section Category: Clinical Section: Clinical Monitoring Title: Monitoring of Patients Undergoing Conscious Sedation Policy #: 09 Revised: 05/00 1.0 DESCRIPTION

More information

Charting Reporting and Recording Dr. Karima Elshamy Faculty of Nursing Mansoura University Egypt Learning Objectives: Define the following terminology chart, charting, patient record Discuss the purpose

More information

Sir Muir Gray, Director,

Sir Muir Gray, Director, Incorporating Specialty Nurses and Advanced Nurse Practice into Multidisciplinary i li Heart Failure Team Abdiqani Qasim, MScN, FNP, ACNP Head, General Nursing Training, Unit Knowledge is the enemy of

More information

Telehealth and the Homebound Heart Failure Patient

Telehealth and the Homebound Heart Failure Patient Telehealth and the Homebound Heart Failure Patient By Karen Malin Garfield, RN, BSN 104 HEART 2010 The Official Guide to a Strong Heart and Healthy Lifestyle PTS Article Heart2010_Suncrest.indd 1 Health

More information

Crash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University

Crash Cart Drugs Drugs used in CPR. Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Crash Cart Drugs Drugs used in CPR Dr. Layla Borham Professor of Clinical Pharmacology Umm Al Qura University Introduction A list of the drugs kept in the crash carts. This list has been approved by the

More information

Paediatric Intensive Care unit Nursing Procedure: The Administration of Inotropes

Paediatric Intensive Care unit Nursing Procedure: The Administration of Inotropes Paediatric Intensive Care unit Nursing Procedure: The Administration of Inotropes Definition The administration of drugs to maintain the child s circulatory system, thus ensuring oxygenation of vital organs.

More information

James F. Kravec, M.D., F.A.C.P

James F. Kravec, M.D., F.A.C.P James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice

More information

A4.7 Management of a totally occluded central catheter and persistent withdrawal occlusion (PWO)

A4.7 Management of a totally occluded central catheter and persistent withdrawal occlusion (PWO) A4.7 Management of a totally occluded central catheter and persistent withdrawal occlusion (PWO) Types of Catheter Related Thrombotic A catheter-related thrombus may be intraluminal (inside the catheter)

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

Diabetic Ketoacidosis: When Sugar Isn t Sweet!!!

Diabetic Ketoacidosis: When Sugar Isn t Sweet!!! Diabetic Ketoacidosis: When Sugar Isn t Sweet!!! W Ricks Hanna Jr MD Assistant Professor of Pediatrics University of Tennessee Health Science Center LeBonheur Children s Hospital Introduction Diabetes

More information

Protocol for New AVF Cannulation

Protocol for New AVF Cannulation Protocol for New AVF Cannulation Protocol for New AVF Cannulation Define successful cannulation Cannulation guidelines New AVF Mature AVF Unsuccessful cannulations Detailed instructions for complications

More information

Nursing Education and Research

Nursing Education and Research Melissa Meloche Meloche, RN RN, MSN MSN, CCRN Nursing Education and Research Describe the purpose p of common clinical equipment found in the Intensive Care Unit and how this equipment could impact a patient

More information

table of contents drug reference

table of contents drug reference table of contents drug reference ADULT DRUG REFERENCE...155 161 PEDIATRIC DRUG REFERENCE...162 164 PEDIATRIC WEIGHT-BASED DOSING CHARTS...165 180 Adenosine...165 Amiodarone...166 Atropine...167 Defibrillation...168

More information

IN-HOME QUALITY IMPROVEMENT BEST PRACTICE: PHYSICIAN RELATIONSHIPS NURSE TRACK

IN-HOME QUALITY IMPROVEMENT BEST PRACTICE: PHYSICIAN RELATIONSHIPS NURSE TRACK IN-HOME QUALITY IMPROVEMENT BEST PRACTICE: PHYSICIAN RELATIONSHIPS NURSE TRACK Best Practice Intervention Packages were designed for use by any In-Home Provider Agency to support reducing avoidable hospitalizations

More information

Detach Patient's Instructions for Use from package insert and dispense with the product.

Detach Patient's Instructions for Use from package insert and dispense with the product. Attention Health Care Professional: Detach Patient's Instructions for Use from package insert and dispense with the product. PROVENTIL HFA (albuterol sulfate) Inhalation Aerosol FOR ORAL INHALATION ONLY

More information

ACLS PRE-TEST ANNOTATED ANSWER KEY

ACLS PRE-TEST ANNOTATED ANSWER KEY ACLS PRE-TEST ANNOTATED ANSWER KEY June, 2011 Question 1: Question 2: There is no pulse with this rhythm. Question 3: Question 4: Question 5: Question 6: Question 7: Question 8: Question 9: Question 10:

More information

Autonomic Nervous System

Autonomic Nervous System CHAPTER 4 Autonomic Nervous System Autonomic Dysreflexia What is Dysreflexia? Autonomic dysreflexia (or hyperreflexia) is a complication which occurs in people with spinal cord injuries at or above the

More information

Flushing and Dressing a Peripherally Inserted Central Catheter (PICC Line): a Guide for Nurses

Flushing and Dressing a Peripherally Inserted Central Catheter (PICC Line): a Guide for Nurses Flushing and Dressing a Peripherally Inserted Central Catheter (PICC Line): a Guide for Nurses Information for Nurses Introduction This information is for community nursing staffs who have been asked to

More information

Procedure -8. Intraosseous Infusion Adult and Pediatric EZIO. Page 1 of 7 APPROVED:

Procedure -8. Intraosseous Infusion Adult and Pediatric EZIO. Page 1 of 7 APPROVED: Page 1 of 7 Intraosseous Infusion Adult and Pediatric APPROVED: EMS Medical Director EMS Administrator 1. Goals/Introduction: 1.1 Intraosseous (IO) infusion provides an effective alternative means of providing

More information

Managing Your Non-Tunneled (Percutaneous) Catheter: PICC, SICC, and JCC. What is a PICC catheter?

Managing Your Non-Tunneled (Percutaneous) Catheter: PICC, SICC, and JCC. What is a PICC catheter? Managing Your Non-Tunneled The staff of the Procedure, Vascular Access, Conscious Sedation Service has written this information to explain your new PICC (peripherally inserted central catheter), SICC (subclavian

More information

Patient Information. PORT-A-CATH Implantable Venous Access Systems

Patient Information. PORT-A-CATH Implantable Venous Access Systems Patient Information PORT-A-CATH Implantable Venous Access Systems Your doctor has prescribed treatment that requires the frequent administration of medications or other fluids directly into your bloodstream

More information

INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure

INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure TITLE: Arterial Catheter Blood Sampling/Blood NUMBER: CC 80-005 Pressure Monitoring/Catheter Removal Effective Date: October 2014 Page 1 of 11 Applies

More information

2. The prescribing clinician will register with the designated manufacturer.

2. The prescribing clinician will register with the designated manufacturer. Clozapine Management Program Description Magellan of Arizona Pharmacy Program Background: Magellan Health Services of Arizona recognizes the importance of a clozapine program. Clozapine received increased

More information

Care for your child s Central Venous Catheter (CVC)

Care for your child s Central Venous Catheter (CVC) Care for your child s Central Venous Catheter (CVC) This booklet is intended for general informational purposes only. You should consult your doctor for medical advice. Please call the clinic or your home

More information