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Marquette General Health System
Pharmacy and Therapeutics Committee
Medication Guideline
Drug Classification: 72:00 Local Anesthetics Used in the On-Q® Pain Pump
Agent:
Formulary
Nonformulary
X
Bupivacaine (Marcaine®)
Restricted
Nonstock
*Approved bupivacaine concentrations include 0.25% and 0.5%.
Pharmacy and Therapeutics Committee-approved Indications for Inpatient Use:
Local anesthetic (bupivacaine)-containing pumps are intended for postoperative pain control in patients
undergoing surgical (i.e., cardiothoracic, orthopedic, general surgery) procedures in which continuous
administration of a local anesthetic is preferred.
Dosage & Administration:
Table: On-Q® pain pumps currently utilized at Marquette General Hospital.
Infusion Pump
PainBuster® (300 mL reservoir)
Model: PM024-A (contains pump kit #P270X5)
Drug**
Bupivacaine 0.5%
Rate***
Single catheter with
constant rate of 5 ml/hr
PainBuster® (400 mL reservoir)
Model: PM028-A (contains pump kit #P400X4D)
Bupivacaine 0.5%
Dual catheters each with
constant rate of 2 ml/hr
* SilverSoaker® catheters should not be used in patients with hypersensitivity reactions to silver.
** Bupivacaine 0.5% is the preferred concentration unless more than one pump is utilized in which 0.25% is the preferred
concentration.
*** Reservoir bags must be removed or changed out at the end of infusion and must not be refilled or reused.
Monitoring / Outcomes:
Therapeutic: Patients should be monitored for the onset and regression of anesthesia as well as for response to pain.
Adverse Events:
Due to risk of ischemic injury, vasoconstrictors such as epinephrine are not recommended for continuous
infusions for the following routes of administration: intraoperative site, perineural and percutaneous.
Avoid placing the catheter in joint spaces. Although there is no definitive established causal relationship, some
literature has shown a possible association between continuous intra-articular infusions and the subsequent
development of chondrolysis.
Acute Local Anesthetic Toxicity:
Monitor blood pressure for detection of hypotension and for signs of cardiotoxicity (i.e., bradyarrhythmia, cardiac
arrest, heart block which can progress to ventricular arrhythmia) central nervous system toxicity (i.e., excitation,
restlessness, paresthesias, dizziness, tremors, disorientation, seizure).
Administer an IV bolus dose of fat emulsion 20% (Intralipid®) 1.2 to 2 ml/kg followed by a continuous infusion of
0.25 to 0.5 ml/kg/min for 30-60 minutes. Bolus could be repeated 1-2 times for persistent asystole.
Special Handling Procedures:
Local anesthetics are not considered hazardous drugs.
Local anesthetics are not considered high-alert drugs.
References:
ISMP Medication Safety Alert Newsletter. Safety Brief: On-Q pump. May 21, 2009. Volume 14, issue 10.
ISMP Medication Safety Alert Newsletter. Process for handling elastomeric pain relief balls (ON-Q
PainBuster and others) requires safety improvements. July 16, 2009. Volume 14, issue 14.
Product information: http://www.iflo.com/prod_onq_classic.php. Accessed August 2012.
Document created: 09/12.
Revised: 06/14.
Cross Reference: None
Marquette General Health System
Marquette General Hospital
Marquette, MI 49855
This is a confidential professional/peer review and quality assessment document of Marquette General Health System of Marquette, MI. It is
protected from disclosure pursuant to the provisions of MCL 333.20175, MCL 333.21513, MCL 21515, MCL 331.531, MCL 331.533, MCL
330.1143a, and other state and federal laws. Unauthorized disclosure or duplication is absolutely prohibited.