I need some recommendations regarding IV Amiodarone- I was asked to find out if a policy recommendation is to infuse IV Amiodarone peripherally through a 22 gauge needle is an appropriate policy. The ph of Amiodarone is such, my recommendation is to infuse via a central line but one facility I work with doesn't always have the option of having a central line in place when the medication is ordered so they would like to make the policy to use a 22 gauge catheter.
It was my understanding that the issue for this drug was having a reliable line as it used to treat life threatening v fib.
Patinets receiving this drug probably should not wait to get a new IV line....
Ann Zonderman, BSN, JD, CRNI
All literature I have seen on this drug states that a CVC is preferred. In an emergency situation, you may have to start infusion with a short peripheral, however I think it would be below the standard of care to continue to rely upon peripheral catheters for this infusion. Think about it this way as this is what I would advise if I were an expert on a legal case. Here is a made up scenario - patient comes in and has Amiodarone ordered and a short peripheral catheter is used. Phlebitis and pain are common with this drug so the site has to be changed frequently due to patient complaints. Pt has very limited peripheral sites and the ICU nurses are unsuccessful at repetitive insertions. So he has to wait for a CVC or the IV team to come and place a PICC or another short peripheral. The patient has a cardiac arrest while he is without the infusion. He survives but ends up with CRPS due to the edema caused by the superficial thrombophlebitis due to peripheral infusions of this drug. My advise to the attorney would be the nurses and physicians did not meet the standard of care because of the recommendations for a CVC for this drug. I would point to the drug literature, the monographs on this drug from books like Gahart's Intravenous Medications, and the Infusion Nursing Standards of Practice. CRPS is a nasty problem that last a lifetime requiring pain management with narcotics and PT and OT. These cases settle for lots of money and the nurse(s) would be named as defendents. If he had not survived the arrest, it would require a medical opinion that the absense of this drug actually caused the arrest. So the family might bring a lawsuit. Either way the nurse(s) are named in the suit. So I would not think it is advisable to rely upon a short peripheral catheter for a critical drug such as this. You might have to start the infusion through a very small gauge peripheral catheter in as large a vein as possible, avoiding areas of joint flexion, and using proper stabilization methods. But the very next step must be to get a CVC of some type inserted and move the infusion to the CVC site ASAP. I see this as a matter of patient safety. 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