Infusion Master - NHIA

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Exhibit 1Occlusion Rates Before and After New Heparin Flush ProtocolsTime Period PICC Lines Occlusions Occlusion RateBefore (2/19/2006 – 2/18/2007) 277 9 3.25%After (2/19/2007 – 2/18/2008) 329 8 2.43%Source: University of Iowa Community HomeCareData collection is key to understanding the outcome of a change in clinical procedures, andsharing this information contributes to the body of home infusion clinical knowledgeJ A N U A R Y / F E B R U A R Y 2 0 0 9comes throughout and following the heparin concentrationchange. We were encouraged by the fact thatwe had no increase in occlusion rates of CVCs followingthe transition, which we defined as a line thatwill not aspirate or flush (see Exhibit 1). In addition,we have not received any reports of patients diagnosedwith HIT since we made the change. We willcontinue to use the 10U/mL heparin, as we evaluatethe feasibility of a change to saline-only flushes.ConclusionThe concentration of heparin used to routinely flushvascular access devices must be carefully evaluated inlight of the risk for heparin-induced thrombocytopeniain susceptible patients. In the absence of home infusionbased clinical research, providers are encouraged toexamine their internal patient outcomes in the applicationof evidence-based research from the hospital setting.Data collection is key to understanding the outcomeof a change in clinical procedures, and sharingthis information contributes to the body of home infusionclinical knowledge.Kelli Krutsinger, R.N., B.S.N., C.R.N.I. ® , is the Nurse Manager atUniversity of Iowa Community HomeCare. She can be reached byphone at (319) 337-8522 or by e-mail at krutsingerk@healthcare.uiowa.edu.References1. Franchini, Massimo. Heparin-induced thrombocytopenia:An update. Thrombosis Journal.2005;(14).2. McNulty I, Eliezer K, Kim K. Thombocytopenia followingheparin flush. Progress in CardiovascularNursing. 2007; 20(4): 143-147.3. Swanson, Joseph. Heparin-Induced Thrombocytopenia.Journal of Infusion Nursing. 2007; 30(4): 232-240.4. Warkentin TE. Platelet count monitoring and laboratorytesting for heparin-induced thrombocytopenia.Arch Pathol Lab Med. 2002; 126: 1415-1423.5. Baroletti SA, Goldhaber SZ. Heparin-inducedthrombocytopenia. Circulation. 2006; 114:e355-e356.6. Gettings E, Brush K, VanCott E, Hurford W.Outcome of postoperative critically ill patients withheparin-induced thrombocytopenia: An observationalretrospective case-control study. Crit Care.2006; 10(6): R161.7. Laster JL, Nichols WK, Silver D. Thrombocytopeniaassociated with heparin-coated catheters inpatients with heparin-associated anti-platelet antibodies.Arch Internal Med. 1989; 149:2285-2287.8. Infusion Nurses Society (INS). Infusion NursingStandards of Practice. 2006; 29; S56.24
A clear solution®Immune globulin intravenous (human)5% solvent/detergent treatedIf you’re thinking about IGIVtreatment, now’s the time toconsider octagam ® . With aproven record of safety, tolerabilityand efficacy 1 ,octagam ® comesready to use and can be stored atroom temperature for 24 months.If you think octagam ® could bethe right solution for you andyour patients please call us tollfree on 866-766-4860 orvisit us during the Baltimoreconference at booth #420.IMPORTANT SAFETY INFORMATIONoctagam ® is contraindicated in individualswith intolerance to immunoglobulins,especially in immunoglobulin A (IgA)deficiency, when the patient has IgEmediated antibodies to IgA.Immune Globulin intravenous (Human)(IGIV) products have been reported to beassociated with renal dysfunction, acuterenal failure, osmotic nephrosis, and death.Other possible side effects with octagam ®include: aseptic meningitis, hemolysis,transfusion-related acute lung disease(TRALI) and thrombotic events.Immune Globulin Intravenous (Human)products have been reported to beassociated with various minor reactions,such as headache, chills, backache, chestpain, fever, allergic reactions, arthralgia,dizziness, changes in blood pressure,cutaneous reactions and/or nausea andvomiting. Cases of reversible asepticmeningitis and migraine and isolated casesof reversible hemolytic anemia andreversible increases in liver function testshave been observed with octagam ® .Immediate anaphylactic andhypersensitivity reactions are a remotepossibility.As with all medicines made from humanplasma, the risk of spreading infectiousagents, including viruses, cannot becompletely eliminated.Some types of blood glucose testingsystems falsely interpret the maltosecontained in octagam ® as glucose. This hasresulted in falsely elevated glucose readingsand, consequently, in the inappropriateadministration of insulin, resulting inlife-threatening hypoglycemia.See brief summary of PI on facing page.1Ochs HD, Pinciaro PJ and the octagam ® StudyGroup. octagam ® 5%, an Intravenous IgG Product,is Efficacious and Well Tolerated in Subjects withPrimary Immunodeficiency Diseases. J. ClinImmunol 2004,24;3:309-314
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