Have a doctor who is adamant about never nurses never checking blood return in CVAD's even when accessing ports. He told me that by doing that I am ruining the port. Comments....
Set the expectation with the doctor that he/she must provide evidence that this his is appropriate. They can not provide this because it is not in the literture. If he will not do his homework, and it is his responsibility and not yours, then take this to your risk manager. But the last thing you can do is to do as he wishes. You can simply say no to his request. You are in control of your practice, not the doctor. You are to act as a patient advocate and what he is proposing is putting the patient at risk for serious problems. Enlist the help of others in your chain of command. Be prepared with all of your documentation that checking for a blood return is critical. But you can not agree with his request. Lynn
ONS (2011) has a guideline on blood return prior to infusion
INS (2011) has a standard on blood return prior to infuson
If one looks at Gahart (intravenous drug administration - 2013) Trissels (Pharmacy handbook of Injectable drugs - 2013) a number of drugs require a blood return prior to administration
Phillips, Joephson, Weinstein common IV textbooks all mention its necessity. It is the standard of practice
I would get your pharmacist involved on this one besides your hosptial risk management department to agree to veer off of the accepted standard of practice
I would also check the instructions for use of the catheter you are using and you are likely to find it right in the instructions for proper usage of your product
Set the expectation with the doctor that he/she must provide evidence that this his is appropriate. They can not provide this because it is not in the literture. If he will not do his homework, and it is his responsibility and not yours, then take this to your risk manager. But the last thing you can do is to do as he wishes. You can simply say no to his request. You are in control of your practice, not the doctor. You are to act as a patient advocate and what he is proposing is putting the patient at risk for serious problems. Enlist the help of others in your chain of command. Be prepared with all of your documentation that checking for a blood return is critical. But you can not agree with his request. 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
ONS (2011) has a guideline on blood return prior to infusion
INS (2011) has a standard on blood return prior to infuson
If one looks at Gahart (intravenous drug administration - 2013) Trissels (Pharmacy handbook of Injectable drugs - 2013) a number of drugs require a blood return prior to administration
Phillips, Joephson, Weinstein common IV textbooks all mention its necessity. It is the standard of practice
I would get your pharmacist involved on this one besides your hosptial risk management department to agree to veer off of the accepted standard of practice
I would also check the instructions for use of the catheter you are using and you are likely to find it right in the instructions for proper usage of your product