Hi Everyone,
An interesting topic came up in our L&D dept. We have a couple different hospitals in our system and they both have different practices when it comes to giving Nubain. At one facility, the nurses draw up the nubain, access the vein and give the nubain directly into the vein in the a/c or metacarpal are using a very small needle. The benefit is that no indwelling line is necessary for a one-time dose of med and the laboring Mom does not need venous access. At the other facility, all laboring women who want nubain, get a PIV inserted (usually just a saline lock). Is there any evidence, studies, or standards out there that prohibits/supports the RN from administering a medication directly into the vein vs using a venous access device to push the medicaion in?
I have never seen any direct studies about this issue. Are you saying that they are using a small needle directly attached to the syringe to make the venipuncture and then inject the drug? If so, this has an extremely high risk in my opinion. It is difficult to have firm control of the venipuncture with any straight needle. Holding the needle/syringe perfectly in place while the med is being slowly pushed is riskly. I can not find Nubain listed in either of 2 drug books I have on my desk. So I would investigate several things. Is this drug still labeled for IV use? What amount of dilution and rate of injection is required for a safe injection? These factors would add to the burden of this direct injection. Also what happens if the patient requires another dose - another injection? That would not mean a satisfied patient, in my opinion. For a single dose injection, the INS Standards of Practice recommends the use of a winged needle device, aka "butterfly". That device will provide greater control but they can not be allowed to reside for a future dose. It would seem to me that a laboring woman in need of IV meds of any kind would benefit from a small gauge short peripheral catheter in a vein of the forearm and away from all areas of joint flexion. In other words avoid use of the hand, wrist and ACF. 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