HHC Health & Home Care Clinical Policy And

More documents

Recommendations

Info

HHC HEALTH & HOME CARE Section: 9-24 Infusion Therapy: (Raaf Catheter, Hemocath, Quinton PermCath, VasCath) RN back to verify blood flow and flush with 10cc 0.9 % sodium chloride, injection,. Repeat with second lumen. 12. Attach 5cc syringe filled with heparin to extension tube. Infuse the heparin by flushing quickly to ensure heparin reaches the distal end of the lumen. Flushing too slowly may cause heparin to exit the catheter from the proximal inlet holes, leaving the distal hole unprotected from clot formation. Re-clamp the extension while instilling the last 0.5cc heparin. Perform this step for both lumens. 13. Discard soiled supplies in appropriate containers. AFTER CARE: 1. Document in patient's record: a. Date, time, procedure and observations. b. Amount of normal saline and heparin flush, including strength of heparin. c. Site appearance. d. Patient's response to procedure. e. Instructions given to patient/caregiver. 200
HHC HEALTH & HOME CARE Section: 9-25 Infusion Therapy: Administration of Pain Medications Via Epidural/Intraspinal Route RN PURPOSE: To provide for the administration of uniform and effective pain management via the epidural/intraspinal route. CONSIDERATIONS: 1. This procedure is to be used as a guide; follow specific physician orders that may vary depending upon type of epidural or intrathecal access device. 2. Epidural or intraspinal administration of medication, i.e., Morphine Sulfate, has a longer duration of action, requires lower doses of medication and results in lower incidence of side effects. A bolus of epidural morphine sulfate analgesia may last for more than 20 hours. 3. Epidural or intraspinal access can be achieved using one of several different devices. Examples are: Implanted ports with attached catheters, tunneled catheters similar to central venous catheters, implanted continuous infusion systems, e.g. Infusaid pump, and intrathecal (spinal) infusion lines. 4. Implanted epidural ports are similar to central venous ports, i.e., Mediport, Port-a-Cath, and require placing of the noncoring needle (Huber) securely against the backplate when accessed. Implanted reservoirs may not have a steel backplate, and care should be taken not to penetrate it upon access. 5. Epidural or intrathecal catheters are for both temporary and long-term use. Temporary catheters are directly placed in the epidural space and are most often used in the hospital until a long-term catheter can be placed. Temporary catheters should be monitored closely for stability and intact, staying sutures. Long-term catheters are placed in the epidural space and tunneled through the subcutaneous tissue to an exit site usually on the anterior aspect of the patient. Epidural port catheter is placed in the epidural space and the port body is placed against a bony prominence on the anterior or side of the patient. 6. A neurosurgeon or anesthesiologist performs placement of epidural or intrathecal access devices. 7. Complications of this therapy include but are not limited to: paraesthesia, pruritus, nausea, vomiting, urinary retention, respiratory depression, hypotension, respiratory arrest, and catheter complications such as infection, dislodgement and leaking. Complications shall be documented and reported to the physician immediately. 8. Initial doses of intraspinal pain medication should be given in the hospital or physician's office. The patient should be stable on the same medication regimen for 24 hours in a controlled setting prior to acceptance for home therapy. 9. Narcan may be ordered by the physician to reduce possible overdose symptoms. 10. Any pain medication given intraspinally MUST BE IN A STERILE, PRESERVATIVE - FREE SALINE SOLUTION. Medications not preservative-free will permanently scar nerve endings when given via the epidural space. 11. ALCOHOL IS CONTRAINDICATED for site preparation or when accessing the catheter because of the potential for migration of alcohol into the epidural space and possible nerve damage. 12. All procedures involving the use or access of an epidural line are to be done using strict aseptic technique. 13. Continuous intraspinal infusions shall be administered via an electronic infusion device (pump). 14. Continuous infusions will only be considered when there is assurance of continued proper catheter positioning (e.g., sutures, tunneled catheter, or port). Do not administer any medication if there is any concern or doubt regarding catheter placement. The nurse can measure the external portion of the catheter with each visit to verify catheter placement. 15. For continuous infusions, the tubing will be changed: a. When replacing the medication cassette. b. Whenever the integrity of the dosed system is violated. c. Weekly if the system remains closed and cassette does not require changing sooner. 16. All medications to be administered through epidural or intrathecal catheters should be labeled for use via those routes. Ex: “Epidural/Intrathecal – No IV Access”. (Intrathecal narcotic doses are 10 times less than epidural doses.) 17. A 0.2 micron filter without surfactant should be utilized for medication administration. 18. The routine aspiration of an intraspinal catheter is not recommended. 19. The RN should check line placement by gentle aspiration with a sterile syringe. a. Before administering a bolus dose of medication. b. When patient is experiencing inadequate pain control or over sedation. If epidural catheter is properly positioned, no fluid will be aspirated. 20. Aspiration of clear fluid may indicate that the epidural catheter has migrated into the intrathecal space. Bloody aspirate may indicate displacement into the vascular system. In either case, do not administer the bolus epidural medication, discontinue the infusion and notify the physician. 21. Epidural or intrathecal catheters do not require routine flushing. After intermittent drug delivery and if the catheter will not inject, flush gently with 1-3cc preservative-free saline. A physician's order is required to flush the catheter. 22. The nurse caring for the infusion, teaching and administering therapy is expected to be knowledgeable of the medication, expected therapeutic effects, recommended dosage range, side effects, toxic symptoms, and the particular equipment used to deliver medication. 23. An education program for self-administration will be initiated, where appropriate and as ordered by the physician. 24. Patient/caregiver education should include: a. Information related to the medication being given. b. Purpose of therapy and procedures. c. Administration of therapy. d. Care of the medication, solution and pump. e. Initiating and maintaining the infusion. f. Recognition of signs and symptoms of complications. g. Emergency phone numbers. 201
Page 1 and 2:
HHC Health & Home Care Clinical Pol
Page 3 and 4:
Title Procedure Page 4.06 Gastroint
Page 5 and 6:
Title Procedure Page 9.16 Infusion
Page 7 and 8:
Title Procedure Page 14.14 Emergenc
Page 9 and 10:
HHC HEALTH & HOME CARE SECTION: 1-2
Page 11 and 12:
Page 13 and 14:
HHC HEALTH & HOMECARE SECTION: 1-4
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
HHC HEALTH & HOME CARE Respiratory:
Page 43 and 44:
HHC HEALTH & HOME CARE Section: 3-1
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
HHC HEALTH & HOME CARE Cardiac Refe
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
HHC HEALTH HOME CARE Section: 4-5 G
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
HHC HEALTH & HOME CARE Gastrointest
Page 71 and 72:
HHC HEALTH & HOME CARE Section 5-2
Page 73 and 74:
HHC HEALTH & HOME CARE Section 5-4
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
HHC HEALTH & HOME CARE GenitoUrinar
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
HHC HEALTH & HOME CARE Skin Care: R
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156: HHC HEALTH & HOME CARE Section: 8-1
Page 159 and 160: HHC HEALTH & HOME CARE Medications:
Page 189 and 190: Infusion Therapy Section: 9-17 Infu
Page 205: HHC HEALTH & HOME CARE Section: 9-2
Page 229 and 230: HHC HEALTH & HOME CARE Infusion The
Page 231 and 232: HHC HEALTH & HOME CARE Section: 10-
Page 253 and 254: HHC HEALTH & HOME CARE Section 11-1
Page 255 and 256: HHC HEALTH & HOME CARE Section 11-2
Page 257 and 258:
HHC HEALTH & HOME CARE Section: 11-
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Name: Vitamin? Yes No Brand: Date P
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
HHC EHALTH & HOME CARE Section: 13-
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Page 343 and 344:
Page 345 and 346:
Page 347 and 348:
Page 349 and 350:
Page 351:
HHC HEALTH & HOME CARE General Prac
show all

HHC Health & Home Care Clinical Policy And

Create successful ePaper yourself

Delete template?

Save as template?