Regarding Floor/ER PIV's, I've discovered an inverse relationship to how elaborate the dressing is, to how well it may flow. If there's all manner of gauze padding, fancy taping/cross taping and multiple layers of Coban (and it's running 10ml/hr on a pump), it's highly likely that peripheral IV is strictly ornamental.
Is phenylephrine so cheap that the pharmacy wouldn't notice an uptick? Like that seems a little redonk. Hospital I'm currently at premixes phenylephrine as 100mg/250ml. It seems like a huge freaking waste to me cause I might use like 5-10cc for a 1-3 hour case depending.
Prefer short axis, minimal needle advances, ultrasound scanning to find the the tip, repeat till you have enough in the vein to slide off, but agree with the conclusion: Very hard to miss a vein.
pubmed.ncbi.nlm.nih.gov
Nonsense study. Retrospective, not prospective. Propensity matching magic. Furthermore, “More patients who received a phenylephrine push achieved hemodynamic stability at hour 3 than those who did not receive a phenylephrine push (28.4% vs. 18.8%, risk difference 10%, 95% CI 0.9% to 18%).”Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock - PubMed
Phenylephrine pushes were associated with a higher incidence of early, but not sustained, hemodynamic stability and were associated independently with higher ICU mortality. Caution is warranted when clinicians are considering the use of phenylephrine pushes in patients with septic shock.
Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock - PubMed
Phenylephrine pushes were associated with a higher incidence of early, but not sustained, hemodynamic stability and were associated independently with higher ICU mortality. Caution is warranted when clinicians are considering the use of phenylephrine pushes in patients with septic shock.
Studies like this one make me think I could become a professor. WTactualF thought this study was a good idea...Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock - PubMed
Phenylephrine pushes were associated with a higher incidence of early, but not sustained, hemodynamic stability and were associated independently with higher ICU mortality. Caution is warranted when clinicians are considering the use of phenylephrine pushes in patients with septic shock.
I mean it’s unbelievable it was published in Chest of all places. It’s as if Anesthesiology published one of the book reports that the nurses write nowadays to get their “doctorate”
I’ve had a few of these kinds of patients release the evil humors and tank in the OR even though they were hemodynamically stable pre op. I’d place aline and central line in the OR, start norepi and send to the unit ASAP. If they were really shady, I’d probably leave them intubated and let the icu see what they look like in a couple hours and decide if it was a good idea to wake and extubate.
