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Review of IV Amiodarone Administration to reduce the occurrence of phlebitis

Review of IV Amiodarone Administration to reduce the occurrence of phlebitis. CSANZ Wellington 2019. Overview. Explanation of Amiodarone The review of the administration of Amiodarone Outcomes of the review The change in practice since the review Conclusion. What is Amiodarone?.

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Review of IV Amiodarone Administration to reduce the occurrence of phlebitis

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  1. Review of IV Amiodarone Administration to reduce the occurrence of phlebitis CSANZ Wellington 2019

  2. Overview • Explanation of Amiodarone • The review of the administration of Amiodarone • Outcomes of the review • The change in practice since the review • Conclusion

  3. What is Amiodarone?

  4. Why was there a review? There was an increase in reportable events with the rates of phlebitis from the administration of IV Amiodarone Contributing factors:

  5. Why is phlebitis a problem? • Phlebitis is the most common complication of having an IV line • Unforeseen additional costs to the health system • Painful for the patient • Common complication of peripheral Amiodarone administration Retrieved from Google images

  6. Review focus areas

  7. Concentration • Review of the manufacturers administration guidelines • Review of international administration guidelines including NICE guidelines • Consideration of the European Cardiology Society Atrial Fibrillation Guidelines and the concentration recommendations Patients are loaded IV with; 300mg in 100ml 5% dextrose over 1 hour 450mg in 250ml 5% dextrose over 12 hours followed by 450mg in 250ml 5% dextrose over 12 hours

  8. Precipitate

  9. Filtration • All Amiodarone must be administered via a non PVC giving set and fluid bag • International literature recommends administering Amiodarone via a 0.2 micron filter • Current giving set used by CCDHB was non-PVC but did NOT have a 0.2 micron filter

  10. What did we do?

  11. 3 month review with non PVC non filtered IV giving sets 52 patients received IV Amiodarone in the initial review 52% patients who had IV amiodarone peripherally had phlebitis

  12. 3 month review of Paclitaxel filtered IV giving sets 50 patients received IV Amiodarone during the second review NO Antibiotic Therapy required

  13. Reduction in rates of chemical phlebitis

  14. Outcomes

  15. Conclusion • 40% reduction of phlebitis by introduction of 0.2 micron filter • Administration of IV Amiodarone in our clinical area now in line with international recommended guidelines • Opportunity for us to review our concentration to possibly reduce rates further • High rates of precipitate in the vials maybe considered as a reason for increased rates of phlebitis

  16. References • McKeown,P. & Gutterman,D. (2005) Executive Summary: American college of Chest physicians guidelines for the prevention and management of post operative atrial fibrillation after cardiac surgery. Chest. 128; 1S-5S • Amiodarone. Preferred Medicine List. Retrieved from https://ccdhb-pml.streamliners.co.nz/index.htm • Hannibal,G.(2016) Peripheral Phlebitis related to Amiodarone Infusion. Advanced Critical Care. 27(4) 465-471 • Hooper,B. (2017) Peripheral IV cannulae (PIVC) Saving a line might save a life. Nursing Review. 1; 13-15 • Slim,M. (2007) The incidence of Phlebitis with Intravenous Amiodarone at Guideline Dose Recommendations. Military Medicine. 172 (12) 1279-1283 • Mowry,J. & Hartman,L. (2010) Intravascular Thrombophlebitis Related to the Peripheral Infusion of Amiodarone and Vancomycin. Western Journal of Nursing Research. XX(X) 1-15 • Intravenous Nursing Society (2016) Intravenous Nursing Standards of Practice, 45 Phlebitis 2016: s95 • Higginson,R. (2011) Phlebitis: Treatment, Care and Prevention. Nursing Times. 107(36) 18-21 • Boyce. A, Yee. B (2012) Incidence and Severity of Phlebitis in patients receiving peripherally infused amiodarone. Critical Care Nurse. Vol 32(4) 27-34 • Norton. L et al (2013) Phlebitis in Amiodarone Administration: Incidence, contributing factors and clinical implications. American Journal of Critical Care. Vol 22(6) 498-505 • Spiering. M (2014) Peripheral Amiodarone-Related Phlebitis: An Institutional Nursing Guideline to Reduce Patient Harm. Journal of Infusion Nursing. Vol 37 (6) 453-460 • Kirchhof. P et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal. Vol 37(38) 2893-2962 • BNM group (2015) New Zealand Data Sheet- IV Amiodarone 150mg/ 3mls. Accessed from http://www.medsafe.govt.nz/profs/Datasheet/a/Amiodaronehydrochlorideinj.pdf • National Institute for Health and Care Excellence (NICE). (2014) Atrial Fibrillation Management. Accessed from https://www.nice.org.uk/guidance/cg180/chapter/1-recommendations

  17. References • Orango,C. et al (2019) Phlebitis in Intravenous Amiodarone Administration: Incidence and Contributing Factors. Critical Care Nurse. 39(1) 1-13 • National Clinical for Health and Care Excellence (NICE) 2019. Amiodarone Hydrochloride. Accessed from https://bnf.nice.org.uk/drug/amiodarone-hydrochloride.html • Seddon, M. et al (2011) Aiming for Zero: decreasing central line associated bacteraemia in the intensive care unit. The New Zealand Medical Journal. 124 (1339)

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