Currently we are reviewing our infiltration documentation and are finding we need improvement in post infiltration assessment documentation. In order to provide the best practices and education, we were trying to develop a guideline for how often and how long you should continue to assess the infiltration. We understand that symptoms can be at their worst hours after the initial incident, but we didn't know how long we should encourage assessment (ex: every hour) and for how long (ex: 48 hours, until symptoms are resolved, etc).
I should also mention we are a pediatric facility.
Thanks
Tammy
Children's Mercy Hospital and Clinics
You need documentation until the site is healed. For some vesicant meds and extravasation, blistering and skin changes may not even begin for several days or weeks. This would require immediate antidote injection with possible surgical debridement and skin grafting at a later date. For infiltration, you will need neurovascular assessments until all signs and symptoms are gone. This involves nerve injury leading to complex regional pain syndrome and/or compartment syndrome leading to fasciotomy with a primary closure several days after the original surgery. These are the most frequent infusion-related complications that will get you involved in a lawsuit. One of the most important aspects is how well was the site assessed and managed after the event occurred. As an expert witness in many of these cases, I divide this into 3 phases. 1. What did the nurse do or not do to prevent infiltration/extravasation? Think adherence to published standards and guidelines for this one. 2. How quickly did they recognize the problem? Did they document edema but state they would continue to observe? This is never appropriate. 3. How appropriately was the complication treated? Was heat used when it should be cold? Was the appropriate antidote used? Was there a surgical consultation in the case of a severe event? This would be applied the same for adults and pediatrics. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861